
Not long ago, New Jersey health system Hackensack Meridian Health faced a multifaceted challenge rooted in the manual, inefficient and fragmented nature of its medication management workflows.
THE CHALLENGE
The core of the problem was a significant data bottleneck within the Epic electronic health record system. When clinicians gathered a patient's medication history, the critical instructions for taking the medication – the dosage, frequency and route, collectively known as the "sig" – often failed to map automatically into the correct structured fields in the patient's chart.
In fact, a staggering 74% of these sigs required manual intervention, a tedious and time-consuming task for doctors, nurses and pharmacists.
This manual data entry was more than just an inconvenience – it was a major contributor to administrative burden and a significant risk to patient safety. The highly trained clinical staff were spending an inordinate amount of time acting as data transcriptionists, diverting their focus from direct patient care, clinical decision-making and meaningful patient interaction.
This process was not only inefficient but also inherently risky, as any manual transcription carries the potential for human error – which could lead to an adverse drug event. The sheer volume of this work across New Jersey's largest health system created a systemic drag on operations and was a key factor contributing to clinician burnout.
"Beyond the data entry challenge, we also struggled with proactively addressing financial barriers to medication adherence," said Will Carroll, vice president and chief pharmacy officer at Hackensack Meridian Health. He holds a doctorate in pharmacy and is an assistant professor in clinical medicine at Hackensack Meridian School of Medicine.
"Clinicians often prescribed medications without real-time insight into a patient's insurance coverage or out-of-pocket costs," he continued. "This led to sticker shock at the pharmacy, causing patients to delay filling or abandoning their prescriptions altogether."
Once a patient left Hackensack care, ensuring they understood their new medication regimen and had the resources to adhere to it was a constant challenge. The health system lacked a streamlined, automated way to deliver personalized education and support, leaving gaps in the care continuum that could compromise patient outcomes.
PROPOSAL
This is when Hackensack Meridian turned to health IT vendor DrFirst. The proposal from DrFirst was a comprehensive, three-pronged strategy designed to attack the health system's medication management challenges from multiple angles – all by integrating intelligent tools directly into the existing Epic EHR workflow. The vision was to move from a reactive, manual process to a proactive, automated and more patient-centric model.
"First, the proposal centered on a data optimization system powered by clinical-grade AI," Carroll explained. "This tool was designed to directly solve our primary pain point: manual sig mapping. The system was proposed to intelligently analyze incoming, often unstructured, medication history data.
"Using advanced AI, it would parse the free-text sigs; accurately identify the discrete elements such as dose, form, route and frequency; then, automatically and correctly populate them into the structured fields within the EHR," he continued. "The promise was to dramatically increase the automatic mapping rate, thereby eliminating the vast majority of manual data entry and freeing our clinicians to focus on verification and patient care, rather than transcription."
The second component of the proposal was a prescription price transparency tool. This was designed to embed real-time prescription benefit data directly into the prescribing moment within Epic.
"Before finalizing a prescription, a provider would be presented with clear information on the patient's coverage and estimated out-of-pocket cost for that specific medication," Carroll explained. "This would empower our doctors and nurses to have informed conversations with patients about affordability.
"If a prescribed drug was too expensive, they could immediately identify more affordable, therapeutically equivalent alternatives – preventing medication abandonment and improving the likelihood of adherence," he added.
Finally, the proposal included a personalized patient messaging platform. This system was designed to automate patient engagement after a prescription was sent. It would send automated mobile messages directly to the patient's phone through a secure, app-free experience.
"These messages were to include critical medication details, pharmacy information, links to educational resources and even cost-saving options," he noted. "The goal was to reinforce the clinician's instructions, improve health literacy, and provide patients with the tools they needed to manage their own care effectively."
MEETING THE CHALLENGE
Hackensack Meridian implemented three integrated systems from DrFirst and embedded them directly into its core clinical workspace, the Epic EHR. This deep integration is the key to the entire initiative's success, as it allows clinicians – primarily doctors, nurses and pharmacists – to access these powerful new capabilities without ever leaving their familiar Epic environment, Carroll said.
"The first tool, the AI-powered data optimization system, has fundamentally changed our medication reconciliation process," he explained. "When a clinician – be it a nurse during admission or a pharmacist reconciling a list – pulls a patient's medication history, the AI engine works in the background. It ingests the medication data and automatically parses and maps the sigs into the appropriate structured fields in the EHR.
"The clinician's task has shifted from tedious manual typing to efficient verification," he continued. "They now see a pre-populated, structured list and can quickly confirm its accuracy, dramatically reducing the time and cognitive load associated with this task."
Simultaneously, prescribing providers – physicians and advanced practice nurses – use the prescription price transparency tool during patient encounters. This allows the provider to immediately see if a medication is on formulary or has a high copay. They can then discuss cost with the patient and, if necessary, select a more affordable alternative on the spot.
"Once a prescription is finalized and sent, the third tool – the personalized patient messaging system – is automatically triggered," Carroll said. "Without any extra work from the clinician, the system sends a secure text message to the patient. This message contains a link to a personalized microsite with their prescription details, information about their pharmacy, educational content about their new medication and available savings options.
"This entire workflow is seamless – the AI data entry, price check and patient messaging all happen as a natural extension of the standard clinical process within the EHR, putting technology to work for our care teams and patients without adding complexity," he added.
RESULTS
The impact of the new tools has been significant and measurable.
"The most dramatic success metric we have achieved is the improvement in automated medication instruction mapping, which soared from 26% to 86%," Carroll reported. "This was measured across a recent sample of more than 300,000 medications, demonstrating a profound system-wide impact.
"The clinical-grade AI from DrFirst is directly responsible for this achievement," he continued. "Its ability to understand and translate complex, unstructured prescription instructions into the discrete data fields required by our Epic EHR eliminated the need for manual entry in an additional 60% of cases."
This has not only accelerated the medication reconciliation process but also enhanced patient safety by drastically reducing the opportunity for manual transcription errors, he added.
"The program has saved our team members time in administrative burden by providing a more comprehensive list of medications," he said. "Instead of spending time transcribing information, physicians, pharmacists and nurses can spend more time reviewing the list for accuracy to ensure appropriate medications are continued during hospitalization.
"The inherent downstream effects will be improved patient medication safety and outcomes," he added. "As the program continues to scale up, we expect these benefits to grow."
ADVICE FOR OTHERS
"My first piece of advice for any healthcare organization considering this type of AI-powered technology is to prioritize practical progress over big, abstract promises," Carroll said. "It's easy to get mesmerized by the potential of AI, but the most successful implementations are those that solve a real, tangible and painful problem for your frontline staff.
"Don't pursue technology for technology's sake," he continued. "Instead, start by identifying a specific, high-friction workflow – like medication reconciliation or prescription affordability – and seek out a tool that is purpose-built to alleviate that specific burden. The goal should be to simplify things for your medical teams, not to add another complex system for them to learn."
Second, insist on deep and seamless integration with existing core systems, particularly the EHR, he advised.
"A standalone AI tool that operates in a separate silo is a liability, not an asset," he contended. "It creates new workflows, requires toggling between screens and risks creating data inconsistencies. The true power of these tools is unlocked when they are embedded directly into the clinician's natural environment, augmenting their existing processes rather than replacing them.
"When evaluating potential vendors, make their ability to integrate deeply with your specific EHR a nonnegotiable requirement," he continued. "This is what transforms a clever piece of software into a genuine system that reduces clinical burden, improves safety and delivers a clear return on investment."
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