UTMB specialty pharmacy team presents workflow innovations at Epic XGM

A multidisciplinary team from The University of Texas Medical Branch (UTMB) recently traveled to Verona, Wisconsin, to share their specialty pharmacy innovations with health systems from across the country at Epic's Expert Group Meetings (XGM).

The UTMB team of Joshua Russow, EHR clinical solutions analyst, Meghan Ha, registered pharmacist and pharmacist informatics specialist, and Pheba Varghese, registered pharmacist and pharmacy manager, presented "Enhancing Specialty Pharmacy Operations: Implementing MSOT and Compass Rose for Improved Medication Capture and Efficiency."

The presentation session highlighted how UTMB redesigned specialty medication workflows within the Epic electronic health record to improve efficiency, reduce delays, and strengthen continuity of care for patients requiring complex therapies.

Epic XGM brings together subject-matter experts from health systems nationwide to share best practices, lessons learned, and operational strategies related to Epic tools and workflows.

"This team's selection to present at XGM reflects UTMB leadership in specialty pharmacy operations, clinical informatics, and information technology," said Jayson Laban, UTMB vice president of information services and chief information officer.

Addressing fragmented specialty medication workflows

Before implementing multistep order transmittal (MSOT), UTMB Health specialty medication workflows faced challenges common across many large health systems. Processes varied by clinic and specialty, relied heavily on manual steps, and lacked consistent visibility from prescribing through dispensing, Varghese said.

Specialty prescriptions were often routed to external pharmacies before prior authorization was completed, leading to lost opportunities to maintain continuity of care within UTMB Health. Clinic staff frequently had to manually reroute prescriptions to the Patient Access team for prior authorization processing, relying on multiple communication methods such as Teams messages, emails, and manual encounter routing.

When prescriptions involved limited distribution drugs or other special situations, providers were required to resend prescriptions to external pharmacies, further increasing turnaround times and disrupting workflows. These disjointed processes created inefficiencies for staff and delays for patients awaiting time-sensitive therapies.

"From both an operational and patient care standpoint, it was clear that the existing process was not sustainable," said Varghese. "There was a need for a more standardized, transparent workflow that supported both our teams and our patients."

Implementing MSOT to streamline access and reduce delays

To address these challenges, UTMB Specialty Pharmacy implemented MSOT to route specialty prescriptions requiring prior authorization directly from provider prescribing to pharmacy teams within Epic.

Using MSOT, prescriptions requiring prior authorization are directed into an in-basket folder, where pharmacy technicians work from shared queues using message flags and filters based on specialty. Clear routing rules and standardized workflows replaced manual steps, reducing maintenance and improving turnaround times.

"MSOT allowed us to create an organized, rules-based workflow that eliminated many of the manual handoffs that were slowing things down," said Russow. "It improved visibility for everyone involved, from prescribers to pharmacy teams."

Expanding the continuum with Compass Rose

Following the success of MSOT, UTMB identified an opportunity to further strengthen patient management and documentation across the specialty medication lifecycle. To support this goal, the team implemented Compass Rose, an Epic patient management module, integrating it with existing MSOT workflows. The combined approach established a comprehensive specialty pharmacy workflow within Epic, spanning prescribing, prior authorization, dispensing, and ongoing patient monitoring.

Compass Rose provides a structured platform for documenting specialty pharmacy touchpoints, including benefit investigations, authorization determinations, adherence checks, clinical follow-up, and refill coordination.

"Once MSOT was in place, Compass Rose helped us complete the picture," said Ha. "It allowed us to document and manage the full specialty medication journey in one system, improving communication and continuity for both patients and care teams."

Sharing UTMB experience on a national stage

At Epic XGM, the UTMB team walked attendees through the challenges that prompted the change, the implementation process, and the measurable operational improvements achieved through MSOT and Compass Rose integration. For UTMB, the opportunity to present reflects a broader commitment to innovation, collaboration, and continuous improvement in patient care.