Maximizing the Effectiveness of EPrescribing Between Physicians and Community Pharmacies: Implementa

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Maximizing the Effectiveness of E-Prescribing
Between Physicians and Community
PharmaciesImplementation

• Principal Investigator
• Kate Lapane, PhD
• Project Manager
• Ken Whittemore, MBA
• Co-Investigators
• Catherine Dubé, EdD
• Mike Rupp, PhD
• Terri Jackson, PhD

AHRQ 2007 Conference September 27, 2007
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OVERVIEW
OBJECTIVES OF THE PROJECT
Evaluation of the implementation of the standards
from multiple perspectives using mixed-method
approach
Testing of interoperability of the standards
certification processes and pilot testing
BREADTH geography, e-prescribing technologies,
practice settings, perspectives 6 states, 6
vendors, 275 docs in 88 practices , 276 retail
pharmacy stores, 1100 patients
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The Perspectives
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Evaluation Strategies

• Mixed-method approach
• Qualitative methods
• Focus groups
• Performance analyses (on-site observation)
  physician practice only
• Quantitative
• Survey
• Providers (physicians and other prescribers,
  pharmacists and pharmacy techs)
• Patients
• Documentation of interventions (pharmacy)

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Clinician perspectives
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Just because a practice has e-Rx capabilities.

• Not all clinicians within the practice e-rx
• Training issues
• Lack of understanding of benefits
• Not all clinicians use e-rx with all patients
• Not with all prescriptions
• Regulations (scheduled drugs)
• Not all functionalities of e-Rx

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Frequency of reviewing patient PBM med history
Physician Software Vendor
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Non-clinician use of review of medication history
Review patient medication history?
Frequency of use of functionality?
Vendor
Vendor

• Users of two vendors reported significant use of
  functionality among non-clinicians.

• If workflow structured to permit it,
  non-clinicians use functionality frequently.

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Variation in frequency of updating medication
list with patient
Physician Software Vendor
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Usefulness of patients medication history
provided through your e-prescribing software in
reconciling the active medication list?
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Med history missed opportunities?

• Data may not be displayed optimally
• Used mostly if there is a problem
• drill back down to learn more
• Need to harness the power of med history and
  train clinicians to use data prospectively to
  prevent medication issues

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Patient perceptions regarding frequency of
discussion with clinician
Adherence
Accuracy of Medication List
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ALERT FATIGUE.
DOSE CHECKS
DRUG-DRUG INTERACTIONS
Physician Software Vendor
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Pharmacy perspective
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Pharmacy chain organizations
Note Respondents from 276 stores with minimum
e-Rx activity (5 per day).
RUPP, JACKSON.
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Pharmacy perspective
RUPP M, JACKSON T.
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Pharmacist perceptions
RUPP M, JACKSON T.
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Variation in how e-RX processed

• Most chains drop e-Rx into the store fill queue
• Some print e-RX and then process (phasing out,
  short term transition issue)
• Most auto populate fields
• Images of e-RX available on some systems
• Some chains treat e-Rx with lower response
  urgency than
• Customers waiting in line
• Clinicians on the phone
• Faxes on the printer
• Other chains grant e-RX the highest fill priority

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Medication history for pharmacists?

• Currently not available to pharmacists
• Some chain wide
• Some store only
• No sharing across pharmacies

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Patient Perspectives
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Does E-Rx offer potential?
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Geriatric patient perspective on e-Rx
Notes of caution QA When do you expect your Rx
to be ready?
18 IMMEDIATELY!
Paper RX helps me remember to pick up my RX?
57 - 74 agree!
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Geriatric patient perspective

• Mismatch in perceptions
• Clinicians think that discussions are occurring
  more frequently than patients report
• Med history and formulary/benefits
• Potential to increase the frequency of medication
  discussions
• Change in quality of discussions unknown
• Missed opportunities for improvement?
• Engaging the patient in the process

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Summary

• Less than optimal use of functionality
• How do we build it to make them come?
• 2nd generation issues
• Who should come?
• Engaging
• Pharmacists med history at point of dispensing?
• Physicians using med history in practice
• Patients tools for them?

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Bibliography

• Lapane KL, Quilliam, Dore. Roadblock on the
  Health IT Superhighway E-prescribing and the
  Controlled Substances Act. J Opioid Management
  2007 3(4)xxx-xxx.
• Lapane KL, Dube C, Schneider K, Quilliam BJ.
  Patient Perceptions Regarding E-prescriptions Is
  the Geriatric Patient Ready? J Am Geriatr Soc.
  2007 Aug55(8)1254-9.
• Dube C, Lapane KL, Rosen R. The business case for
  e-prescribing (in preparation)
• Goldman R, Dube C, Lapane KL. The status of
  electronic processing of refills (in preparation)
• Lapane KL, Waring ME, Schneider KL, Quilliam BJ,
  Dube C. A mixed-method Study Of The Value Of Drug
  Alerts At Point Of E-Prescribing In Primary Care
  (in revision, JGIM)
• Dube C, Lapane KL. Medication history at the
  point of prescribing changing clinical practice
  (in preparation)
• Lapane KL, Dube C, Schneider K, Quilliam BJ.
  (Mis)Perceptions of Patients and Providers
  Regarding Medication Issues, In revision, Am J
  Managed Care
• Lapane KL, Waring ME, Dube C, Schneider KL,
  Whittemore K. E-prescribing as an agent of
  patient safety A mixed-method study. (under
  review AHRQ)
• Rupp M, Jackson T. Pharmacy personnel attitudes
  towards e-prescribing. (in preparation)
• Jackson T, Rupp M. Medication therapy
  interventions on e-prescriptions. (in
  preparation)
• Lapane KL, Waring ME. Medicare Part D
  implementation Lessons learned (in preparation)