ePrescribing In Long Term Care Challenges and Opportunities

1
ePrescribing In Long Term CareChallenges and
Opportunities

• How Electronic Medication Management Systems Can
  Improve Medication Safety and Reduce Cost

2
What is ePrescribing

• The fully automated, electronic transmission of
  prescriptions from the prescriber to the pharmacy
• Benefits include
• Eliminates paper at facility and pharmacy
• Not email
• Not eFax
• No re-entry of information
• Bi-directional allows three way communication
• Prescriber
• Facility
• Pharmacy
• Formulary Information presented at the beginning
  of the process
• DUR and Allergy Information presented at the
  order entry

3
ePrescribing in Long Term Care

• Challenges
• Universal adoption requires standards for
  information sharing
• LTC requirements have historically been ignored
• Existing standards did not allow type of
  information unique to LTC to be included
• Census only transactions
• Facility specific information
• Lack of appropriate standards drive development
  of proprietary applications
• Proprietary applications increase cost and
  reduce adoption

4
What is Unique About Long Term Care

• Characteristics of Retail Electronic Prescribing
• One Way
• Many to Many
• Unpredictable
• Requires significant adoption to realize
  benefits
• Heavily dependent on physician adoption

5
What is Unique About Long Term Care

• Characteristics of Electronic Prescribing in Long
  Term Care
• Involves three-way communication
• Prescriber
• Facility
• Pharmacy
• Requires two way information flow
• Volumes are much more predictable
• Pharmacy has greater role in medication
  decisions, higher level of accountability

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What is Unique About Long Term Care

• Characteristics of Electronic Prescribing in Long
  Term Care
• Close One to one relationship Between Facility
  and Pharmacy
• Different roles in Long Term Care
• Consultant Pharmacist
• Physician adoption desired but not required
• Use of Nurse Practioners and Physicians
  Assistants
• Nurse as an agent
• Small number of pharmacy software vendors
  compared to the retail market

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ePrescribing in Long Term Care

• Advantages
• Close relationship between facility and pharmacy
  enable realization of benefits quickly
• Smaller number of systems allows broad access in
  a very short time frame
• Potential for impacting adverse drug events
  (ADEs) and Medication errors is significant
• Although the size of the population is small
  compared to the ambulatory market the number of
  medications per resident is far greater, an
  average of 10 per resident and acuity levels are
  far higher
• In July 2006 the Institute of Medicines report
  on Preventing Medication Errors states 800,000
  preventable ADEs each year in LTC setting alone
• Sourcehttp//www.iom.edu/Object.File/Master/35/94
  3/medication20errors20new.pdf

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ePrescribing in Long Term Care

• Advantages
• Opportunity to reduce cost and improve care are
  much greater due to the percentage of medication
  dollars spent on this population
• High percentage of medication dollars are spent
  in by Seniors
• According to the 2003 report released by Families
  USA, a Washington based consumer health
  organization, seniors represent 13 of the total
  population and yet they account for about 34 of
  all prescriptions dispensed and 42 of all
  prescription drug spending.
• Due to high acuity levels of typical residents
  many of the medications are more costly than the
  average ambulatory patient
• Residents often do not participate in medication
  administration so responsibility of physician,
  facility and pharmacy is much greater
• Reducing time spent in the prescribing process
  and the opportunity for errors can significantly
  increase overall quality of care
• Source Compiled by PRIME Institute, University
  of Minn., for Families USA

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ePrescribing in Long Term Care

• Conclusion
• Although there are definite challenges to
  implementing electronic prescribing in Long Term
  Care the ability is real
• The results from the CMS pilot has proven that
  the standards can and do work in an LTC setting
• Subsequent Pilots have enabled the expansion and
  refinement of the standards to include even more
  relevant information
• Industry leaders have demonstrated a willingness
  to work together to enable the technology
• Real benefits have been proven in
• Cost and productivity savings
• Safety improvements
• The opportunity for impact is immense

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ePrescribing in Long Term Care

• What Needs To Be Done
• Standards must continue to include Long Term
  Care
• Long Term Care must not be exempted from
  requirements
• All participants must continue to be a part of
  the standards creation and adoption
• Facilities
• Pharmacies
• Software Vendors
• States must not be allowed to create complex and
  expensive regulations that deter or delay the
  implementation of this functionality

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Questions?