Electronic Prescribing: Its About Improving the Prescribing Process

1
Electronic Prescribing Its About Improving the
Prescribing Process

• Kevin Hutchinson
• President CEO
• SureScripts

2
How is the Industry Doing Today?
3
The number of prescriptions in the US is rapidly
increasing

• 823 million visits to physician offices in 20001
• 4 out of 5 patients who visit a physician leave
  with at least one prescription2
• 65 of the US population use a prescription
  medication each year3
• About 3 billion prescriptions are written each
  year4
• The number is expected to rise to 4 billion by
  20064

Unfilled
Refills
0.4 B
Renewals
0.5 B
1.5 B
1.4 B
New Scripts
3.5 Billion Total Filled Prescription
Transactions in 2003
1) Pastor PN et. al. Chartbook on trends in the
health of Americans. Health, United States, 2002.
National Center for Health Statistics.
2002. 2) The chain pharmacy industry profile.
National Association of Chain Drug Stores.
2001. 3) Agency for Healthcare Research and
Quality. MEPS Highlights 11 distribution of
health care expenses, 1999. 4) NACDS estimates
4
The efficiency of the total prescription system
is challenged by hundreds of millions of phone
calls and faxes

• One study estimates that indecipherable or
  unclear prescriptions result in more than 150
  million calls from pharmacists to physicians
  asking for clarification1
• Others estimate the number of prescription-related
  telephone calls annually at 900 million, citing
  practices reporting almost 30 of prescriptions
  required pharmacy callbacks2,3
• Requesting and receiving approval for refills
  alone, estimated at nearly 500 million per year,
  adds to the telephone and fax burdons4

(1) Institute for Safe Medicine Practices. A Call
to Action Eliminate Handwritten Prescriptions
Within Three Years, 2000. (2) Forrester Research,
2002. (3) Medco Health, 1/29/03, via
ePharmaceuticals (4) NACDS and SureScripts
estimates
5
Many resulting errors can be prevented

• More than 8.8 million adverse drug events (ADEs)
  occur each year in ambulatory care, of which over
  3 million are preventable1
• 1 out of 131 ambulatory patient deaths can be
  attributed to medication error2
• According to the Institute for Safe Medication
  Practices, many errors result from
• Miscommunication due to illegible handwriting
• Unclear abbreviations and dose designations
• Unclear telephone or verbal orders
• Ambiguous orders and fax-related problems

• Gurwitz, JAMA, 20033
• 25 of patients had ADEs
• 13 were serious
• 39 of total were either ameliorable or
  preventable
• Gandhi, NEJM, 20034
• 28 of ADEs preventable
• 42 of the most serious

1 Center for Information Technology Leadership.
The Value of Computerized Provider Order Entry in
Ambulatory Settings, 2003Institute of Medicine,
Committee on Quality in Healthcare in America. To
Err is Human Building a Safer Health System,
Washington, DC, National Academy Press
1999 2 Gurwitz JH et al. Incidence and
Preventability of Adverse Drug Events Among Older
Persons in the Ambulatory Setting, JAMA, 2003
289 1107-1116. 3 Gandhi TK et al. Adverse Drug
Events in Ambulatory Care, N Engl J Med, 2003
348 1556-64.
6
Electronic Prescribing Process or Application???
7
What do you think of When You Hear the Term(
e-Prescribing )?
8
The Number One Problem with Historical
Approachesto e-Prescribing
9
The Overall Prescribing Process
A Closer Look at the Current Physician
Pharmacist Workflow and Automation Within
Physician Practices and Pharmacies
10
The Overall Prescription is Often Overlooked when
Thinking About Electronic Prescribing
PHYSICIAN
PHARMACIST
BEFORE ENCOUNTER
ACQUIRE PRESCRIPTION
Schedule Patient
Drop Off, Phone, Fax, IVR
Pull Patients Chart
Insurance ID Card
Review Chart
Data Input Into Computer
AT ENCOUNTER
PROCESS PRESCRIPTION
Interview Patient
Pharmacy DUR
Determine Therapy
Claim Transmission
Write Prescription
Order Fulfillment/Dispense
Document Prescription in Notes
AFTER ENCOUNTER
COMMUNICATE
Re-File Chart
Review of Payor DUR
Clarification Calls
Handling of Payor Issues
Handle Drug Coverage Issues
Patient Counseling
Renewal Authorizations
Renewal Requests
11
The Overall Prescribing Process is Much More
Complex Than Writing the Prescription and
Dispensing
12
The Prescription Workflow in the Physicians
Practices is still Predominantly Paper Based Today
PHYSICIAN
BEFORE ENCOUNTER
Schedule Patient
Schedule Patient

• The majority of practice automation is around
  patient scheduling ( and billing ) activities

Pull Patients Chart
Review Chart
ENCOUNTER
Interview Patient
Determine Therapy
Write Prescription
Write Prescription

• According to eHI, current studies show between5
  18 of physicians and other clinicians are
  using electronic prescribing

Document Prescription in Notes
AFTER ENCOUNTER
Re-File Chart
Clarification Calls
Handle Drug Coverage Issues
Renewal Authorizations
13
Although A Small Number of Physicians Use
e-prescribing, the Act of Writing the
Prescription is Mostly Paper Based
PHYSICIAN

• Automation of prescription writing is estimated
  by Forrester Research at
• 11 in 1-2 physician practices
• 17 in 3-10 physician practices
• 38 in 11 physician practices

BEFORE ENCOUNTER
Schedule Patient
Pull Patients Chart
Review Chart
ENCOUNTER
Interview Patient
Determine Therapy

• According to Manhattan Research, 7 of all
  physicians currently use an electronic
  prescribing system

Write Prescription
Write Prescription
Document Prescription in Notes
AFTER ENCOUNTER
Re-File Chart
Clarification Calls
Handle Drug Coverage Issues
Source Brown E. EMRs for Small Physician Groups.
Forrester. Decemeber, 2003
Renewal Authorizations
14
EMR Adoption is Increasing Rapidly
Figure 3 Forecast US PMS and EMR Adoption, 2003
to 2008
Total Revenue (US Millions)
PMS systems 998 948 901 856 813 772 733 6
96 EMR systems for large groups
229 330 450 532 585 599 581 544 EMR
systems for small groups 158 244 366 491 62
2 736 809 829 Total EMR systems 387 574 816
1,023 1,207 1,335 1,390 1,373 Grand
total 1,385 1,522 1,717 1,879 2,020 2,107 2
,123 2,069 (US Millions)
Source Forrester Research, Inc.
15
The majority of e-prescribing still has NO
connection to the pharmacy strictly a one-way
fax communication
Among Those Using an eRx System
Does Your Electronic Prescribing System Link
Directly to the Pharmacy?
Do You Currently Use Any Type of Electronic
Prescribing System?
No
No
Yes
Yes
Data used courtesy of
16
Physicians Indicate a Strong Interest in Using an
Electronic Prescribing System in the Next 12
Months
All Physicians
Essential Integrators
Future Intenders
Data used courtesy of
17
Future Drivers of Electronic Prescribing are
Largely Based on Increased Safety Efficiency
Among Those Not Currently ePrescribing and
Interested in Using eRx in the Future
Increased Accuracy
Reduced Pharmacy Callbacks
Commonly Used Rx in Lists
Better Order Entry Devices
Verified Formulary Coverage
Financial Incentives From Payers
Better Interface Between eRx and Other Office
Systems
Ability to Charge Transaction Fee
Decreasing Over Time
Data used courtesy of
4 or 5 on a 5-Point Scale
18
In Contrast to Physician Practices, Much More
Automation Exists in the Pharmacy Today
PHARMACIST
ACQUIRE PRESCRIPTION
Drop Off, Phone, Fax, IVR
Insurance ID Card
Data Input Into Computer
PROCESS PRESCRIPTION

• Pharmacies by law, all perform a Drug Utilization
  Review (DUR) that queries internal databases to
  assess the medication prior to dispensing

Pharmacy DUR
Pharmacy DUR
Claim Transmission
Claim Transmission
Order Fulfillment/Dispense

• Pharmacies are connected to virtually 100 ofthe
  payers
• Check member eligibility and member-specific
  pharmacy benefits ( formulary management )
• Another DUR against payer medication history

COMMUNICATE
Review of Payor DUR
Review of Payor DUR
Handling of Payor Issues
Handling of Payor Issues

• Over 50 of the pharmacies, or pharmacy software
  vendors that serve them, have upgraded their
  systems to exchange prescription information
  electronically

Patient Counseling
Renewal Requests
Renewal Requests
19
In fact, some aspects of automation are largely
duplicative
PHARMACIST
ACQUIRE PRESCRIPTION
Rx
Rx
Rx
Rx
Drop Off, Phone, Fax, IVR
Rx
Rx
Rx
Rx
Insurance ID Card
Data Input Into Computer

• 1 in 10 Payor DUR result in an alert
• 88 are immediately overridden by the Pharmacist

Rx
Rx
PROCESS PRESCRIPTION
Pharmacy DUR
Pharmacy DUR
Claim Transmission
Claim Transmission
Order Fulfillment/Dispense
OK
COMMUNICATE
Review of Payor DUR
Review of Payor DUR
Handling of Payor Issues
Handling of Payor Issues
Patient Counseling
Source Evaluation of Online Prospective DUR
Programs in Community Pharmacy Practice, Journal
of Managed Care Pharmacy, Vol. 6, No. 1,
Jan./Feb. 2000
Renewal Requests
Renewal Requests
20
Its at the Encounter when the Process is Most at
Risk for Error and Inefficiencies
PHYSICIAN
BEFORE ENCOUNTER
Schedule Patient

• Illegible handwriting
• Incorrect medication choice
• Incorrect dosing regimen
• Failure to account for drug interactions
• Failure to account for contraindications
• Unappreciated allergy history

Pull Patients Chart
Review Chart
ENCOUNTER
Interview Patient
Determine Therapy
Write Prescription
Document Prescription in Notes
AFTER ENCOUNTER
Re-File Chart
Clarification Calls
Handle Drug Coverage Issues
Renewal Authorizations
21
Its at the Encounter when the Process is Most at
Risk for Error and Inefficiencies
PHYSICIAN

• When monitoring the current medication list,
  prescribers may wonder, What medications dont I
  know about?
• When thinking about drug interactions and complex
  dosing, prescribers might benefit from a resource
  that understands all the latest knowledge
• Prescription drug coverage is getting
  increasingly complex
• 3 4 Tier Formularies
• Multiple Carriers in a Typical Geography
• 1000s of Plan Variations per Payer
• And right after the visit, for certain patients,
  prescribers may wonder, Have they picked up the
  prescription?

BEFORE ENCOUNTER
Schedule Patient
Pull Patients Chart
Review Chart
ENCOUNTER
Interview Patient
Determine Therapy
Write Prescription
Write Prescription
Document Prescription in Notes
AFTER ENCOUNTER
Re-File Chart
Clarification Calls
Handle Drug Coverage Issues
Renewal Authorizations
22
Its After the Encounter that Communication
Hassles Cause Inefficiencies and Impact
Prescriber and Staff Satisfaction
PHYSICIAN

• Most prescribers and staff rank the renewal
  authorization process as the most time-consuming,
  sometimes taking hours of staff time in a small
  office to handle the phone calls and faxes
• Chart pulls and re-filling are required for every
  pharmacy call concerning a prescription
• Nurses report spending most of their time
  handling administrative issues when they would
  rather be in direct patient care
• More than 80 of clarifications are attributed
  to
• Directions unclear or missing
• Refill quantity unclear or missing
• Dosage unclear
• Drug name/strength unclear

BEFORE ENCOUNTER
Schedule Patient
Pull Patients Chart
Review Chart
ENCOUNTER
Interview Patient
Determine Therapy
Write Prescription
Document Prescription in Notes
AFTER ENCOUNTER
Re-File Chart
Clarification Calls
Handle Drug Coverage Issues
Source Mail-Order Prescriptions Requiring
Clarification Contact With the Prescriber
Prevalence, Reasons, and Implications, Richard A.
Feifer, Md Linda M. Nevins, Rn, Mba Kimberly A.
Mcguigan, Phd Les Paul, Md, Ms And Jacob Lee,
Mba, Rph
Renewal Authorizations
23
Physicians and Pharmacists can Establish True
Electronic Prescribing Connectivity Improve the
Prescribing Process
With a direct two-wayexchange of
prescriptioninformation, physicians and
pharmacists can collaborate to improve the
prescribing process
ePrescribing becomes truly electronic -
providing significant value to all
24
Computer-to-Computer Connectivity between
Physicians Pharmacists Provide the Foundation
for Process Improvements
PHYSICIAN
PHARMACIST
BEFORE ENCOUNTER
ACQUIRE PRESCRIPTION
Schedule Patient
Drop Off, Phone, Fax, IVR
Drop Off, Phone, Fax, IVR
Pull Patients Chart
Insurance ID Card
Review Chart
Data Input Into Computer
AT ENCOUNTER
PROCESS PRESCRIPTION
Interview Patient
Pharmacy DUR
Determine Therapy
Claim Transmission
Write Prescription
Order Fulfillment/Dispense
Write Prescription
Document Prescription in Notes
AFTER ENCOUNTER
COMMUNICATE
Re-File Chart
Review of Payor DUR
Clarification Calls
Handling of Payor Issues
Handle Drug Coverage Issues
Patient Counseling
Renewal Authorizations
Renewal Requests
25
Computer-to-Computer Connectivity between
Physicians Pharmacists Provide the Foundation
for Process Improvements
PHYSICIAN
PHARMACIST
BEFORE ENCOUNTER
ACQUIRE PRESCRIPTION
Schedule Patient
Drop Off, Phone, Fax, IVR
Drop Off, Phone, Fax, IVR
Pull Patients Chart
Insurance ID Card
Review Chart
Data Input Into Computer
AT ENCOUNTER
PROCESS PRESCRIPTION
Interview Patient
Pharmacy DUR
Determine Therapy
Claim Transmission
Write Prescription
Order Fulfillment/Dispense
Write Prescription
Document Prescription in Notes
AFTER ENCOUNTER
COMMUNICATE
Re-File Chart
Review of Payor DUR
Clarification Calls
Handling of Payor Issues
Patient Counseling
Handle Drug Coverage Issues
Renewal Authorizations
Renewal Requests
26
Computer-to-Computer Connectivity between
Physicians Pharmacists Provide the Foundation
for Process Improvements
PHYSICIAN
PHARMACIST
BEFORE ENCOUNTER
ACQUIRE PRESCRIPTION
Schedule Patient
Drop Off, Phone, Fax, IVR
Pull Patients Chart
Insurance ID Card
Review Chart
Data Input Into Computer
AT ENCOUNTER
PROCESS PRESCRIPTION
Interview Patient
Pharmacy DUR
Pharmacy DUR
Determine Therapy
Claim Transmission
Write Prescription
Order Fulfillment/Dispense
Write Prescription
Document Prescription in Notes
AFTER ENCOUNTER
COMMUNICATE
Review of Payor DUR
Review of Payor DUR
Re-File Chart
Clarification Calls
Handling of Payor Issues
Handling of Payor Issues
Clarification Calls
Patient Counseling
Handle Drug Coverage Issues
Handle Drug Coverage Issues
Renewal Authorizations
Renewal Requests
27
Computer-to-Computer Connectivity between
Physicians Pharmacists Provide the Foundation
for Future Advancements
PHARMACIST
PHYSICIAN
BEFORE ENCOUNTER
ACQUIRE PRESCRIPTION
Schedule Patient
Drop Off, Phone, Fax, IVR
Pull Patients Chart
Insurance ID Card
Review Chart
Data Input Into Computer
AT ENCOUNTER
PROCESS PRESCRIPTION
Interview Patient
Pharmacy DUR
Pharmacy DUR
Determine Therapy
Claim Transmission
Write Prescription
Order Fulfillment/Dispense
Write Prescription
Document Prescription in Notes
AFTER ENCOUNTER
COMMUNICATE
Review of Payor DUR
Review of Payor DUR
Re-File Chart
Clarification Calls
Handling of Payor Issues
Handling of Payor Issues
Clarification Calls
The Possibilities for Continued Collaboration
Once Connected are Endless
Patient Counseling
Handle Drug Coverage Issues
Handle Drug Coverage Issues
Renewal Authorizations
Renewal Requests
28
The Medicare Bill and Electronic Prescribing

• Where do We go From Here?

29
An Overview of Key Wins

• The Bill is Voluntary (sort of)
• Allows for adequate time to develop meaningful
  and realistic standards
• Ensures that industry momentum relating to
  electronic prescribing will not be slowed due to
  mandatory provisions and onerous implementation
  requirements
• Provides for the transmittal of information to
  both Physician and Pharmacist
• Only upon request
• On an interactive real time basis, but only to
  the extent feasible
• Report language confirms that Conferees do not
  intend for the provision to preclude any entity
  due to their inability to transmit information on
  a real-time basis

30
An Overview of Key Wins

• Preserves Patient and Physician Choice
• Explicitly permits patients to designate a
  particular pharmacy to dispense a prescribed drug
• Allows paper scripts to be written upon patient
  request
• The Bill also supports physician choice of
  medication. The Report language notes that
  conferees intend for prescribing professionals to
  have ready access to neutral and unbiased
  information on the full range of covered
  outpatient drugs
• The Bill limits Commercial Messaging at the point
  of care
• The standards allow for the messaging of
  information only if it relates to the
  appropriate prescribing of drugs
• Report language goes on to state that conferees
  do not intend for electronic prescribing to be
  used as a marketing platform or other mechanism
  to unduly influence the clinical decisions of
  physicians

31
Some Important Business Lies Ahead

• Design of Standards
• Leverage existing NCPDP Script Standards for
  transmission of scripts
• Enhanced security measures must be established to
  ensure privacy and integrity of data
• There is continued debate related to physician
  authentication and electronic signatures
• Standards and requirements at the state level
  vastly differ
• Medicare legislation supersedes state law and/or
  regulation
• Work Flow Issues
• Must evaluate roles and responsibilities of
  stakeholders in the DUR process
• Must determine the most cost-effective way to
  deliver patient medication history and formulary
  information
• Must evaluate what information to deliver to
  physicians and pharmacists (entire medication
  history, drug interaction alerts, medical
  history, diagnosis information, etc.)

32
How Far Along ise-Prescribing Today?

• SureScripts Strategy, Guiding Principles and
  Current Focus

33
SureScripts was Formed to Improve the Prescribing
Process in Ways that Serve the Collective
Interest of Patients, Physicians and Pharmacists

• Incorporated in August 2001
• Formed by the two associations that represent the
  55,000 pharmacies in the US
• NCPA (independents)
• NACDS (large chains)
• Organized to support a strategic industry
  alliance to
• Improve the overall prescribing process
• Safety
• Efficiency
• Quality of Care
• Enable true electronic connectivity between
  physicians and pharmacies

Over 50 of the nations pharmacies have
completed the certification process required to
connect SureScripts Messenger Services and by
summer that number is expected to exceed 75
34
SureScripts Guiding Principles
Ensure
Enhance
Promote

• Neutrality
• Work in collaboration with industry stakeholders
• Dont endorse a particular approach
• Dont compete with end user applications
• Open Access
• Adherence to industry standards including NCPDP
• Process for Certified Solutions Providers
• Implementation Guide

• Patient Safety
• Deliver prescriptions in a legible format
• Eliminate duplicate entry of prescription
  information
• Eliminate telephone orders for similar sounding
  medication names
• Professional Relationship Physicians and
  Pharmacists
• Enhance DUR based on roles of physicians and
  pharmacists
• Medication therapy is increasingly complex
• Benefits demonstrated in partnerships with other
  healthcare professionals (i.e., lab techs,
  radiologists)

• Choice
• Provide patient choice of pharmacy
• Ensure physician choice of therapy
• Allow application systems of choice
• Innovation
• Foster unique alliances
• Create an infrastructure for secure
  communications
• Drive innovation through education
• Adoption
• Provide research on trends, processes, and
  effective approaches for the use of electronic
  prescribing
• Act as cross industry coordinator of
  community-based adoption efforts

35
SureScripts does NOT develop, sell, or endorse
electronic prescribing software, but works with
existing technology vendor to certify and connect
their solutions to the network
What the Physician Needs
What the Pharmacy Needs
SureScripts provides the behind-the-scenes
network that makes the two-way electronic
exchange of new prescription and renewal
information possible

• Electronic Prescribing Software that has been
  certified by SureScripts
• An Internet connection

• Pharmacy management software has been certified
  by SureScripts

36
SureScripts Strategy
SureScripts works across a number of levels to
drive its partnership vision of electronic
prescribing

• Physicians, pharmacies, health plans, technology
  vendors and other stakeholders

Shared Vision

• Partner for patient adherence
• Original research
• Enhanced clinical information and transactions

Information Services
Integrated Programs

• Community-based programs
• Pharmacies and technology vendors
• Legislative and regulatory initiatives

Adoption Programs

• Manage transactions
• Facilitate connections
• Business model

Core Transactions
37
Initially SureScripts must focus on 1) driving
pharmacy support 2) connecting physician
practices 3) delivering transaction services
Pharmacy Connectivity
Physician Connectivity
Transaction Services
Driving Pharmacy Support
Connecting Physician Practices
Delivering Transaction Services

• Owned by NACDS and NCPA
• Community pharmacy steering committees
• Expect connectivity to pharmacy organizations
  representing at least 75 of 55,000 US stores by
  the end of the year
• Promotion by retail pharmacies encourage
  community adoption
• Mailings, in-store, on-hold messages, telephone
  FAQ

• Physician solutions from stand-alone-Rx to EMR
• Emphasis on benefits of automating renewal
  authorizations
• 30 of physicians drive 80 of retail
  prescription transactions in the U.S.
• Work with major stakeholders in each region to
  produce and coordinate a regional Community
  Adoption Program for the National Rollout of
  electronic prescribing

• SureScripts Messenger Services in production
• New script
• Refill request / response
• Rx-change request / response
• Rx-fill message
• Managing certification processes to assure
  appropriate connectivity
• Direct
• Thru an aggregator
• Thru a VAR
• Providing a detailed implementation guide to help
  partners integrate the NCPDP SCRIPT standard in
  their application
• Ongoing support services

38
SureScripts Messenger Services, is the Nations
Largest Electronic Prescribing Network
Over 50 of the nations pharmacies are certified
and connected to the network, and are at various
stages of pharmacy activation
39
SureScripts has a Unique Collaborative Community
Approach to Raise Awareness Encourage Adoption
of Electronic Prescribing by Working With Local
Stakeholders
Community Adoption Program (CAP) Overview
Local Market Assessment
Stakeholder Partnerships
Prescriber Adoption Program
Pharmacy Implementation
Communications And Outreach
Impact Study, Results, Measurement

• The CAP is a community-based, grassroots program
  that seeks to involve all local healthcare
  stakeholders
• Medical societies/associations
• Healthcare systems
• Health quality organizations
• Payors
• Legislators
• Regulators

40
Health Systems, Quality Groups, and Medical
Societiesare getting increasingly involved in
the rollout processfor physicians

• Cleveland Clinic, Johns Hopkins, Lifespan,
  MedStar
• AAFP, Massachusetts Medical Society, San Diego
  County Medical Society Foundation
• Rhode Island Quality Institute ( RIQI ), North
  Carolina Healthcare Information and
  Communications Alliance ( NCHICA )

41
The SureScripts Regulatory Assessment
Intervention Process has cleared the way for
SureScripts and its partners in 30 states
As of April 22, 2004
42
Physician Prescription Volume Distribution
across 2004 Target CAP Markets
Key Decile 10 6 physicians generate 50 of all
Rxs Decile 10 3 physicians generate 80 of all
Rxs
43
There is Still Muchto Learn Aboute-Prescribing

• SureScripts Prescription Process Validation
  Research (PPV)

44
Prescription Process Validation 2003 Snapshot
Summary

• 100 interest in a neutral gateway approach to
  electronic prescribing
• Significant staff and physician time savings were
  anticipated with automation of renewals
• There is a value for automating new scripts based
  partially on time savings to busy physicians
• Renewals and new scripts should be pitched
  together but could be rolled out in series
• Drug interaction checking against practice data
  will enhance adoption
• Formulary management information at the plan
  level will enhance adoption
• An understanding of future services will enhance
  adoption
• Physicians judged a fair price expressing value (
  75 median / 97 average per provider per month )
• Physicians want to hear about electronic
  prescribing from other physicians and from
  pharmacists

45
Prescription Process Validation 2004 Big
Questions

• Physician / Pharmacist Collaboration What
  opportunities exist for collaboration between
  physicians and pharmacists to improve the
  prescription process?
• Explore new areas for communications and services
  
• How can technology help move pharmacy closer to
  the clinical process?
• Beyond the Basics How should advanced electronic
  prescribing functions be implemented to improve
  the prescription process?
• Consider patient compliance, medication history,
  formulary management, others
• Work with physicians, community pharmacy,
  technology vendors and other stakeholders

46
Prescription Process Validation 2004 Big
Questions ( contd )

• Total System Impact How does electronic
  prescribing impact efficiency, safety and care
  quality?
• Quantify ROI and quality impacts for basic and
  advanced functions
• Focus on pharmacies and physician practice (
  health plans and health systems opportunistically
  )
• Enabling and Integrating the EHR How can
  automating the prescription process best be
  integrated with the electronic health record and
  other clinical technologies?
• Identify the implementation roadmap and customer
  migration strategies from basic prescribing to
  EHR
• Identify EHR features that can improve the
  prescription process

47
Summary Takeaways
48
Why now? The problems of past prescribing
automation efforts have been addressed
49
Electronic Prescribing Much has been
accomplished

• Pharmacies are connected
• 50 connected for electronic prescribing growing
  to 75 by mid-year
• Near 100 of pharmacies are connected
  electronically to PBMs and Payers for the Drug
  Utilization Review (DUR) and electronic Claims
  Adjudication process.
• Pharmacy participation working with SureScripts
  to drive physician adoption is exceeding original
  expectations.
• Physician adoption is at the tipping point
• Physician Technology Vendors representing
  thousands of physicians are establishing
  connectivity to the same national electronic
  prescribing network
• EMR use and the rate of adoption rapidly
  increasing, ERx use is highest among smaller
  practices - Forrester Research, Dec. 2003
• States are removing roadblocks to electronic
  prescribing
• Few problem areas remaining (30 states cleared to
  date)
• Neutrality and Choice are critical to ensure the
  successful adoption and use of electronic
  prescribing
• Physician choice of therapy and patient choice of
  pharmacy