ePrescribing Evolution

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CROSSING THE CHASM

• ePrescribing Evolution
• Todd Hardman
• Director of Business Development

January 22, 2007
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Key Topics for Today...

• SureScripts background
• ePrescribing strategies
• Market development models
• Stakeholder perspectives
• Emerging initiatives
• Open discussion, questions

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HISTORY ? STRATEGY ? VISION
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SureScripts was formed to improve the
prescribing process in ways that serve the
collective interests 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)
• Pharmacy membership organization
• Operating capital driven solely by membership
  dues
• Works closely with community pharmacy
• 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

90 of the nations pharmacies are certified to
connect to SureScripts
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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

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What is true electronic prescribing?

• Secure, two-way, computer-to-computer information
  exchange between the physician practice and
  pharmacy
• Automation of the entire prescribing process
• Pre-prescribing providing clinical decision
  support information by sharing eligibility/coverag
  e, formulary, and medication history information
  at the point of care
• Distribution - Send and receive renewal
  authorizations and new prescription information
  from your computer to the pharmacy

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

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

• Pharmacy management software has been certified
  by SureScripts

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Improve the Prescribing Process Efficiency,
Safety, Quality of Care
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Over 90 of the nations retail pharmacies have
systems certified to connect to the Pharmacy
Health Information Exchange operated by
SureScripts
Just some of the pharmacies connected to the
SureScripts Electronic Prescribing Network.
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48 States Live w/E-Prescribing Overcoming
legal and regulatory barriers
As of February 2st, 2004 - 25 States cleared for
electronic prescribing
As of Oct 1st, 2006 - 48 States cleared for
electronic prescribing
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Tennessee Physician Landscape (N8,217)
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Sample of over 50 EMR and ePrescribing solutions

• EMR Solutions
• A4 Health Systems
• Allscripts
• ASP.MD
• AthenaHealth
• Axolotl
• Bond Medical
• Cerner
• ChartConnect
• Companion Technologies
• eMD
• Epic
• eClinicalWorks
• Health Systems Research
• iMedica
• InteGreat
• Medical Communication Systems

• EMR Solutions
• McKesson
• MedicWare
• MedNet System
• MedPlexus
• MOST LLC
• NextGen
• Practice Partners (Physician Micro Systems)
• Polaris Management, Inc.
• Smart EMR/VIPA Health
• SOAPware
• Synamed
• Wellogic

• ERx Solutions
• NetSmart Technologies
• DAW Systems
• DrFirst
• eHealth Solutions
• Gold Standard
• InstantDx
• LighthouseMD
• MDanywhere Technologies
• NewCrop
• MedPlus
• OA Systems
• MedAvant Healthcare Solutions
• RxNT
• Zix Corporation
• Other Services
• Kryptiq
• Navimedix
• RelayHealth

Completed SureScripts certification registered
as a SureScripts Certified Solution Provider
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Pharmacy solutions

• Chain Pharmacy Solutions
• Albertsons
• Brooks/Eckerd
• CVS
• Longs
• Rite Aid
• Walgreens
• WalMart

• Pharmacy Mgmt. Solutions
• Abacus Systems
• Automated Pharmacy System
• Best Computer Systems
• Carepoint
• Compusolve
• Computer-Rx
• DataDoc
• DataScan
• eRx / PDX
• Etreby Computers
• Foundation Systems
• HBS Pharmacy System
• HCC Alpha PC
• HCC Synercom
• HCC Visual Pharmacy

• Pharmacy Mgmt. Solutions
• Jascorp
• McKesson Pharmaserv
• Micro Merchant Systems
• Midco Data
• NDCHealth Condor
• NDCHealth PharmacyRX
• NDCHealth Zadall
• Opus/ISM - ISM Solution
• OPUS-Core
• Pacific Pharmacy Computers
• QS/1 CRx
• QS/1 RxCare Plus
• Systems Xcellence
• TDS Rx30
• THOT/RxHome

Completed SureScripts certification registered
as a SureScripts Certified Solution Provider
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The SureScripts story over time
Current (Dec 06)
July 2003 Test
January 2004
July 2004
January 2005
July 2005
January 2006
Pharmacy Connectivity
50
75
80
85
90
90
Activated Pharmacies
800
8,000
17,000
20,000
24,000
33,500
States Live With ERx
5
24
33
45
47
48
ERx Capable Physicians
130,000
150,000
150,000
7,800
71,200
98,100
Contracted Solutions
20
35
53
74
85
100
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Adoption Evolution Strategies
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The industry is poised for dramatically
increasing the adoption and utilization of
electronic prescribing
Tipping Point

• We remain at the tipping point of adoption of
  clinical systems at the point of care
• Early adopters are on board and EMRs are now
  mainstream in the larger practices
• SureScripts and community pharmacy have built the
  nations largest network for electronic
  prescribing
• Over 90 of the pharmacies are certified
• 150,000 physicians use E-Rx capable applications
• And we intend to work with others to create
  value-added programs
• That encourage CSPs to increase client
  utilization of ERx
• That encourage PBMs, health plans, manufacturers
  and government policymakers to support ERx
  projects

Enthusiasts And KOLs
eHIT
Mainstream Market
2.5
13.5
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Note The ideas concerning the technology
adoption cycle were abstracted from Crossing the
Chasm by Geoff Moore (1991)
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Total Market Maturity Industry Evolution
Medication History (DUR)
Patient Rx Benefits Information
Patient Compliance Adherence
Renewals
Shared Vision With Pharmacy
New Scripts
Roadmap To Practice Automation
Current Tipping Point
Access to medication history across providers for
Drug Utilization Review
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The whole product concept for electronic
prescribing - outlines those elements
attractive to the mainstream buyer and grows
more comprehensive over time
True connectivity to community pharmacy enabling
renewals
Integration with existing systems (PMS,EMR, PHR)
End-to-end Integration
Std. Sig
RxNorm
Medication History
Support for implementation and ongoing
Integrated physician practice to pharmacy workflow
Cancel Tx.
Change Tx.
New Scripts Renewals
Adherence Alerts
Connectivity for formulary and medication history
Prior Auth
Clinical alerting
Eligibility Formulary
Diag. Allergy Data
Others
Training for professionals and staff
Broadband and WiFi
Support Services
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Stakeholders will develop programs leveraging the
whole product that improve quality of care and
further drive physician adoption and utilization

• Example Patient Adherence and Pay-for
  Performance Programs
• Pharmaceutical manufacturers and health plans are
  interested in funding condition-specific patient
  adherence programs
• RHIOs partnering with community pharmacy to
  enable MAX (Adherence Programs)
• Certified solution providers will implement
  utilization programs to enable more physicians

Value-added programs can operate on top of the
electronic prescribing whole product
infrastructure
Patient Adherence Programs
P4P / DM
PHR Rx Data
IDN Rx Reconcile
ERx Patient Data
AHRQ Studies / Grants
Pharmacy MTMS
Bio-surveillance
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PharmacyPhysician-Payer/PBM Interoperability
can be foundation for improved medication
management and adherence programs
Predictive Modeling
Payer Clinical Data
Pharmacy Rx History
Pharmacy
MTM Care Mgmt

• Rx history exchange
• Adherence program enrollment
• Pharmacy MTM-based care management
• Rx review
• Personal Rx record
• Healthcare services

Payer Rx History
Patients of Interest
In-store Clinics
Payer/PBM

• Rx history exchange
• Integration with DM
• Gaps in care
• Predictive modeling

Health

• Patients of interest
• Non-adherent
• At risk multiple drugs cost
• Filtered by condition

Information Exchange
Patient
Physician Practice

• Patient education
• Reminders / alerts
• Secure email, PHR, mobile, IVR
• Personalized
• Meds, therapy Dx specific
• Pharmacy, payer, physician

Health Buddies

• Integrated Rx history
• Adherence report
• Physician support
• Program introduction
• Adherence dialog

PHR
eCap
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BEST PRACTICES
R
e
X
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The complete best practices model is nine steps
beginning and ending at the same point (9-0) as
the vision for electronic prescribing is realized
Management ERx Vision
Practice Transformation Process
Acquisition Process
9/0
Benefits Realization
Solution Evaluation
1
8
Selection Agreement
Day-to-day Use
2
7
Solution Introduction
Go Live With Stakeholders
3
6
5
4
Installation Training
Integration Workflow
Implementation Process
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Sowhere are we today?
R
e
X
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Examples of eRx/EMR/HIE Initiatives

• Rhode Island initial launch with RIQI,
  multi-stakeholder group working to drive adoption
  and utilization, Governor set goal that majority
  of prescriptions would go electronically by end
  of 2007
• Massachusetts -- MA eRx Collaborative, MA eHealth
  Collaborative
• Nevada Southwest Medical roll out with
  Allscripts
• North Carolina BCBS program with DrFirst, Zix,
  Allscripts, NCHICA e-prescribing program
  including web-based e-prescribing CME program and
  other education programs
• Maryland CareFirst program with DrFirst
• Ohio Cleveland Clinic roll out with Epic
• New Hampshire Governor announced goal to
  connect physicians electronically with pharmacies
  for e-prescribing

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Examples of eRx/EMR/HIE Initiatives

• Michigan SEMI E-prescribing project, roll out
  with Henry Ford
• Pennsylvania Highmarks eHealth Collaborative
• Illinois Governor issued Executive Order
  encouraging e-prescribing, Blue Cross Blue Shield
  program with DrFirst and Zix
• New York HEAL NY grants fueling e-prescribing
  and HIE projects, NYC Department of Health
  expanding its eRx/EMR program, HIP certifying
  e-prescribing application
• Louisiana -- Blue Cross Blue Shield e-prescribing
  program with Zix starting to get physicians on
  the network
• Alabama Blue Cross Blue Shield (SureScripts
  physician CSP) expanding roll out, UAB Family
  Physicians in Mobile interested
• Tennessee clinical information exchange
  initiatives, increased interest in e-prescribing,
  multi-stakeholder coalition forming

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Examples of eRx/EMR/HIE Initiatives

• Florida Medicaid program funded e-prescribing
  with Gold Standard
• California supported CAL-RHIOs grant proposal
  to CMS for a medication management program
• New Jersey health plans (Horizon BCBS, Aetna)
  subsidizing e-prescribing
• New Mexico QIO is leading multi-stakeholder
  initiative to accelerate adoption and utilization
  of e-prescribing
• Oklahoma Medicaid soon to issue vendor RFP and
  launch e-prescribing program
• Maine HealthInfoNet (statewide health
  information exchange) very interested in
  SureScripts med history, also launching statewide
  e-prescribing initiative
• Kentucky Governor recently announced HIT
  initiative, grants being offered to encourage
  e-prescribing pilots
• Colorado clinical information exchange
  initiatives, increased interest in e-prescribing

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Drivers for Physician Pharmacy Interoperability

• Institute of Medicine Report
• More than 1.5 million Americans are injured every
  year by drug errors
• Recommendation All prescriptions be
  sent/received electronically by 2010
• CCHIT certification of EMRs including
  e-prescribing
• President signed Executive Order enforcing
  standards for e-prescribing
• The Administration and Secretary Leavitts HIT
  initiatives
• Medication history seen as playing strategic role
  within AHIC
• Value-driver for EMRs, Bio-surveillance, Consumer
  Empowerment (PHRs)
• CMS Pilots testing of additional e-prescribing
  message types
• State and Regional eRx/EMR/HIE Initiatives
• MA, RI, MI, MD, FL, NH, NC, VA, IL, PA, NV, NY,
  NJ, LA, AL, TN, CA, ME, NM, CO, OK
• Exceptions to Stark Anti-fraud and Anti-kickback
  Laws - HHS announced in August
• Covers both e-prescribing and electronic medical
  records

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Next Steps.Questions?

• THANK YOU!