Why you should be using it NOW

1
- Why you should be using it NOW!

• Electronic Prescribing

Tuesday, February 27, 100 PM - 200 PM Patricia
Hale, MD, PhD, FACPHIMSS 07 Education Session 81
www.pathalemd.com
2
Electronic Prescribing Why you should be using
it NOW!

• Objectives
• Describe how the electronic prescribing process
  specifically works to transmit medication
  information from the physician office to the
  pharmacy and within a regional health information
  network.
• List specific opportunities electronic
  prescribing provides to improve patient safety,
  office efficiency and control of health care
  costs.
• Specify challenges and barriers to implementation
  of electronic prescribing and how to address
  these issues.
• Evaluate resources available to assist in
  evaluation of electronic prescribing options and
  successful implementation.
• Discuss national electronic prescribing
  initiatives and how they may affect
  implementation.

3
A Public Health Crisis
7,000 Americans Die Annually From Preventable
Medication Errors
1.5 Million Americans Injured Annually by
Preventable Medication Errors
Source The Institute of Medicine of the National
Academies of Science (IOM). Slide used by
permission from SureScripts
4
The Challenge

• The Challenge of Prescription Hand-offs
• Illegible Handwriting
• Unclear Abbreviations and Doses
• Verbal Communication Among
• Physicians, Patients and Pharmacists

• Physicians write
• 4.5 billion prescriptions
• each year. . . .

• On Paper!

5
The Technology is Available TodayBut Not Used

• 3.2 Billion Prescriptions Written Annually
• Less than 1 in 5 of Physicians Use ePrescribing
• Only 20 of prescriptions are electronically
  prescribed with 80 still handwritten
• Most electronic prescriptions are still sent by
  FAX

National savings from universal adoption
of electronic prescribing systems could be as
high as 27 billion
Sources eHealth Initiative, 2004 and Center
for Information Technology Leadership, The Value
of Computerized Provider Order Entry in
Ambulatory Settings, 2003.
6
The Current System Causes a Number of Serious
Problems !
Rx

• Patient safety
• Between 1.5-4.0 prescriptions are in error with
  serious patient risk
• Adverse drug events occur in 5-18 of ambulatory
  patients
• Quality of care - Compliance
• 20 of scripts are never filled
• Patient satisfaction is declining
• Cost of errors 2 billion / year
• Impact on productivity
• Physician practice 3 hours per day
• Pharmacy 4 hours per day (up to 1 call per Rx)
• Inefficient delivery

Rx

• Illegible handwriting
• Phone tag and fax tag
• Patient waiting in the pharmacy

7
The number of prescriptions in the US is rapidly
increasing
Unfilled

• 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 (91 of Medicare) use a
  prescription medication each year3

0.4 B
Renewals
0.5 B
1.5 B
Refills
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.
8
Electronic prescribing is under-utilized
Purchasing software does not equal adoption or
effective use
Rx InterOp
150,000 Certified EMR Users
Large is defined as gt 20 physician FTEs in one
study with 39 adoption and gt50 in two another
studies with 47 and 57 adoption respectively.

• Certified version typically a simple upgrade away
• Extremely low awareness among install base

Sources Jha et al, Health Affairs, 10/11/06
MGMA, 2005 CDC/NCHS Natl Ambulatory Medical
Care Survey, 2005 HSC Community Tracking Study,
2006 Forrester, 2003 SureScripts estimates,
2006. Slide used by permission from SureScripts
9
Full e-Prescribing includes

• Ability to create a prescription electronically
• Ability to receive automated decision support
  during script creation
• Medication lists and information
• Eligibility determination
• Formulary coverage from insurer including co-pay
  information
• Prior authorization
• clinical decision support including Drug
  interactions, drug-allergy, etc.
• Ability to send script electronically to pharmacy
  using standard transmission messaging (NCPDP
  SCRIPT, ASC12)
• Ability to receive/authorize pharmacy
  initiated-renewals electronically
• Ability to determine fill status as a measure
  of compliance (medication history)
• Ability for pharmacy to process electronic script
  in their system

Slide used by permission from SureScripts
10
Intermediaries for Data Transfer
Pharmacy and PBM eRx Software
Prescriber eRx Software
ProxyMed and others
SureScripts Provides New Rx, refills, renewals,
authorizations, change Rx, Prescription history
from pharmacies
Medimedia and others
RxHub Provides Eligibility, Formularies,
medication claims histories
11
Impact of e-prescribing on time spent
(minutes/day) on refills/renewals
Minutes per day
Prescribers
Office staff
(2006 Study Brown University)
Slide used by permission from SureScripts
12
Impact of E-Prescribing on Preventable Adverse
Drug Events (ADEs)
Pen
Print?6
Fax?37
EDI Decision Support ?61
Source CITL
Slide used by permission from SureScripts
13
Connectivity Roadmap Using computer technology
to improve patient care
Evidence-Based Medicine
National Disease Databases
16-40
lt5
National Health Information Infrastructure
Regional Health Information Networks
Electronic Medical Records Systems
7-20
40-80
Electronic Prescribing
Patient Physicians Access Medical Websites
Increased Decision Support

• Algorithm-driven medicine and decision making

• Population-based outcomes and cost information
  readily available to consumers, physicians, payers

• Streamlined information retrieval valuable for
  epidemiology

• Integrated database allow decision support tools

• Gains in accuracy and connectivity enhance safety
  and efficiency

• Better informed consumers

14
Who Benefits from eRx?
15
Potential Benefits of eRx

• Patients
• Increased safety, efficiency and compliance
• Lower co-pays
• Pharmacies
• Increased efficiency, improved care, improved
  patient satisfaction
• Payors/PBMs
• Increased generic/formulary usage, efficiency, Rx
  compliance and prevention of ADEs (reduced costs)
• Providers
• Increased efficiency, improved care, patient
  satisfaction and potential incentives
  (pay-for-performance)

16
But Providers are concerned about

• Cost of buying, installing and supporting a
  system
• Lack of reimbursement for costs and resources
• Increased time to use the system reduced
  productivity (initially)
• Time required to review warnings, alerts and
  recommendations
• Still not considered a routine standard of
  practice

17
Why now? The problems of past efforts have been
successfully addressed
18
What Initiatives and Incentives Will Drive Future
Adoption of eRx?
19
An Overview of Potential Incentives

• Economic Incentives
• Grant and Loan Programs
• Reimbursement for Utilization
• Pay for Performance
• Malpractice Insurance Premium Reductions
• Healthcare IT Suppliers discounts, etc
• Pharmacies or Transaction Brokers Defray Costs
• Policy Incentives and Programs
• Accreditation (JCAHO 2005 Hospitals National
  Patient Safety Goals, others in development)
• Employer Programs (Leapfrog and others)
• Medicare support for economic incentives
• DOQ-IT
• CCHIT certification of inpatient and ambulatory
  EMRs
• Mandates ???

20
2003 Medicare Bill - eRx Provisions

• Voluntary program
• Mandatory National eRx Standards for Medicare
• Initial standards 2005 Pilot program 2006, Final
  Standards 2009
• Recommendations delivered by NCVHS
• Information Requirements include
• Lower cost, therapeutically appropriate
  alternatives
• Interactive, real-time to the extent feasible
• Encourages Physician Adoption
• Permits use of appropriate messaging
• Eliminates anti-kickback regulation for hospital,
  physician groups and plan administrators to give
  out eRx hardware and training
• Allows plans to pay-for-technology and
  pay-for-cost effective performance in Medicare
  Advantage Plans
• 50MM of federal grant money in 2007
• Preempts State Laws contrary to the national
  standards or those that restrict the ability to
  carry out the new law.

21
Regulations (CMS/MMA) ePrescribing

• Progress-to-date
• Issued Notice of Proposed Rule-Making (10/05)
• Issued final rule naming foundation standards
  (11/05)
• Pilot programs competed and reports submitted
  (2/06)

22
Examples of Current Pay for Performance
Initiatives for eRx

• Bridges to Excellence
• Physician Office Link
• NCQAs Physician Practice Connections
• Points for registry lt eRx lt EMR
• Integrated HealthCare Assoc (California)
• technology is so critical to (program) success
  (Williams)
• 20 of bonus tied to (data collection) tech
  investment
• CMS
• Five pilots (includes tracking technology)
• could account for 20-30 of what CMS pays
  providers
• McClellan, WSJ, 9/17/04

23
Whats New?
24
New Programs to promote electronic prescribing
25
New Efforts to Increase eRx Adoption
The National ePrescribing Patient Safety
Initiative (NEPSI) A Coalition of the Nations
Most Prominent Technology Companies, Healthcare
Benefit And Medical Provider Organizations
Dedicated to improving patient safety by
providing free electronic prescribing for every
physician in America
Slide used by permission from NEPSI
26
NEPSI Coalition Sponsors
National Sponsors
Technology Sponsors
Health Benefit Sponsors
Search Sponsor
Connectivity Sponsors
Slide used by permission from NEPSI
27
Regional Supporters
Slide used by permission from NEPSI
28
eRx NOW - Simple, Safe, Secure and Free
ePrescribing
The ATM of Healthcare

• eRx NOW from Allscripts
• Simple Web-based E-prescribing Software
• Easy To Install and update
• Easy Interoperability
• Custom search engine from Google
• Safe
• Comprehensive Drug Interaction Checking
• Allscripts used by 20,000 MDs Nationwide
• Secure
• Secure anytime, anywhere access
• State-of-the-Art Privacy and Security
• Rigorous credentialing and authentication

www.nationaleRx.com
Slide used by permission from NEPSI
29
The Pharmacy Health Information Exchange
Rx
LTC
Hospital
Payer /PBM
Others
Lab
Rad
Example Vendors
NHIN and RHIOs
Application Services (ERx, EMR, HIS, PBHR, PHR,
etc.)
Member
Physician
Nurse
Patient
Employee
Pharmacist
Lab Tech
Family
Slide used by permission from SureScripts
30
Over 95 of the nations community pharmacies
have systems certified to connect to the Pharmacy
Health Information Exchange
Slide used by permission from SureScripts
31
All major physician technology vendors in the
United States are certified on the Pharmacy
Health Information Exchange
Slide used by permission from SureScripts
32
SureScripts The Network and The Services
Pharmacy Health Information Exchange, operated
by SureScripts
Formulary
E-Prescribing
Eligibility
Rx History
E-Refills
Slide used by permission from SureScripts
33
Pharmacy Interoperability Summary
In-store Clinics
Pharmacy Rx History
MTM Care Mgmt
Pharmacies



Slide used by permission from SureScripts
34
SureScripts Certification is Not Universal
Vendors are Certified by Service/Message Type
Slide used by permission from SureScripts
35
SureScripts Certification is Not Universal
Vendors are Certified by Service/Message Type
Slide used by permission from SureScripts
36
SureScripts Certification is Not Universal
Vendors are Certified by Service/Message Type
Slide used by permission from SureScripts
37
SureScripts Certification is Not Universal
Vendors are Certified by Service/Message Type
Slide used by permission from SureScripts
38
Granting physician software and service providers
a uniform certification for pharmacy
interoperability is no longer adequate

• GoldRx certification status
• Certification based on standards alone no longer
  adequate
• Which vendors are not just testing and marketing
  interoperability
• Which vendors are truly delivering and committed
  to
• Customer Education
• Proven Pharmacy Interoperability
• Advanced Medication Management
• Workflow Enhancements Demonstrable Expert
  Experience with Electronic Prescribing Process

Slide used by permission from SureScripts
39
Granting physician software and service providers
a uniform certification for pharmacy
interoperability is no longer adequate

• The first products to achieve GoldRx
  certification
• TouchWorks EHR(Allscripts)
• ChartConnect EMR
• Rcopia (DrFirst)
• NextGen EMR
• eScript (RelayHealth)
• Pocketscript (Zix)

Slide used by permission from SureScripts
40
Nations Community Pharmacies Announce Key
Indicator For Patient Safety In The U.S. The Top
10 States For Electronic Prescribing
Last Year RI was 1, MA was 3, MI was 10, WA
and NJ not on last years list and  FL and VA were
in last years Top 10
Slide used by permission from SureScripts
41
Certification by CCHIT

• Certification Commission for Health Information
  Technology (CCHIT)

42
Ambulatory EMR CCHIT ePrescibing Criteria
43
Medication History
44
Medication History Current Options
45
Example of Rx Claims History via RxHub
46
(No Transcript)
47
RxHub-connected eRx/EMR Vendors

• OA Systems
• Phytel
• Purkinje
• Relay Health RxNT
• SafeMed
• Script IQ
• ScriptRx
• Scriptsure
• Sequel Systems
• SSIMED
• STI Con
• Synamed
• Zix Corporation

• A4 Health
• Achieve
• Allscripts
• Athena Health
• Bond Medical
• Catalis Health
• Cerner
• DrFirst
• eClinical Works
• eHealth Solutions
• EmDeon/WebMD
• EPIC
• Gold Standard
• H2H Solutions
• Health Vision

• InstantDx
• iScribe
• MA Share
• McKesson
• MDAnywhere
• MdOffices
• Medical Info Sys
• MedicWare
• MedKeeper
• MedPlus
• Medport
• NewCrop
• NextGen

Bold in production
48
Evidence of increased adoption
49
Over 150,000 physicians use technology that is
SureScripts certified or contracted/in process of
certification

• SureScripts Certified EMR solution providers
  represent approximately 65 of all physicians
  that use an EMR system
• SureScripts Certified e-prescribing solution
  providers represent approximately 90 of total
  market of stand-alone solutions
• SureScripts contracted, but not yet certified EMR
  solution providers represent close to 20 of all
  Physician EMR users

SureScripts Certified and contracted solution
providers represent over 150,000 prescribers
Slide used by permission from SureScripts
50
Paving the way for pharmacy connectivity Overco
ming legal and regulatory barriers
As of February 2nd, 2007 - 48 States and
Washington, D.C. cleared for electronic
prescribing
As of February 2nd, 2004 - 25 States cleared for
electronic prescribing
Slide used by permission from SureScripts
51
Pharmacy Activation By State
Not shown HI 42 AL 24 As of November 9,
2006
52
RxHub Adoption Data

• Access to more than 160 million patient
  prescription information records for consenting
  patients, via payers and PBMs, through the
  growing list of RxHub certified technology
  partners. Contracts with payers and PBMs were
  executed representing additional access to more
  than 50 million patients though RxHub.
• An increase in transaction volumes of 50 from 29
  million transactions in 2005 to more than 43
  million transactions in 2006. These transactions
  were real-time requests for patient eligibility
  and benefits, formulary, and medication history
  information, made at the point-of-care in the
  ambulatory and acute care settings from
  clinicians across the United States.
• A ten-fold increase in true electronic
  prescriptions, which includes the transmission of
  patient-specific clinical decision support
  information at the point of prescribing, to
  retail and mail order pharmacy locations of the
  patients choice.

53
(No Transcript)
54
Why Now?

• More options for stand alone, certified EMR and
  information network based electronic prescribing
  products
• Increased connectivity of pharmacies and PBMs
• Increased functionality to improve office
  efficiency (electronic refills)
• Support for implementation through programs like
  DOQ-IT and others
• Grant, P4P and other funding opportunities
• Educational material and resources

55
We tried dedicating this computer to deciphering
our doctors' handwriting." Cartoon by Dave
Harbaugh
56
Questions?

• Contact me at pathale_at_pathalemd.com
• Web site with further information and links
  www.pathalemd.com