Electronic Prescribing (e-Rx), it’s coming!

Electronic Prescribing (e-Rx), it’s coming!

Although I believe deadlines are still a few years away, Behavioral Healthcare should be keeping an eye on e-prescribing trends and assure their EHR-S vendor is too. I recommend implementing e-prescribing as soon as feasible, as the benefits can be significant to clients and the agency.

Many pharmacies are already set to receive electronic prescriptions, but the adoption curve among prescribers has been slow until recently.

The way it works is simple:

1. Psychiatrist enters diagnosis for patient or refers to patient diagnosis in EHR-S
2. System can recommend drug based on diagnosis
3. System identifies if drug is on formulary, what tier, and if prior authorization is needed
4. System identifies if patient is already on drug in same class
5. System can recommend dosage based on age or weight
6. System can check interactions, such as drug drug, drug allergy, drug food
7. System can recommend lab work to be done based on drug selected
8. System can calculate # to dispense
9. System electronically submits script to pharmacy
10. System prints instructions for patient
11. Patient drives to pharmacy and script is waiting for patient

What you will need:

• Software in Doctor’s office
  – Stand-alone or within EHR
  – Drug Database
  » Allergy checking
  » Age, Weight, Disease, Lab checks
  – Formulary Information
• Connectivity to Pharmacies
• Connectivity to Payer/ Pharmacy Benefit Managers (PBM)

Example of solutions to provide what you need (it should be your EHR-S vendor that selects the appropriate partnership here):

• SureScripts, and others like ProxyMed, WebMD, and RxNT can provide:
  – Connectivity between doctor and pharmacy
  – Eliminates transcription errors
  – Can simplify refill process
  
• RxHub National Patient Health Information Network™ can provide:
  – Connectivity between doctor and PBM
  – Formulary Knowledge
  – Identifies drugs prescribed elsewhere

For example, in order to receive requests for prescription renewals on your computer, and send responses and new prescription information to computers at your local pharmacies, you can secure a connection through the Pharmacy Health Information Exchange, operated by SureScripts.
The Pharmacy Health Information Exchange, operated by SureScripts, is the common secure exchange that pharmacies use for the electronic transmission of prescription information. Connection is only possible if you use, or obtain, an electronic prescribing application that is certified by SureScripts.

SureScripts works with existing medical software companies and EHR-S vendors to certify their prescribing systems for connection. This way you get to choose the system that best suits the needs of your practice, from simple prescribing software to more robust EHR systems.

You can also choose to implement PDA’s for your psychiatrists / prescribers, with products like PocketScript. Through a wireless handheld PDA, they can write prescriptions and then send them immediately and electronically to pharmacies via the SureScripts network. Or use a secure web site product and a standard browser.

With all these solutions, you need integration with your EHR-S, so that the medication history can be viewed and utilized by the clinician and reporting tools.

The potential benefits of e-prescribing include:

• Reduce the risk of errors associated with illegible written prescriptions.
• Have the script ready by the time the patient arrives at the pharmacy
• Reduced telephone time with pharmacy
• Reduce the risk of patient adverse reactions to medication due to allergies and medication interactions
• Reduce the delay in prescription filling for patients due to off-formulary scripts

It’s just a matter of time before Behavioral Healthcare providers are required to use e-prescribing. Medicare is currently completing standards for electronic prescribing software and Medi-Cal is also pushing in this direction. The American Medical Association is urging Congress to force HHS to finalize standards needed to support electronic prescriptions. The MMA created a new voluntary prescription drug benefit under Medicare. In April, the Centers for Medicare and Medicaid Services issued a final rule adopting three standards to support formulary and benefits, medication history and fill status notification components of e-prescribing.

Although e-prescribing will be optional for physicians and pharmacies, Medicare will require drug plans participating in the new prescription benefit to support electronic prescribing. When it does become a standard and mandated, there will likely be a two year transition period for doctors and pharmacies. http://www.cms.hhs.gov/EPrescribing/

“Establishing standards for e-prescribing under Medicare’s prescription drug program will help pave the way for widespread adoption of e-prescribing throughout the medical community. Broader use of e-prescribing offers beneficiaries safer and more efficient care at lower costs,” said Mike Leavitt, secretary of the department of Health and Human Services.

Relevant Articles:
http://www.connectup.org/eprescribing.html - California project
http://www.newsobserver.com/business/v-print/story/954194.html
http://www.healthdatamanagement.com/news/standards_e-prescribing26255-1.html

Testimonial: http://runningahospital.blogspot.com/2008/03/benefits-of-electronic-prescription.html

FAQ’s: http://www.surescripts.com/faqs.aspx?ptype=physician#15