Based on a presentation by Ajit Dhavle, Pharm.D., MBA at the Community Pharmacy Management Conference, 2007
Many pharmacies are taking a step out of their comfort zones and moving their practice to the next level with the help of e- prescribing connectivity options. The Pharmacy Health Information ExchangeTM, operated by SureScripts-RxHub is the e-prescribing network that connects physicians and pharmacists.
What is Electronic Prescribing?
Electronic prescribing (or “E-Prescribing”) is a physician’s use of real-time, patient-specific clinical and economic information, for consenting patients, to prescribe the most medically appropriate and cost effective prescription at the point of care, and transmit the prescription electronically -- from the computer at the practice to the computer system at the patient’s pharmacy of choice.
After consulting with a patient, the doctor enters the prescription information into a computer or handheld device and transmits the prescription through the software system to the patient’s pharmacy. A pharmacist a couple of miles or more away logs on to the pharmacy computer system, receives the prescription information and fills the prescription. No paper. No sloppy doctor’s prescription notes for pharmacy technicians to decipher.
The system is also bi- directional. If a patient calls or enters the pharmacy and requests a refill for their prescription, the pharmacist can make a note on the patient’s file, and the renewal request is sent to the prescriber. The prescriber can then authorize or deny the renewal with a few mouse clicks, thereby eliminating the game of phone and fax tag normally associated with the prescription renewal process. In addition, the e-prescribing system allows change requests to be made and prescription histories and other clinical information to be stored.
Why do Electronic Prescribing?
More than 1.5 million Americans are injured annually by medication errors. More than 25% of these injuries are preventable1. Many of the errors are due to lack of communication between the physician and the pharmacist and can be avoided with e-prescribing. E-prescribing helps to reduce errors resulting from illegible handwriting, unclear abbreviations and doses, and telephone or verbal orders that are missed or misinterpreted.
With e-prescribing, prescribers and practice staff have the potential to access clinical decision support information such as patient medication history, formulary, benefits and pharmacy eligibility information, drug-drug interaction alerts, drug-allergy interaction alerts, and other information that can result in a safer prescribing decision. By having more comprehensive and accurate information at the time of prescribing, the practice can improve the quality of care, potentially increase adherence, and also reduce the number of call backs from the pharmacist to clarify prescription information. If the practice and the pharmacy are both connected to the electronic prescripting system, the prescription renewal authorization process can be streamlined. This then improves practice efficiency and the timeliness of medication delivery to the patient.
Over 97% of chain pharmacies as well as thousands of independents in the U.S. have invested in e-prescribing because they view it as strategically important to improving quality, safety, efficiency, and consumer convenience. There is also a business case for pharmacies to e-prescribe. Unlike faxes, e- prescriptions go directly into the pharmacy computer (no re-keying required). When compared with all other forms of prescriptions, e-prescriptions reduce the amount of time needed to complete dispensing activities by 26.6% for new prescriptions and 10.2% for renewals (valued at $1.07 and $0.41 per Rx respectively2). In addition, preliminary research shows that the number of Rx’s filled at pharmacies increased 11% once physicians began actively using e-prescribing, suggesting a relationship between the use of e-prescribing and the long standing issue of leakage. The same research also suggests that e-prescriptions are picked up by patients at an equal or greater rate than other prescriptions3.
Electronic prescribing offers great value to patients by eliminating the trip to the pharmacy to drop off the prescription. Additionally, an important advantage of a prescription being sent electronically is that the message is already formatted in such a way that the pharmacy computer can assimilate the information for rapid dispensing. Pharmacists have the comfort of knowing that an accurate, legible prescription will arrive at the pharmacy, and that it will not be lost, misplaced, destroyed or forgotten by the patient.
What Are the Primary Challenges?
As with any technological innovation, some setbacks must be overcome for the product to run smoothly. In the past, very few pharmacies were directly connected to physician’s offices. Now, over 70% of U.S. pharmacies (including over 97% of chain pharmacies) are receiving e- prescriptions via the Pharmacy Health Information Exchange, and that number is growing. Initially, workflow issues such as integration with practice management systems bogged down some early adopters but this issue was resolved by integrating the software into existing practice systems.
An Introduction to SureScripts-RxHub
In July of 2008, the nation’s retail pharmacies and leading pharmacy benefit managers (PBMs) announced an unprecedented collaboration to unite the country’s two leading health information networks.
RxHub’s expertise in patient identification and delivering drug benefit information to the physician at the point of care complements SureScripts’ focus on electronic prescription routing from the physician’s office to the pharmacy. The merger combines these strengths with a shared focus on more access to patient medication history to form a single suite of comprehensive services. The new organization enables physicians to securely access vital health information when caring for their patients through a fast and efficient health information exchange. This allows them to transmit electronic prescriptions and renewal requests to both retail and mail-order pharmacies.
In 2008, the combined organization expects to transmit 100 million electronic prescription transactions and respond to more than 70 million requests by physicians confirming information about their patients’ drug coverages and medication histories. With appropriate patient consent, the combined organization will extend this information to clinicians caring for more than 200 million patients across the United States.
Where is the Technology Headed?
Widespread physician adoption of e-prescribing might be coming sooner than later. Starting January 1, 2009, CMS, under the Medicare Modernization Act (MMA), will require all Medicare Part D computer generated prescriptions to comply with NCPDP Script standard, and thus be transmitted electronically and not via fax. In addition, many organizations – including state governments, payer organizations, medical associations and individual technology vendors – have developed special incentive programs to encourage prescribers to adopt e- prescribing technology (a partial list is available at www. surescripts.com/initiatives).
As the technology progresses, new capabilities will be added to the existing system. Some possible additions could include diagnoses, laboratory data, and medication reconciliation. Strides are also being taken to address patient compliance and adherence. Electronic prescribing is without a doubt a great innovative addition to pharmacy practice and will continue to impact the profession for years to come.
1 Institute of Medicine. Preventing Medication Errors, 2006
2 e-Prescribing: The Value Proposition. Rupp, April 2005, America’s Pharmacist, Figures updated August 2007
3 Research conducted by SureScripts and Walgreens using prescriber data from IMS Health, 2007