All clinicians are familiar with the term e- Prescribing, and many of you may have encountered the use of this technology in the academic or real-world practice setting. For those of you who have yet to be exposed—you soon will be.
E-Prescribing has emerged as one of the most important elements for capitalizing on the Meaningful Use incentives that have been put forth by CMS under the auspices of MIPPA, the Medicare Improvements for Patients and Providers Act. Physicians have received financial rewards from CMS for utilizing this technology since 2009 and will continue to receive increased reimbursement throughout 2011—before the “stick” is introduced. Starting in 2012, those physicians not utilizing a certified e- Prescribing product will find their Medicare payments reduced, with increases to these reductions occurring each year thereafter.
Whether to move to e-Prescribing or not is a moot point. Among medical specialists, 49 percent of cardiologists, 47 percent of family practitioners, 45 percent of internists, and 40 percent of ophthalmologists are already utilizing this technology, and not just for reasons of increased reimbursement. I do not have a good estimate relative to neurology adoption rates, but other specialties tend to be around 20 percent.
E-Prescribing will afford you more benefits than you can now imagine, including: letting you know if your patient is eligible for Rx coverage; an obvious plus. If the patient is eligible, the e-Prescribing product will tell you exactly what your patient is eligible for; in other words the formulary that their employer is willing to pay for. Why does this matter? Payers are constantly changing their benefit plan designs, especially as they relate to prescription drug coverage. Why waste time prescribing medications for patients that aren't part of their benefit plan design, only to have to interrupt your day, and your staff's day, taking calls from pharmacies requesting “substitution” authorizations? These calls will drop off once e-Prescribing becomes your primary means of generating prescriptions.
You'll be able to see a two-year retrospective view of all medications that have been prescribed for your patients, whether by a PCP down the hall, in the next building, or in another state altogether. Now you don't have to rely on your patient's memory, or their bringing in the shoe box of medications, in order to determine what else they may be taking. Having access to this data up-front allows you to ensure that there will be no unexpected drug-drug interactions as the result of the medication that you are about to prescribe to the patient negatively interacting with another medication that you knew nothing about.
Patient safety is elevated to new levels with e- Prescribing, and the same capabilities apply to prospectively looking for drug-food and drug-allergy interactions that may pose risks, all before your patient ever leaves your office. With many e- Prescribing systems you have the ability to titrate the level of warnings presented as well, so that if you prefer, only moderate to severe threats will be presented, in lieu of every potential interaction possible. Prescribers across the spectrum will appreciate this customization feature.
You will be able to address patient requests for refills electronically from anywhere you have Internet connectivity. Patients can phone the pharmacy that provided the original prescription, request a refill, and the pharmacy will send an electronic request to your e-Prescribing program, notifying you and allowing you to approve, deny, deny with a new prescription, etc., all from your computer or smartphone, anywhere in the country. You will even be able to electronically advise the pharmacy to have the patient contact your office for an appointment, especially if patient has not been seen for a prolonged period.
With many e-Prescribing products, Role Based Profiling is allowed, so that many persons within the practice can be afforded varying levels of access to the e-Prescribing tool, consistent with state and federal laws that apply. Most e-Prescribing vendors allow these “non-Prescribing” staff members access at no monthly charge. With this capability, some practices may choose to have certain staff members input “drafts” of prescriptions that can be deposited into the authorized prescriber's “Saved Rx” folder. The prescriber can then review these prescriptions and if they concur with the information entered, ultimately press the “Send to Pharmacy” button. Flexibility is the operative word here, and e- Prescribing tools should afford each practice the opportunity to fit the tool into the existing practice work-flow as much as possible.
Surescripts certification, especially “Gold Certified” vendors, have demonstrated a level of functionality and product support that has surpassed all base level standards required of e- Prescribing vendors. These products tend to offer excellent functionality, solid training programs, excellent support, and are frequently incorporated into a wide array of EMR and EHR products by vendors that elected to forgo developing their own e-Rx interface. In many instances, Prescribers may wish to start utilizing a “stand-alone” e-Prescribing product, as opposed to jumping into a full featured EMR product, with the security of knowing that all data entered into the stand-alone e- Prescribing database can be seamlessly incorporated into their future EMR platform.
For practices that have yet to implement a fully functional EMR, I would encourage looking into implementing a stand-alone e-Prescribing product now. The benefits outlined above, and many others, are very real and can begin to benefit your practice today, while positioning you to move into the EMR realm in the future.
Upcoming articles will be targeted to enhance your knowledge of e-Prescribing and EMR use, including articles that will explain what your staff members and you can expect in terms of “realworld” implementation planning, work-flow suggestion, etc. We welcome your thoughts as to other topics that would be useful to your practice/ professional development. Please direct your comments or questions to email@example.com.
Milan Popovich is the Vice President of H2H Solutions, Inc., a Michigan based health care information technology company that provides high level IT resources to health care payers across the country. H2H has also developed a Surescripts Gold Certified e-Prescribing product called Digital Rx™ that is available as a stand-alone application, in addition to having been incorporated into over 40 EMR/EHR/Practice Management products that are in use by prescribers across the country. For more information: www.h2hsolutions.com