Electronic Prescribing and the Department of Health Central Pharmacy

1. Electronic Prescribing and theDepartment of Health Central Pharmacy Florida Public Health Association Medical Director’s Meeting July 29, 2008 Christopher B. Sullivan, Ph.D. Florida Center for Health Information and Policy Analysis Agency for Health Care Administration

2. ePrescribing Today 29% 70% 1% 2. or & or Phone Cursive eRx Fax (Cursive/Typed) 1. Typed vs. Physician Evaluates Patient & Prescribes Drug 3. Pharmacist reviews prescription and routes it to the patient’s insurer. Manual Entry By Pharmacist 5. Script to Patient Benefit Manager for Adjudication 4. Payment is collected and Medication is dispensed to the patient Rx Approval Patient Benefit Manager Approves Script MJJ - 2007

3. Medicaid Wireless Handheld PDA Pilot In 2002, the Florida Legislature directed AHCA to develop a wireless handheld drug information application for prescribers to use at point of care The system was expected to provide: Continuously updated clinical pharmacology information for prescriber reference Reference to the Florida Medicaid PDL Individual Medicaid patient medication history Ongoing education and support for prescribers

4. Value of the Wireless Handheld PDA Florida Medicaid Wireless PDA Pilot makes 100 days of a patient’s prescription drug history available to practitioners. The medication history: is available at the point of service; permits immediate utilization and compliance review; provides information about coverage and restrictions; incorporates an e-prescribing function that permits immediate transmission of prescription authorization to the patient’s pharmacy.

5. Medicaid eMPOWERx ePrescribing

6. Outcomes from the Wireless Handheld PDA Pilot eMPOWERx allows physician participation in prospective drug utilization review to: Minimize adverse drug reactions. Detect overuse or under use of drugs. Detect duplicate therapies. Detect potential allergic responses. Screen for appropriate dosage. Halt “doctor shopping” for medications

7. eMPOWERx Can Improve Patient Adherence Refill Compliance Indicator Date of Last Fill

8. eMPOWERx Can Enhance Safety Automatic Clinical Reports Supported by Clinical Content

9. Wireless Handheld PDA Drug Interaction Alerts eMPOWERx Is integrated with a clinical information database, which includes screening tools to reduce the potential for medication errors before they occur. Employs Clinical Pharmacology and clinical report tools, empowering clinicians to screen a prescription for adverse effects. Alerts the provider to potential drug-drug or drug-allergy interactions The ePrescribing component providesMedicaid Preferred Drug List status information and Recommendations for alternative medications.

10. Lower Drug Costs Drug Interactions Comprehensive medication history for well informed therapeutic decisions Therapeutic duplications flagged for further review

11. eMPOWERx E-Prescribing Features The eMPOWERx system is supported through a Web-based, real-time prescribing system: Allows providers to write prescriptions from a desktop computer or a PDA with prompts for the patient’s last pharmacy. The desktop version of eMPOWERx includes a data feed from SureScripts-RxHub. Physicians can obtain a medication history from both Medicaid and non-Medicaid sources using the desktop version. One significant barrier for the County Health Departments is the need for extra security and two factor authentication.

12. Prescribers who used eMPOWERx write 25% fewer prescriptions than physicians not using the system. • Prescribers who use eMPOWERx save Medicaid an average of $48 more per month per patient on prescription claims. • Florida Medicaid reports $1.8 - $2 million in monthly savings from electronic prescribing. • During 2006, eMPOWERx users received more than 5,000 drug interaction alerts each week, more than 1,000 of which were of high or very high severity. Outcomes of the Medicaid e-Prescribing Wireless PDA Pilot Project

13. Lower Average Medicaid Prescription Claims in the Pilot Program

14. Greater Medicaid Cost Savings per Patient in the Pilot Program

15. Avoiding Adverse Incidents with Interaction Alerts October-December 2007

16. Accessing Medicaid Data through Gold Standard • Florida Medicaid Gold Standard eMPOWERx e-prescribing software is available to all Medicaid physicians at no cost. • AHCA is working with Gold Standard and Medicaid to make eMPOWERxmedication history available to Medicaid physicians through Florida RHIO portals. • AHCA would like to work with the Department of Health to support the adoption of e-prescribing in the County Health Departments.

17. Opportunities for eMPOWERx • Duval County Health Department is initiating a pilot project using eMPOWERx. • Florida Medicaid is working with the Duval County Health Department to obtain extra PDAs. • The eMPOWERx Desktop version has extra benefits with its RxHub feed, but security is an important issue that needs to be resolved. • AHCA and Medicaid would like to reach out to work with the DOH to make eMPOWERx available to all County Health Departments in Florida, either directly or through a data feed to the Central Pharmacy QS1 system.

18. DOH Health Maintenance System Gold Standard eMPOWERx Data Feed Through the QS1 System?

19. Christopher B. Sullivan, Ph.D. Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Office of Health Information Technology 2727 Mahan Drive Tallahassee, FL 32308