Electronic Prescriptions

1. Can we make it work? Mrunal Shah, MD, ABFM Vice President, Physician Technology Services, OhioHealth Electronic Prescriptions

2. Agenda • What it is • How it works • Why we should do it • Barriers • Incentive programs

3. What It Is • Prescribing and information • Sent electronically • Prescriber, dispenser, PBM/Health plan • Formulary decision support

4. What It Isn’t • Printed prescriptions • Faxed prescriptions • Scanned and transmitted hand-written prescriptions

5. How It Works

6. How It Works • Surescripts transactional interface • Stand-alone online tools • RxNT • DrFirst • RelayHealth • Quicker startup, lower cost • Separate documentation and workflow

7. How It Works • Integrated into office EMR • GE Centricity • NextGen • Allscripts • Expensive to bring up EMR • Time consuming to set up and train • Integrated documentation and workflow

8. How It Works • Patients are either • Manually entered into the tools • Interfaced directly from practice management system • Already in EMR

9. Workflow • New prescriptions • Log into tool • Find your patient, know their formulary and choose the pharmacy • Complete the Rx and send • Refills • Sent from pharmacy, onto desktop • Accepted or declined • Sent back to pharmacy

10. Screenshot of RxNT

12. Screenshot of GE

13. Workflow • Who can do this • Physician • NP/PA • RN, MA • Each practice considers their policy • Assignments are given accordingly

14. Device Choice • When using stand-alone tool • Internet connected PC • Desktop • Laptop/Tablet • PDA/Smartphone • Blackberry • iPhone • Windows Mobile • Others

15. Why Should We Do It? • Saves money? • Might be free from healthcare system? • Might receive incentives? • P4P programs? • Patient safety and adherence! • Office efficiency! • Cost containment!

16. Patient Safety and Adherence • Automated cross-checks • Drug-drug • Drug-allergy • Potentially drug-condition • Digitization leads to mobility of data • Legibility • Proper dosing • Cost and convenience drive adherence

17. Office Efficiency • Paper rarely generated • Phone calls virtually eliminated • Workflow directly to physician • Refills are clicks away • Risk mitigation • Patient confidence and satisfaction

18. Cost Containment Study • Archives Internal Medicine 2008 • 18 months • Compared baseline use of Tier 1, 2, 3 • 1.5 Million patients • 17.4 Million prescriptions (20% Erx)

19. Study Results • 3.3% increase in Tier 1 prescribing • Corresponding decrease in tier 2, 3 • Estimated savings of $845,000/100,000 patients OR $845/pt during study period • Columbus would save $14,787,500

20. Barriers • Board of Pharmacy requirements • Positive ID • Signed daily or weekly logs • Physician workflows/habits • Paper is “always faster” • Productivity is too precious • Online tools are “always harder”

21. Barriers • Pharmacy/pharmacist resistance • Impending decision to go with EMR • Compatibility with practice management or future use of EMR

22. Incentive Programs • Local healthcare systems • Stark Law changes • CCHIT directive • PQRI variable for incentive pay • Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) • Led to 2009 E-prescribing incentive program

23. ERx Incentive Payment

24. Eligible and Successful • Any provider who can prescribe • Report ERx on >50% patients to Medicare Part B • Must be >10% total Part B charges • Part D data instead of claims being considered

25. Qualified ERx System • Complete medication list of choices • Electronic transmission and alerts • Information on lower cost alternatives • Formulary and tiered cost information • Faxing not allowed unless the receiving pharmacy required conversion

26. Reporting • Submit standard office CPT code • Consults, new/established visits, Preventive • Add appropriate G-code

27. Summary • Reasons to do it: safety, efficiency, cost • Reasons to consider: incentives, automation, patient satisfaction • Earlier start, better outcomes • Consider timing of EMR adoption • Reach out to local healthcare systems • Know CMS requirements