CMS Updates Quality Reporting Initiative, E-Prescribing Program (11/2/09)

Under CMS' 2010 Medicare Physician Fee Schedule, health care providers who participate in the agency's quality reporting initiative can earn increased bonus payments. The agency also said it plans to simplify its electronic prescribing program. Health Data Management et al.

---

 

Rhode Island uses e-prescriptions to track H1N1 cases. (10/26/09)

The AP (10/25 Tucker) reports that Rhode Island "health officials are tracking the spread of swine flu through electronic prescription records, developing what they believe is a model that could help doctors more easily identify an outbreak of the illness." Surescripts, which operates the country's largest electronic prescriptions network, "is using information supplied by pharmacies to document how much Tamiflu and other antivirals are being distributed" then "giving the data - categorized by zip codes of the pharmacies where the medicine is dispensed and the age group of the patient receiving it - to epidemiologists at the state health department."

---

Making sure the prescription works (10/23/09)

By Jeff Rowe, Editor

In the perfect world, policy ideas would be thoroughly tested before public policymakers were called upon to support one idea or another with a large allocation of taxpayer dollars.

But we obviously don’t live in a perfect world, so we often have to settle for testing new ideas and programs after they’ve already been put in motion.

Take e-prescriptions, for example. Over the past couple weeks, a number of states have announced efforts to develop or expand statewide e-prescription programs as an early step toward a more comprehensive implementation of electronic health records.

In Virginia, a group of healthcare executives, pharmacists and other stakeholders has launched an effort to push the commonwealth toward e-prescribing. In Iowa, a public-private collaborative has launched ePrescribe Iowa, a web-based program that will take advantage of Iowa Health System’s HealthNet connect, a 3,200 mile-long fiberoptic network.

Finally, the Vermont Information Technology Leaders Inc. (VITL) recently announced that it will use federal grant funds to try to move Vermont physicians toward greater use of electronic prescriptions.

The move makes sense, as e-prescribing constitutes a relatively simple foray into the world of EHRs. Moreover, in many states, there’s a lot of room for improvement. In Iowa, for example, surveys show that less than 3 percent of all prescriptions written in Iowa in 2008 used e-prescribing. In the policy world, that’s a clear example of low-hanging fruit.

But perhaps the best news of all is that, even as states are jumping onto the e-prescription bandwagon, researchers are launching efforts to determine the effectiveness of e-prescriptions, both in terms of how they can improve patient compliance and how they can lower healthcare costs.

With any luck, state and federal policymakers will be watching this and other similar studies in an effort to improve their programs as they go forward. After all, it’s one thing to come up with an idea and commit the resources to get it moving. It’s another thing altogether to make sure it’s going to work.

http://ehr.healthcareitnews.com/blog/making-sure-prescription-works

 

---

 

SureScripts Adopts New E-Prescribing Standard for 'Meaningful Use' (10/20/09)

SureScripts has adopted NCPDP SCRIPT 10.6 to help physicians access prescription data from health plans and pharmacies nationwide. The electronic prescribing network said the standard corresponds to the "meaningful use" requirements of the stimulus package. Healthcare IT News.

 

---

Vermont Set To Receive $1M Grant To Support E-Prescribing Network (10/20/09)

HHS' Health Resources and Services Administration has awarded a $1 million grant to help Vermont strengthen its electronic prescribing system. The funding will help physicians and pharmacists purchase the technology necessary to tap into the network. Health Data Management et al.

 

---

Iowa Unveils Statewide Initiative To Promote Electronic Prescribing (10/15/09)

---

 

By: Morgan Lewis Jr. Medical Economics

---

 

Vermont Acts to Make Drug Makers’ Gifts Public (5/19/09)

By NATASHA SINGER

Published: NY Times, May 19, 2009

Cracking down on medical industry payments to doctors, theVermont legislature has passed a law requiring drug and device makers to publicly disclose all money given to physicians and other health care providers, naming names and listing dollar amounts. Read More.CCHIT Reveals 2009-2010 Game Plan (5/19/09)

 

---

 

CCHIT Reveals 2009-2010 Game Plan (5/19/09)

 

The Certification Commission for Healthcare Information Technology has approved final 2009-2010 criteria for a number of its EHR certification efforts including electronic health-records systems used in ambulatory care, inpatient and emergency department environments as well as for stand-alone electronic-prescribing systems. But it will delay launching its inspection programs using the new criteria until the federal government prepares a draft rule for carrying out the economic stimulus EHR incentives.

Read More

 

---

 

Senators petition for controlled substance e-prescribing (5/8/09)

A bipartisan group of U.S. Senators asked Secretary of Health and Human Services (HHS) Kathleen Sebelius and Attorney General Eric Holder to quickly put federal regulations in place that would allow e-prescribing for controlled substances.  Read more

 

---

 

New Hampshire hospital adopts e-prescribing technology. (5/5/09)

The Concord (NH) Monitor (5/4, Sanger-Katz) reported that ConcordHospital has adopted electronic prescribing technology "that allows doctors to beam patients' prescriptions directly from their laptops to the pharmacy." The system went "live across all the practices this month" and "is designed to reduce errors and improve efficiencies." The hospital's Chief Medical Information Officer Dr. Joel Berman said "nearly all area pharmacies have the technology to accept the electronic prescriptions, and the technology can be used with discount mail order pharmacies. For the few remaining stores that need paper prescriptions, or the patient who prefers the old-fashioned way, doctors can still use printouts." The hospital also plans to implement a system that will communicate "with a patient's health insurance company" so "the doctor and patient can discover, right in the office, whether a medication is covered and what the likely co-pay will be."

---

 What is the relationship between the AMA and DrFirst? (4/22/09)

The AMA is launching a major, innovative value added benefit for its members. Their website will be re-engineered to add a secure portal providing access to sophisticated web services that materially advance the practice of medicine nationwide. The first service to be offered is electronic prescribing (eRx) from DrFirst. The addition of eRx to the AMA website is a significant benefit made available through the AMA exclusively to its members.  Read more

---

 

Study predicts stimulus incentives will double e-prescribing rate by 2014.

(March 17, 2009)

 

Government Health IT (3/17, Ferris) reports, "The stimulus law's incentives for providers to adopt health IT will double the rate of e-prescribing and result in a $22-billion reduction in drug and medical costs in the next decade," according to a study commissioned by the Pharmaceutical Care Management Association. If the study's authors "at consulting firm Visante are correct, the e-prescribing savings alone will more than pay for the $19 billion in adoption incentives and other health IT promotion activities required under the stimulus law." The researchers project that by "2014, more than three-quarters of prescribers will be using e-prescribing," a figure which is "double the number anticipated after passage of the Medicare Improvements for Patients and Providers Act of 2008." Still, according to the report, "fewer than 15 percent of prescribers" are presently using e-prescribing.

 

---

 

Stimulus Package To Boost E-Prescribing, Cut Costs

(March 17, 2009)

The $19 billion in health IT funding included in the federal stimulus package will significantly increase the rate of physician electronic prescribing and save $22 billion in drug and medical costs over the next decade, according to a new report commissioned by the Pharmaceutical Care Management Association. Government Health IT, Reuters.

 

 

---

SureScripts-RxHub changes name to Surescripts, launches new website.

(March 10, 2009)

Healthcare IT News (3/10, Merrill) reported, "SureScripts-RxHub, the country's largest national electronic prescribing network, has changed its name to Surescripts and launched a new e-Prescribing Resource Center Website." Features of the Surescripts "website include: The ability to find which physicians and pharmacies e-prescribe based on zip code and a list of the payers; pharmacy benefit managers and pharmacies connected to the Surescripts network; the ability to check a software vendor's certification status and gauge its product's support for e-prescribing;" and "a step-by-step guide on how to establish a connection to the Surescripts network for technology vendors, physicians, payers, and pharmacies."

---

Study Raises Questions About Value of E-Prescribing Alerts

(March 9, 2009)

 

A study in the Archives of Internal Medicine found that physicians bypassed more than 90% of drug interaction alerts and 77% of drug allergy alerts. The study's lead author said it shows that the alerts are not tailored for clinical practice, stressing that doctors are not disregarding warnings irresponsibly. Healthcare IT News, American Medical News. 

---

 

California Physicians Slow To Transition to Electronic Prescribing

(February 25, 2009)

 

In 2007, just 1.2% of prescriptions written in California by clinics and physicians in private practice were filed electronically, according to the California HealthCare Foundation. Barriers to adoption include cost and federal drug regulations that prohibit electronic prescribing of controlled substances. Sacramento Bee.

---

Medicaid Incentive Program Boosts E-Prescribing in Arkansas

(February 24, 2009)

Since the Arkansas Medicaid program launched an electronic prescribing incentive program last December, the number of physicians in the state who e-prescribe has significantly increased. However, access to computers and high-speed Internet remains a barrier for some doctors. Arkansas Democrat-Gazette.

---

Public Comment on CCHIT ePrescribing security opens

(2/10/09)

 

A three-week period for public comment begins today on security criteria proposed for CCHIT’s certification program covering stand-alone e-prescribing systems. The program, which has been in development since November 2008, is on an accelerated track separate from other certification development cycles as a result of legislation that provides Medicare bonus payments to clinicians using a qualified e-prescribing system with certain advanced features.

Following a collaborative effort between the work groups for security and e-prescribing in January, a set of proposed security criteria and test scripts was generated for stand-alone e-prescribing systems, the objective of which is to support privacy and security provisions in pending legislation. The regular January public comment cycle encompassed e-prescribing functionality, interoperability and a limited set of security criteria.

 

For the public comment period Feb. 11 through March 4, CCHIT has posted drafts of:

• Standard Security Criteria
• Standard Test Script
• E-prescribing Audit Trail Worksheet

 

You can view the material in the Public Comment area of cchit.org.  Pilot test vendors will use the Standard Security Test Script, and both public comments and pilot results will feed into development of proposed final versions. Those versions will be available for public comment from March 30 through April 28. The program is set to begin testing stand-alone e-prescribing products in July.

---

 

Clinicians Ignore Most e-Prescribing Alerts

 

A large study of electronic prescribing in the outpatient setting suggests that prescribers override most warnings that indicate a medication allergy or drug interaction.  http://www.ashp.org/import/news/HealthSystemPharmacyNews/newsarticle.aspx?id=3022

---

 

Overrides of Medication Alerts in Ambulatory Care

(2/9/09)

Thomas Isaac, MD, MBA, MPH; Joel S. Weissman, PhD; Roger B. Davis, ScD; Michael Massagli, PhD; Adrienne Cyrulik, MPH; Daniel Z. Sands, MD, MPH; Saul N. Weingart, MD, PhD

Arch Intern Med. 2009;169(3):305-311.

 

Abstract

Background  Electronic prescribing systems with decision support may improve patient safety in ambulatory care by offering drug allergy and drug interaction alerts. However, preliminary studies show that clinicians override most of these alerts.

Methods  We performed a retrospective analysis of 233 537 medication safety alerts generated by 2872 clinicians in Massachusetts, New Jersey, and Pennsylvania who used a common electronic prescribing system from January 1, 2006, through September 30, 2006. We used multivariate techniques to examine factors associated with alert acceptance.

Results  A total of 6.6% of electronic prescription attempts generated alerts. Clinicians accepted 9.2% of drug interaction alerts and 23.0% of allergy alerts. High-severity interactions accounted for most alerts (61.6%); clinicians accepted high-severity alerts slightly more often than moderate- or low-severity interaction alerts (10.4%, 7.3%, and 7.1%, respectively; P < .001). Clinicians accepted 2.2% to 43.1% of high-severity interaction alerts, depending on the classes of interacting medications. In multivariable analyses, we found no difference in alert acceptance among clinicians of different specialties (P = .16). Clinicians were less likely to accept a drug interaction alert if the patient had previously received the alerted medication (odds ratio, 0.03; 95% confidence interval, 0.03-0.03).

Conclusion  Clinicians override most medication alerts, suggesting that current medication safety alerts may be inadequate to protect patient safety.

Author Affiliations: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (Drs Isaac, Davis, Sands, and Weingart), Institute for Health Policy, Massachusetts General Hospital (Dr Weissman), Blue Cross Blue Shield of Massachusetts (Ms Cyrulik), Center for Patient Safety, Dana-Farber Cancer Institute (Drs Isaac and Weingart), and Department of Medicine, Harvard Medical School (Drs Isaac, Weissman, Davis, Sands, and Weingart), Boston; PatientsLikeMe Inc, Cambridge, Massachusetts (Dr Massagli); and Cisco Systems, San Jose, California (Dr Sands).

---

 

E-prescribing expected to grow, but some barriers remain.

Wall Street Journal (1/21/09)

 

The Informed Patient column, Laura Landro writes, "With a host of new incentives, doctors are finally beginning to scrap pen and paper in favor of electronic prescriptions." To reduce costs and errors, Medicare and some private health plans now pay doctors a bonus for switching to e-prescribing, and technology firms are providing free software to encourage automated prescription-writing, which has in the past year doubled, to 12 percent of all office-based physicians. Landro notes that further growth is expected, as the Obama Administration plans to invest $50 billion over five years to promote improved health-information technology, but points out that "there are still barriers to full-fledged adoption of e-prescribing. Federal drug laws...prohibit electronic prescribing of controlled medications such as narcotics, insomnia drugs, and anti-depressants." Some "safety experts also warn that selecting prescriptions on a computer screen can cause a doctor to inadvertently enter, for instance, a quick-release version of a drug instead of a long-acting formulation because they appear in sequence on an e-prescribing program."

 

---

 

Study Finds Doctors’ Use of E-Prescribing Systems Linked to Formulary Data Can Boost Drug Cost Savings

Archives of Internal Medicine (12/9/08)

 

Electronic prescribing (e-prescribing) systems that allow doctors to select lower cost or generic medications can save $845,000 per 100,000 patients per year and possibly more system-wide, according to findings from a new AHRQ-funded study. The study, entitled “Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost,” was published in the December 8 issue of the Archives of Internal Medicine. The finding may have important financial implications, the study authors concluded. As e-prescribing systems become more widely available and easier to use, their greater use among doctors is likely. Complete use of e-prescribing systems with formulary decision support could reduce prescription drug spending by up to $3.9 million per 100,000 patients per year, according to the study’s authors. Select to read our press release and select to read the abstract.

---

Assessment of ePrescription quality: an observational study at three mail-order pharmacies

Bengt Astrand , Emelie Montelius , Goran Petersson and Anders Ekedahl

BMC Medical Informatics and Decision Making 2009, 9:8doi:10.1186/1472-6947-9-8

Published:	26 January 2009

http://www.biomedcentral.com/1472-6947/9/8

 

Abstract (provisional)

Background

The introduction of electronic transfer of prescriptions (ETP), or ePrescriptions, in ambulatory health care has been suggested to have a positive impact on the prescribing and dispensing processes, implying that ePrescribing can improve safety, quality, efficiency, and cost-effectiveness. In December 2007, 68% of all new prescriptions were transferred electronically in Sweden. The aim of the present study was to estimate the quality of ePrescriptions by comparing the ratios of ePrescriptions and non-electronic prescriptions necessitating a clarification contact with the prescriber at the time of dispensing.

Methods

A direct observational study was performed at three Swedish mail-order pharmacies which were known to dispense a large proportion of ePrescriptions (38-75%). Data were gathered on all ePrescriptions dispensed at these pharmacies over three weeks in February 2006. All clarification contacts with prescribers were included in the study, and were classified and assessed in comparison with all drug prescriptions dispensed at the same pharmacies over the same period.

Results

Of the 31225 prescriptions dispensed during the study period, 1.00% (312/31225) necessitated a clarification contact with the prescriber; these comprised 1.57% (226/14365) of all new prescriptions and 0.51% (86/16860) of all refill prescriptions. The increased rate ratio (RR) for clarification contacts for new ePrescriptions compared to new non-electronic prescriptions was estimated at 1.69 (95% CI 1.29-2.21). This increased RR was mainly due to 'Dosage and directions for use', which had a RR of 7.60 (95% CI 2.83-20.4) when compared to other clarification contacts. In all, 89.5% of the suggested pharmacist interventions were accepted by the prescriber; 77.7% (192/247) as suggested and an additional 11.7% (29/247) after a modification during the contact with the prescriber.

Conclusions

The increased ratio of prescriptions necessitating a clarification contact, for ePrescriptions compared to non-electronic prescriptions, indicates the need for an increased focus on quality aspects in ePrescribing deployment. ETP technology should be developed towards a two-way communication between the prescriber and the pharmacist, with automated checks of missing, inaccurate, or ambiguous information, in order to increase safety and quality for the patient and to improve efficiency and cost-effectiveness within the health care system

 

Comment:  this is similar to our early experience, although we have not quantified it.  Clearly there are still some issues on the receiving and communication end. - John Poikonen.

---

Some older ePrescribing news links from American Medical News from 2008 and early 2009:

http://www.ama-assn.org/amednews/2008/12/15/gvsc1215.htm

http://www.ama-assn.org/amednews/2008/12/08/bica1208.htm

http://www.ama-assn.org/amednews/2008/08/04/gvl10804.htm

http://www.ama-assn.org/amednews/2008/06/02/bisb0602.htm