Transcript Electronic Prescriptions

Can we make it work?
Mrunal Shah, MD, ABFM
Vice President, Physician Technology Services,
OhioHealth
Agenda
What it is
 How it works
 Why we should do it
 Barriers
 Incentive programs

What It Is
Prescribing and information
 Sent electronically
 Prescriber, dispenser, PBM/Health plan
 Formulary decision support

What It Isn’t
Printed prescriptions
 Faxed prescriptions
 Scanned and transmitted hand-written
prescriptions

How It Works
How It Works

Surescripts transactional interface

Stand-alone online tools
 RxNT
 DrFirst
 RelayHealth
Quicker startup, lower cost
 Separate documentation and workflow

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

How It Works

Patients are either
 Manually entered into the tools
 Interfaced directly from practice
management system
 Already in EMR
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
Screenshot of RxNT
Screenshot of GE
Workflow

Who can do this
 Physician
 NP/PA
 RN, MA
Each practice considers their policy
 Assignments are given accordingly

Device Choice
When using stand-alone tool
 Internet connected PC

 Desktop
 Laptop/Tablet

PDA/Smartphone
 Blackberry
 iPhone
 Windows Mobile
 Others
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!

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

Office Efficiency
Paper rarely generated
 Phone calls virtually eliminated
 Workflow directly to physician
 Refills are clicks away
 Risk mitigation
 Patient confidence and satisfaction

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)

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
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”
Barriers
Pharmacy/pharmacist resistance
 Impending decision to go with EMR
 Compatibility with practice management
or future use of EMR

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
ERx Incentive Payment
Calendar Year
Payment Incentive
2009
2.0%
2010
2.0%
2011
1.0%
2012
1.0%
2013
0.5%
If you are not ERx by 2012, then…
Calendar Year
Differential (Penalty)
2012
99% (-1%)
2013
98.5%
2014
98%
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

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
Reporting

Submit standard office CPT code
 Consults, new/established visits, Preventive

Add appropriate G-code
If you…
Report
ERx all meds
G8443
Have ERx, but didn’t use it
G8445
Have ERx, but didn’t use it
because of: CII, required a
phone call or print, patient
request, pharmacy can’t
accept
G8446
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
