Sunday, November 23, 2008

ePrescribing Today

The World Health Care Congress Leadership Summit on ePrescribing and Medication Management presented speakers from CMS, the state of Massachusetts, and associations. In addition, many other outstanding speakers from a variety of other organizations invested in the field, gathered to discuss their ideas on this important topic at the Summit held on November 17th at the Westin Hotel just outside of Washington D.C.

According to speakers from CMS, Medicare is uniquely positioned to spur the broader adoption of electronic prescribing and able to link physician reimbursement to ePrescribing. Medicare is using the “carrot stick” approach by providing 2 percent bonus payment for 2009 and 2010 with 1 percent for 2011 and 2012, and 0.5% for 2012. The key to broad adoption is to have sufficient reimbursement for physicians, develop standards consist with Part D, and secure the full adoption by all eligible physicians.

Concerning standards, Tony Trenkle, Director, Office of e-Health Standards and Services, at CMS, reported that the goal of his agency is to seek mature standards with a track record and then to work with industry to develop other standards as needed. In 2006, pilot tests were conducted to look at standards for formulary and benefits, and as a result, three standards were eligible for adoption with the final rule expected to be published in 2009. Future standards will be developed as identified.

He added that CMS helped to move ePrescribing forward by awarding Transformation Grants for $150 million to states to improve effectiveness and efficiency under Medicaid. The funds can be used to find ways to reduce patient error rates, for electronic health records, electronic clinical decision support tools, and ePrescribing programs.

Trenkle noted that using ePrescribing for controlled substances is an issue still being debated. However, a proposed rulemaking was issued in July 2008 with DEA receiving over 200 comments. DEA is very concerned with the integrity of the issue and will work with HHS to develop a final rule. They are optimistic that the rule can be published next year.

Massachusetts House of Representative Peter J. Koutoujian, (D-MA), House Chair, Joint Committee on Public Health, talked specifically about his state’s efforts to increase the use of ePrescribing. He explained how his state is in a good position to move ahead with technology since the state is the hub for healthcare, biotechnology, and life sciences. The state also has a number of premier medical centers, schools, and hospitals, plus the state’s legislative environment is very open to innovation, and in addition, the private sector has been very cooperative.

Specific groups have also been very helpful and active in the state such as the Mass Tech Leadership Council established to help software and technology-enabled companies, and the eRx Collaborative resulting from individual ePrescribing pilots.

Mark Merritt, President and CEO for the Pharmaceutical Care Management Association, pointed out that physicians are trying hard to implement the eRx system, but the real problem is there is no sense of urgency to do this from physicians or from the physician community as a whole.

Merritt specifically talked about the Southeast Michigan ePrescribing Initiative (SEMI) where he reported that 60% of physicians have switched prescriptions due to drug alerts, generic utilization has increased from 56.7 percent to 66.6 percent and 75 percent of the physicians are saying that ePrescribing improves care.

Emmanuel Curry, MPH, Senior Health Care Analyst at the Ford Motor Company, also discussed SEMI. According to Curry, as of June 2008, there are over three thousand physicians enrolled in the program with 9.5 million ePrescriptions written, and 448,100 dispensed medical histories downloaded. The aggressive mail program really impacts the SEMI bottom line. The total number of mail prescriptions written by SEMI prescribers during the analysis period totaled $219,133 and produced a cost savings of $1,630.349.

As David Gans, MSHA, FACMPE, Vice President, Practice Management Resources, for the Medical Group Management Association, noted in a survey done this year, one of the biggest problem affecting electronic transmission of prescriptions is that not all pharmacies are able to accept ePrescribing, For example independent pharmacies can’t always afford the technology to pay for the connectivity especially in rural areas. Today, these pharmacies are struggling to exist and just trying to keep up with the big chains. They really need financial help and assistance to put electronic prescribing in place.

Gans commented on how the workflow can be disruptive when initiating ePrescribing, but the staff will find that by sending prescriptions electronically to the pharmacies, their work will be a lot easier with less paperwork, fewer calls for refills, and fewer calls from pharmacies. He emphasized that it is important to have the support of the nursing staff so that coordinating the job is easier. He went on to say that vendors need to work with the staff to develop a hands-on approach and then work the tools needed to operate the system into the work flow of the office.

For more information on the Summit, go to