Advantages to Health Care Providers
"Patient safety, significant error reduction, efficiency, less data entry and less repetitive work for our staff are just few of the benefits that electronic prescribing has brought to our practice. Electronic prescribing is a low-risk and low-cost introduction to technology that will eventually be integral to electronic medical records, and I would recommend physicians consider this technology for their practice and their patients." -- Alberto Sobrado, M.D
Abstract
J Manag Care Pharm. 2005 May;11(4):353-5, 356-7.
Twelve-month drug cost savings related to use of an electronic prescribing system with integrated decision support in primary care.
McMullin ST, Lonergan TP, Rynearson CS.
Department of Clinical Decision Support, Purkinje, St. Louis, Missouri 63132, USA. tmcmullin@purkinje.com
OBJECTIVE: We reported previously the results of a 6-month controlled trial in which the use of a commercially available electronic prescribing system with integrated clinical decision support and evidence-based message capability was associated with significantly lower primary care drug costs. The original study focused on new prescriptions, defined as claims for a medication that the patient had not received in the previous 12 months. The main objectives of this follow-up report were to (a) determine if the 6-month savings on new prescriptions were sustained during 12 months of follow-up, (b) evaluate the impact of the computerized decision support system (CDSS) on all pharmacy claims and per-member-per-month (PMPM) expenditures, and (c) evaluate the prescribing behaviors within 8 high-cost therapeutic categories that were frequently targeted by the electronic messages to prescribers to help verify that the drug cost savings were due to the recommendations in the electronic prescribing system.
RESULTS: During 12 months of follow-up, clinicians using the electronic prescribing system continued to have lower prescription costs than the controls. Clinicians using the electronic prescribing system had average costs for 26,674 new prescriptions that were dollar 4.12 lower (95% confidence interval, dollar 1.53-dollar 6.71; P=0.003) and PMPM expenditures that were dollar 0.57 lower than expected based on the changes observed for 24,507 new prescriptions written by clinicians in the control group. The average drug cost savings on new prescriptions were dollar 482 per prescriber per month (PPPM), based upon prescription cost and dollar 465 PPPM based upon PMPM analysis. When all pharmacy claims (156,429) were analyzed, the intervention group.s average prescription cost was dollar 2.57 lower and their PMPM expenditures were dollar 1.07 lower than expected based on the changes observed in the control group. The average drug cost savings on all pharmacy claims were dollar 863 PPPM based on average prescription cost and dollar 873 PPPM based on PMPM analysis. The proportion of prescriptions for highcost drugs that were the target of the CDSS messages to prescribers was a relative 17.5% lower among the intervention group (35.8%) compared with the control group (43.4%; P=0.03). CONCLUSIONS: An electronic prescribing system with integrated decision support shifted prescribing behavior away from high-cost therapies and significantly lowered prescription drug costs. The savings associated with altered prescribing behavior offset the monthly subscription cost of the system.
PMID: 15871643 [PubMed - indexed for MEDLINE]
Abstract Source: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&
TermToSearch=15871643&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.
Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
Full Text: http://www.amcp.org/data/jmcp/contemporary_322_332.pdf
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Abstract
Ann Fam Med. 2004 Sep-Oct;2(5):494-8.
Impact of an evidence-based computerized decision support system on primary care prescription costs.
Department of Clinical Decision Support, WELLINX, St. Louis, MO, USA. tmcmullin@wellinx.com
PURPOSE: Although newer, heavily promoted medications are commonly prescribed, published evidence and consensus guidelines often support the use of less expensive alternatives. This study was designed to evaluate the impact on prescription costs of a computerized decision support system (CDSS) that provides evidence-based recommendations to clinicians during the electronic prescribing process. METHODS: A retrospective cohort study was performed using a pharmacy claims database. Clinicians using the CDSS were matched with a control group by pharmacy billed amount, number of patients treated, and number of new prescriptions filled during a 6-month baseline period in which neither group used the system. The primary outcome measure was the difference in prescription costs between the 2 groups after implementation of the CDSS in the intervention group. RESULTS: Clinicians who received evidence-based messages had significantly lower prescription costs than those in the control group. The average cost per new prescription was 4.16 dollars lower (P = .02) in the intervention group, and the average cost for new and refilled prescriptions was 4.99 dollars lower (P = .01). The 6-month savings from new prescriptions and their refills are estimated to be 3,450 dollars (95% CI, 1,030-5,863 dollars) per clinician. CONCLUSIONS: Providing electronic, evidence-based decision support during the prescribing process can shift prescribing decisions toward more evidence-based care and significantly decrease primary care prescription costs.
PMID: 15506587 [PubMed - indexed for MEDLINE]
Abstract Source: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermTo
Search=15506587&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.
Pubmed_RVAbstractPlus
Full Text: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15506587
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Abstract
J Am Med Inform Assoc. 2005 May–Jun; 12(3): 346–356.
doi: 10.1197/jamia.M1759. Functional Characteristics of Commercial Ambulatory Electronic Prescribing Systems: A Field Study
C. Jason Wang, MD, Richard S. Marken, PhD, Robin C. Meili, MBA, Julie B. Straus, BS, Adam B. Landman, MS, MIS, MD, and Douglas S. Bell, MD, PhD
Objective: To compare the functional capabilities being offered by commercial ambulatory electronic prescribing systems with a set of expert panel recommendations.
Design: A descriptive field study of ten commercially available ambulatory electronic prescribing systems, each of which had established a significant market presence. Data were collected from vendors by telephone interview and at sites where the systems were functioning through direct observation of the systems and through personal interviews with prescribers and technical staff.
Measurements: The capabilities of electronic prescribing systems were compared with 60 expert panel recommendations for capabilities that would improve patient safety, health outcomes, or patients' costs. Each recommended capability was judged as having been implemented fully, partially, or not at all by each system to which the recommendation applied. Vendors' claims about capabilities were compared with the capabilities found in the site visits.
Results: On average, the systems fully implemented 50% of the recommended capabilities, with individual systems ranging from 26% to 64% implementation. Only 15% of the recommended capabilities were not implemented by any system. Prescribing systems that were part of electronic health records (EHRs) tended to implement more recommendations. Vendors' claims about their systems' capabilities had a 96% sensitivity and a 72% specificity when site visit findings were considered the gold standard.
Conclusions: The commercial electronic prescribing marketplace may not be selecting for capabilities that would most benefit patients. Electronic prescribing standards should include minimal functional capabilities, and certification of adherence to standards may need to take place where systems are installed and operating.
Abstract Source: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1090467&rendertype=abstract
Full Text: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1090467
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