ePrescribing News
2008 ePrescribing News
News relevant to the scope of Florida's ePrescribe Clearinghouse mandate are shown below.
July 31, 2008
HHS Takes New Steps to Accelerate Adoption of Electronic Prescribing
Medicare Payments for Successful Electronic Prescribers,
Reporting Quality Data are Important Steps Toward a Value-Driven Health Care System
Medicare is starting a new program to encourage physicians to adopt e-prescribing systems. Incentive payments will be available beginning in 2009 for physicians who meet the requirements of the program. The initiative is part of the Administration’s broader efforts to accelerate the adoption of health IT and the establishment of a health care system based on value.
Beginning in 2009, and during the next four years, Medicare will provide incentive payments to eligible professionals who are successful electronic prescribers. Eligible professionals will receive a 2 percent incentive payment in 2009 and 2010; a 1 percent incentive payment in 2011 and 2012; and a one half percent incentive payment in 2013.
Beginning in 2012, eligible professionals who are not successful electronic prescribers will receive a reduction in payment. Eligible professionals may be exempted from the reduction in payment, on a case-by-case basis if it is determined that compliance with requirement for being a successful prescriber would result in significant hardship.
To read more, see the entire HHS Fact Sheet at http://www.hhs.gov/news/facts/eprescribing.html
July 10, 2008
Senate OKs Medicare Bill With E-Rx Incentives for Physicians
On Wednesday, the Senate approved by a veto-proof margin a bill that would halt a scheduled 10.6% Medicare physician pay cut and provide financial incentives to physicians for using electronic prescriptions, Healthcare IT News reports.
The House passed the bill, called the Medicare Improvements for Patients and Providers Act of 2008 (HR 6331), by a veto-proof margin in June (Manos, Healthcare IT News, 7/10).
Under the bill, Medicare physicians who use e-prescribing technology would be eligible for incentive payments of 2% in fiscal year 2009 and 2010, 1% in FY 2011 and 2012 and 0.5% in 2013 (Health Data Management, 7/10). Physicians participating in Medicare who do not e-prescribe by 2012 would see a 2% payment cut (Healthcare IT News, 7/10).
According to the Wall Street Journal, the increase in payments for adopting e-prescribing for Medicare physicians is the "most significant long-term effect" of the bill (Mathews/Lueck, Wall Street Journal, 7/10).
The bill also includes a measure to expand Medicare payments for telehealth in hospital-based renal dialysis centers, skilled nursing facilities and community mental health centers (Healthcare IT News, 7/10).
The bill now goes to President Bush (Health Data Management, 7/10).
Reaction
"E-prescribing is a fundamental step toward modernizing our health care system," Sen. John Kerry (D-Mass.) said in a written statement, adding, "It will save lives by reducing medical errors and save billions of dollars."
Kerry authored much of the bill's health IT language, which was based partly on health IT legislation he introduced last year (DoBias, Modern Healthcare, 7/10).
In a joint statement, the co-CEOs of SureScripts-RxHub, J.P. Little and Rick Ratliff, said, "The potential impact of this legislation on the everyday lives of patients in the U.S. health care system cannot be overstated."
They added that lawmakers "are wisely applying the federal government's leverage as the nation's largest health care insurer to accelerate the adoption of e-prescribing" (SureScripts-RxHub press release, 7/9).
In a statement, the Pharmaceutical Care Management Association said, "From a patient's perspective, e-prescribing is the most important issue in the Medicare bill because it saves lives and saves money." The group added, "This is a historic step forward for e-prescribing, as the new requirement in Medicare will now lead to broader adoption of overall health care IT" (PCMA press release, 7/9).
Source: http://www.ihealthbeat.org/articles/2008/7/10/Senate-OKs-Medicare-Bill-With-ERx-Incentives-for-Physicians.aspx?topicID=56
Physician Adoption of E-Prescribing Technology Increasing
The hand-written prescription is "on its way to becoming a historical curiosity," as physicians and pharmacies increasingly adopt electronic prescribing systems, according to a New England Journal of Medicine article by Richard Steinbrook, a physician and the national correspondent for NEJM, the Newark Star-Ledger reports.
Physicians and pharmacies are being motivated to adopt the technology by the promise of fewer prescribing errors and the possibility of e-prescribing mandates.
As of March, about 7% of the 560,400 office-based physicians were regularly writing e-prescriptions and about 73% of the 57,500 retail pharmacies in the U.S. were regularly receiving them, according to the article. Nationwide, about 2% of all prescriptions are sent electronically, the Star-Ledger reports.
Steinbrook said, "With any new technology, it takes a period of time for it to be adopted, and some people would rather let others work out the bugs."
He added that there still are barriers to the adoption of e-prescribing technology, including high start-up costs and Drug Enforcement Agency restrictions on e-prescribing of controlled substances.
DEA is considering lifting the ban. However, Steinbrook said that some physicians "aren't moving until they can do everything electronically" (Stewart, Newark Star-Ledger, 7/10).
Source: http://www.ihealthbeat.org/articles/2008/7/10/Physician-Adoption-of-EPrescribing-Technology-Increasing.aspx?topicID=57
July 8, 2008
New CMS Proposal To Allow Some Computer Faxes for Prescriptions
A proposed CMS rule establishing Medicare physician payment policies for 2009 includes an exemption to the planned elimination of computer-generated faxes for prescriptions and refills, Health Data Management reports.
As of Jan. 1, 2009, CMS was scheduled to prohibit the use of computer-generated faxes to transmit prescriptions and refill requests, except during temporary network transmission failures. The policy did not mandate electronic prescribing but would have eliminated computer-generated faxes to encourage vendors to build and physicians to use "true" e-prescribing systems.
However, comments on the proposal indicated that the industry is not yet ready to transition from computerized faxes to true electronic transmissions for prescription and refill requests, according to policymakers.
The new CMS proposal would allow computer-generated faxes "when the prescriber is incapable of receiving electronic transmissions using the NCPDP SCRIPT standard."
CMS periodically will revisit the topic and is seeking comments on an acceptable timeframe to transition to the electronic standards (Health Data Management, 7/7).
Source: http://www.ihealthbeat.org/articles/2008/7/8/New-CMS-Proposal-To-Allow-Some-Computer-Faxes-for-Prescriptions.aspx?topicID=56#
July 1, 2008
One nationwide network will support e-prescribing
The nation’s two major e-prescribing networks are merging and will form a single, comprehensive network for the exchange of prescriptions and related information.
RxHub and SureScripts will each bring different expertise to the newly merged organization, which will be known for now as SureScripts-RxHub.
RxHub was founded by companies that manage pharmacy benefits and has focused on delivering medication histories and eligibility and benefits information to doctors, other prescribers and pharmacies. SureScripts was founded by two associations of drug stores and has focused on linking doctor’s offices and pharmacies for the routing of prescriptions.
In 2008, SureScripts-RxHub expects to handle 100 million electronic prescription transactions and respond to more than 70 million requests from doctors for benefits information and medication histories, according to a news release.
The merger comes at a time when momentum for e-prescribing is increasing. Congress is considering whether to mandate that doctors who treat Medicare patients must use the technology, and other recent developments in Washington are helping to drive the trend.
“This merger represents a collaboration between industries that are equally committed to improving health care,” said Bruce Roberts, executive vice president and chief executive officer of the National Community Pharmacists Association, in a statement. “The combined strengths of the two organizations will enable the delivery of a single suite of services that will dramatically improve the safety, efficiency and quality of one of the largest segments in health care.”
The merger will streamline development of technical interfaces with e-prescribing software and electronic health record systems, officials of the new organization said. Software vendors can now use a single process for testing their interfaces and becoming certified as compatible with the e-prescribing network.
Each organization will retain half ownership of the private network. No cash changed hands in the merger, according to the news release. The CEOs of the two former organizations are jointly managing the new company while the board of directors undertakes a search and selection process for a new CEO.
SureScripts-RxHub will have more than 75 employees and will maintain offices in St. Paul, Minn., and Alexandria, Va.
Source: http://www.govhealthit.com/online/news/350453-1.html
June 27, 2008
DEA proposes rules to allow e-prescribing of controlled substances
The Drug Enforcement Administration has proposed rules to allow e-prescribing of controlled substances, such as painkillers and stimulants, and will accept public comments until Sept. 25.
The proposed rules, as explained in a 62-page Federal Register notice today, require doctors to use two forms of identification for each transmission of e-prescriptions for controlled substances in addition to an annual audit of each system by a certified public accountancy.
Under current rules, doctors may use e-prescribing for most prescriptions but must sign a written prescription for Schedule II controlled substances, such as Nembutal, OxyContin and opium. The DEA rule, if it becomes final, would allow doctors to use the same system for generating and transmitting all prescriptions.
The rules call for doctors and other prescribers to have their identity verified in person at a DEA-registered hospital that has granted the doctor privileges to practice at the hospital, a state professional or licensing board, or a state or local law enforcement agency...
E-prescribing systems in use by doctors, pharmacies and intermediaries would have to support two-factor authentication and implement strong security so there would be virtually no possibility that the e-prescription could be diverted or altered. If a diversion occurred, it would have to be possible to identify the perpetrator and exonerate the doctor who wrote a legitimate prescription.
“In the absence of appropriate controls, allowing electronic prescriptions for controlled substances could exacerbate the already increasing problem of…controlled substance abuse,” the draft rules state.
“The publication of this proposed rule is an important step toward making electronic prescribing an option for practitioners who prescribe controlled substances,” said Joseph Rannazzisi, deputy assistant DEA administrator of the Office of Diversion Control. “Our goal is to put in place an electronic prescribing system that is efficient, medically beneficial to patients and prescribers, and provides security from hackers and others who might seek to engage in fraudulent prescribing activities.”...
Source: http://www.govhealthit.com/online/news/350451-1.html?GHITNL=yes
DEA proposed rule: http://edocket.access.gpo.gov/2008/pdf/E8-14405.pdf
June 26, 2008
House Passes Bill To Create Incentives for Using E-Prescribing
On Tuesday, the House approved a bill (HR 6331) that would delay Medicare physician fee cuts and authorize incentive payments for physicians who use electronic prescriptions, Health Data Management reports.
The incentive payments would be 2% in fiscal years 2009 and 2010, 1% in 2011 and 2012, and 0.5% in 2013.
The bill also would require physicians to report any e-prescribing quality measures established under Medicare's physician reporting system (Health Data Management, 6/25).
Senate Majority Leader Harry Reid (D-Nev.) invoked a rule to allow the bill to bypass the Senate Finance Committee, which means it could be considered in the Senate as early as today.
The House bill, which was passed by a veto-proof margin of 355-59, is based on a similar bill (S 3101) by Senate Finance Committee Chair Max Baucus (D-Mont.) (Lubell, Modern Healthcare, 6/25).
Source: http://www.ihealthbeat.org/articles/2008/6/26/House-Subcommittee-OKs-Measure-Aiming-To-Boost-EHR-Adoption.aspx?topicID=54
June 20, 2008
E-prescribing of controlled drugs could be allowed soon
Nancy Ferris
The Drug Enforcement Administration will soon propose a rule change to allow doctors to prescribe painkillers and other potentially dangerous drugs electronically.
The rule would lift the ban at least partially, said DEA spokeswoman Rogene Waite, adding, “We’re close to publication at this point.”
Under current rules, doctors cannot legally use electronic systems to send prescriptions for controlled substances to pharmacies. The rules require a paper prescription with the doctor’s signature.
Experts say the limitation has hampered the adoption of e-prescribing technology because it’s inconvenient for doctors to use two different means of writing prescriptions. Controlled substances account for about 20 percent of prescriptions.
Waite declined to say when the proposed rule would be published or which of the several categories of controlled substances it would cover.
Under the federal rule-making process, agencies must publish proposed rules in the Federal Register and give the public time to comment on them. After reviewing those comments, agencies typically publish a final version of the rule.
DEA has been under pressure to change its e-prescribing rules for some time. In December 2007, 19 senators signed a letter to the Justice Department, the DEA’s parent agency, urging officials to address their security concerns rather than continue postponing progress on adopting the technology.
DEA officials have said they are concerned that e-prescribing systems are not secure and could be used to obtain drugs illegally. Experts say prescription drugs are becoming more widely abused than illegal drugs such as cocaine and marijuana.
Health information technology advocates say e-prescribing could encourage more doctors to use electronic health record systems, which promise to improve care and reduce costs.
Pending legislation in the Senate to avert cuts in Medicare reimbursements would require doctors to use e-prescribing by 2011 or face a reduction in their Medicare fees. Those provisions would cut Medicare outlays by $2 billion or $2.5 billion, depending on which version of the legislation is enacted, said Peter Orszag, director of the Congressional Budget Office.
Source:
Government HealthIT- http://www.govhealthit.com/online/news/350439-1.html
June 11, 2008
eHealth Initiative and The Center for Improving Medication Management Release National Roadmap and Practical Guides for Rapid Expansion of Electronic Prescribing
A new report indicates more than 35 million prescription transactions were sent electronically in 2007, a 170 percent increase over the previous year. The report, “Electronic Prescribing: Becoming Mainstream Practice,” offers a detailed examination of the progress made, obstacles that remain, and recommendations for helping the nation’s prescribers migrate from paper-based prescriptions to an electronic system.
The report, developed collaboratively by the eHealth Initiative (eHI) and The Center for Improving Medication Management (The Center) with guidance and leadership from a diverse Steering Group of health care stakeholders, summarizes the national experience with e-prescribing over the past four years – from its pilot phase in several states such as California, Massachusetts, Michigan and Rhode Island, to its present day use in all 50 states and Washington, D.C. It outlines additional steps that should be taken to realize optimal results in health care improvement. The report includes corresponding guides that offer practical information for health care payers to support effective adoption, and for consumers to better understand e-prescribing’s benefits and use. A third guide for prescribers is under development now, in collaboration with leading medical societies.
“Our report and the guides released today reflect a broad consensus among consumers, physicians, pharmacies, employers, insurers and others that e-prescribing can offer significant benefits in terms of patient safety, improved outcomes, and cost savings, especially if remaining challenges are addressed. The report contains several consensus recommendations to address those challenges effectively, and we look forward to working with all health care stakeholders to move those recommendations forward immediately,” said Janet Marchibroda, Chief Executive Officer, eHealth Initiative.
“E-prescribing works and its benefits for many stakeholders are proven,” said Kate Berry, executive director of The Center. “However, education, incentives, and implementation assistance are needed. We are hopeful that this report and the accompanying guides as well as the efforts of many industry leaders will serve to further accelerate the growth in e-prescribing and move it into mainstream practice.”...
To read the entire article go to: http://www.ehealthinitiative.org/news/2008-06-11.mspx
June 2, 2008
Minnesota Governor Signs Law Requiring E-Prescribing by 2011
Minnesota Gov. Tim Pawlenty (R) signed into law a bill that requires electronic prescriptions and creates new quality reporting rules for physicians, Modern Healthcare reports (Evans, Modern Healthcare, 5/30).
Under the law, pharmacists, physicians and others who prescribe or dispense medication in the state will be required to use electronic systems by 2011.
The measure also calls on Minnesota's health commissioner to create a set of provider quality measures for public reporting and incentive payments.
Beginning in July 2010, the bill would require the state to publish comparative price and quality information for groups of services typically used to diagnose or treat an illness. (iHealthBeat, 5/20).
The bill is projected to save 10% to 15% from state employee benefits and public health plan spending by 2015.
Pawlenty vetoed an earlier version of the bill because it would have expanded coverage for the state's safety net health plans (Evans, Modern Healthcare, 6/2).
Source: iHealthBeat.org
May 25, 2008
Electronic prescriptions gain ground
Technology seeks to reduce problems caused by doctors' lousy handwriting
Sunday, May 25, 2008, By Hannah Wolfson, Newhouse News Service
Doctors' sloppy handwriting might be an old joke, but it's no laughing matter. After all, a recent study shows that as many as 7,000 people are killed each year by faulty prescriptions based on illegible handwriting.
To avoid problems, an increasing number of doctors are using a handheld computer instead of an old-fashioned pad to send prescriptions straight to the pharmacy with the touch of a button.
Among them is Dr. Michael Geer, who's in private practice in Birmingham, Ala.
"It's definitely the wave of the future," said Geer, one of an estimated 40,000 doctors nationwide who have switched to e-prescriptions. "I rarely write prescriptions these days, which is nice."
Experts say about 85,000 doctors nationwide will be writing e-prescriptions by the end of this year.
Five medical associations, including the American Academy of Family Physicians and American Academy of Pediatrics, are urging their doctors to use e-prescriptions. And just last month the Pharmaceutical Care Management Association, a national association of drug plan administrators, started a national ad campaign to promote the practice. The group, which supports legislation that would require e-prescriptions in Medicare, claims it could prevent as many as 1.9 million medication errors and save the federal government billions of dollars over the next decade.
"From a patient's perspective, e-prescribing is by far the most important issue in the current Medicare debate because it could save their life or the life of someone they love," association president and CEO Mark Merritt said when the ad was released.
Geer started prescribing electronically at the suggestion of Blue Cross/Blue Shield, which provided him with the necessary hardware and software. Using a Microsoft PocketPC and his office's wireless network, he can check patients' prescription records right in the exam room and see what medications they're taking. The system even warns him of potential drug interactions or allergies.
"It's all in one spot. I can pull them up and see exactly what they're on," Geer said. That's a help, since many patients can't remember the exact medication they're on or may be taking dozens of drugs.
It also transmits the prescription to the pharmacy instantly, saving patients time. More than 70 percent of pharmacies in the country accept e-prescriptions, with more joining every day, according to a Web site operated by SureScripts, an e-prescription company. Another prescription service, eRX NOW, allows doctors to use their own desktop, laptop or handheld computers -- or even a cell phone with wireless access -- to transmit prescriptions over the Internet.
Many pharmacists are enthusiastic, saying it saves them the hassle of having to decode sloppy handwritten prescriptions.
But Jerry Newman, a pharmacist at Harbin Pharmacy in Mountain Brook, Ala., said that although e-prescriptions save time, he worries about not having a hard copy to refer back to as he fills orders calling for multiple medications.
"I'm not sure it's 100 percent safe at this point," he said. "If you're not really careful and paying attention, you could miss something."
Nonetheless, Newman said, there's a sense that his whole business might be wireless someday.
Source: New Orleans Times-Picayune http://www.nola.com/timespic/stories/index.ssf?/base/living-10/121169293223950.xml&coll=1
May 6, 2008
Arizona Ordered to Step Up E-Prescribing
Governor Janet Napolitano has issued an Executive Order (PDF) to significantly increase patient safety through the use of e-prescribing in Arizona. It is estimated that patients in the United States suffer 1.5 million preventable adverse drug "events" every year because of mistakes with their medications. Costs associated with those errors are estimated to exceed $4 billion annually.
"E-prescribing can reduce mistakes and the associated costs dramatically," said Governor Napolitano. "Arizona has been a leader in developing electronic health records and the means by which to exchange those records while still protecting personal privacy. This order will ensure that we stay on that cutting-edge of health care technology."
Currently, less than 3 percent of Arizona health care providers use any form of e-prescribing. Yet, by ordering and transmitting prescriptions electronically, providers can avoid the mistakes that often accompany hand-written prescriptions; allow providers to create systems that can catch potential drug interactions; and can help provide accurate patient data quickly, especially in the case of an emergency.
The Governor's Order also urges Arizona's executive branch agencies to develop awareness and use of consumer tools that assist in medication safety. One example is the Med Form, available at www.themedform.com.
In 2005, the Governor created Arizona's Health-e Connection to research, organize and implement a statewide e-health information system. In 2007, Arizona was awarded a $12 million federal grant to enhance and expand that work. Arizona Health-e Connection, along with executive branch agencies, will play a leading role in coordinating the promotion of e-prescription capabilities in Arizona.
For more information about the Office of the Governor, please visit www.azgovernor.gov.
Source: Government Technology - http://www.govtech.com/gt/314909?topic=117677
April 29, 2008
Gingrich calls for medical update
At forum on preventable medication errors he urges a switch to electronic records
By David Kohn, Sun reporter
Former House Speaker Newt Gingrich stressed the merits of switching to electronic medical records in an appearance in Baltimore yesterday.
"It's been a very great disappointment that the administration has not proposed to go to 100 percent electronic health records," Gingrich said yesterday. He was in Baltimore to speak at a health care symposium sponsored by Siemens, which ends today.
He said Congress could have paid for such a changeover with the money now being directed to the subprime mortgage loan bailout. During a wide-ranging speech, he likened the changes in the medical industry to Major League Baseball, which in recent years has increasingly focused on using data to make personnel decisions.
The symposium is concentrating on preventable medication errors, health care information technology and health care issues. Siemens makes software that allows doctors and hospitals to distribute prescriptions electronically; the conference is also focusing on users of its software, which is called Computerized Physician Order Entry.
Gingrich, a Georgia Republican, was first elected to the U.S. House of Representatives in 1978. He was elected speaker in 1995 after Republicans took over the House, a post he held until he left Congress in 1999. He has served as author, speaker and political commentator.
He has long focused on health reform, and he founded the Center for Health Transformation, a think tank in Washington. Siemens is among its funders.
Gingrich said that the current political debate was not really addressing health care. "There's a big lag between the current political conversation and the next generation of ideas," he said.
Many experts say electronic health records will improve care, reduce medical errors and reduce waste. But 90 percent of U.S. doctors and more than two-thirds of U.S. hospitals still use paper for patient records. Experts say the federal government should do more to encourage the switch.
The federal government will spend up to $150 million over the next five years. But many other countries spend more: The United Kingdom allocated more than $11 billion to digitize its health care system, and Canada is spending a billion dollars.
Gingrich also advocated increasing the focus on preventive care instead of treatment, which he said would save billions. "I think we ought to go to K-through-12 physical education five days a week," he said.
He said the Center for Health Transformation is working on proposals to create tax credits for inner city grocery stores to stock more healthy food such as fruits and vegetables. Some researchers have argued that poor inner-city health is partially explained by lack of easy access to healthier food.
Source: www.baltimoresun.com/news/health/bal-md.gingrich29apr29,0,7578180.story
SureScripts takes on doctors' e-mail resistance
By Mark Albright, Times Staff Writer
The voice mail and facsimile machines got their usual Monday morning workout at the Walgreens at 900 49th St. N in St. Petersburg. By the end of lunch hour, doctors' offices had left 20 prescriptions on the pharmacy voice mail for transcription and a stack of 40 handwritten refills coughed through the fax machine.
And how many prescriptions did doctors e-mail? Four.
"Changing old habits is hard, especially after physicians have been handwriting prescriptions more than 100 years," said Mark Percifield, the 32-year-old pharmacy manager. "But we've been equipped to accept e-mail prescriptions since 2004."
It might seem quaint that in this day of instant communications, prescriptions are still handwritten to be hand-carried, faxed or called in to be filled. But after eight years of getting its act together, SureScripts, a nationwide secure e-prescription service, thinks it is time to juice up acceptance by e-mail.
Started with a $100-million investment from the two big drugstore trade groups seven years ago, SureScripts today kicks off a campaign to get more patients to ask their physician for labor-saving e-mail prescriptions. The brochures and in-store promotional signs will be supported by advertising in coming months.
Nationally in 2007, only 2 percent of 1.47-billion prescriptions were e-mailed from a medical facility to drugstores. Only 6 percent of doctors' offices are equipped to handle it. In Massachusetts, more than 13 percent of all prescriptions are e-mailed. Florida is in 19th place among all states with only 1.6 percent.
The arrival of e-mail prescriptions does not mean doctors cannot keep scribbling down prescriptions if patients prefer them that way.
"We've been educating the physician and medical community for some time," said Rob Cronin, spokesman for SureScripts. "Now it's time to engage the patients so they'll start asking their doctors for it."
The company is armed with a study showing physicians' offices could save about $8.5-billion in medical practice staff time by equipping their staffs to file prescription traffic to the secure Internet site.
The savings are big for drugstores, too. Phoned-in prescriptions must be transcribed. The faxed and handwritten ones frequently require pharmacy workers to make followup calls to the doctors' offices to ensure accuracy. Questions range from verifying chicken scratch signatures to matching pill counts. Interns at Percifield's Walgreens stores did a study that found that each day his staff phones a doctor's office 20 times for clarification.
E-mail prescriptions arrive ready for a visual verification and the bottle label printer.
Many medical clinics have steered a cautious course. Early on there were questions of security, then of how few drugstores were equipped to handle the Internet option. Today more than 70 percent of all drugstores can accept them.
Another holdup: E-mail equipment becomes entwined in the technical difficulties and expense of shifting clinics to paperless record keeping. That's not required to send e-mail prescriptions. The hardware and software cost less than $200 a month.
"It sounds simple, but it's really a lot more complex," said Dave Bailey, CEO of Suncoast Medical Clinic, a huge practice in St. Petersburg that invested $1.25-million over five years to make all its medical records paperless this year and will be ready for e-prescriptions by winter. "There's a lot of making sure everything fits and a huge training component. Changing habits from paper files to computer screens is enormous."
Source: St. Petersburg Times http://www.tampabay.com/news/business/retail/article477809.ece
April 9, 2008
E-Prescribing Can Cut Costs and Improve Patient Safety, but Physicians Are Slow to Embrace It
Reprinted from HEALTH PLAN WEEK, the industry's leading source of business, financial and regulatory news of health plans, PPOs and POS plans.
While physicians have been slow to embrace electronic prescribing, the experiences of several health plans in the forefront of e-prescribing point to four critical ingredients that, when used, will help such an initiative succeed and produce a significant return on investment.
There are quantifiable costs and safety benefits being realized by health plans, physicians and patients, the insurers contend. E-prescribing, they say, not only can bolster a health plan's quality measurement efforts and are a logical part of pay-for-performance (PFP) programs, but also there's a bigger-picture benefit: E-prescribing is the logical first step in getting physicians to move to the use of electronic health records (EHRs).
Insurers uniformly cite several cost and safety benefits associated with e-prescribing. "The patient's history is all there on the screen," says Matt Walsh, associate vice president, purchaser initiatives at Health Alliance Plan (HAP), a part of the Henry Ford Health System and a member of the Southeastern Michigan ePrescribing Initiative (SEMI). "Plus there's real-time alerts concerning drug interactions and messaging about therapeutic duplicates and more appropriate drugs, including generics."
In 2006, a survey of Henry Ford Medical Group physicians, the first to test e-prescribing through SEMI, found that of 500,000 e-prescriptions, 80,000 were changed or canceled due to drug interaction alerts, and more than 50,000 prescriptions were changed or canceled due to formulary alerts, which increased the use of generic drugs. Walsh says that helped the medical group improve its overall generic use rates by 7.3%.
Increased use of generic prescriptions is one of three "value drivers" used by HAP to prove the business case for e-prescribing, Walsh tells HPW. The other two: reduced administrative costs and reduced adverse drug events, tracked by the number of times physicians changed or canceled prescriptions because of an alert. The result: a $4 million annual savings.
Kate Wodecki, a manager in the Electronic Business Interchange Group at Blue Cross Blue Shield of Michigan, points to results of a study released October 2007 by SEMI, of which the Michigan Blues plan is also a member. That study reviewed 3.3 million e-prescriptions written by physicians participating in SEMI during 2007 and found that physicians changed prescriptions 39% of the time, often to less expensive generics, when a formulary alert was presented at the point of care. More than 1 million alerts were sent on moderate to severe drug-to-drug risks, resulting in 41% of those prescriptions being changed or canceled by the physician.
Savings to health plan members is also a benefit. Blue Cross Blue Shield of Massachusetts, a member of the eRx Collaborative, found that providers who used e-prescribing during 2007 saved 5% on drug costs by selecting more cost-effective drugs. That translated to members saving approximately $800,000 in copayments associated with their prescriptions, says Steve Fox, vice president of provider network management.
Getting physicians to e-prescribe isn't easy. "You're competing with a piece of paper that the physician hands to the patient and never sees again," says Anthony Schueth, CEO and managing partner of Point-of-Care Partners, a Coral Springs, Fla.-based consulting firm. Schueth also is the SEMI project manager. Other barriers: getting physicians over the technology hump, which includes the cost of the technology, the time and effort required to install the technology, and psychological resistance to adopting new technology and new ways of doing business.
Four Ingredients to Boost e-Prescribing
Health plans point to four ingredients in their e-prescribing initiatives that they say will help propel physicians over that hump and into the game. And they report that once physicians start e-prescribing, most become true believers.
(1) Be sure e-prescribing is embedded in the medical practice. And this requires skills that the average medical practice doesn't have. Walsh says HAP is using the experience it gained from working with Henry Ford Medical Group sites to build a team that is now working with the health plan's independent practice associations (IPAs) to get their e-prescribing systems up and running. "This isn't something a practice can do on its own," Walsh says. "They need training, and they need ongoing support with the process and technology issues. You provide training for physicians, but you must also sit with them after the system is up and running to work through the real-time problems and glitches."
(2) Use incentives to encourage adoption and build e-prescribing into PFP programs. SEMI provides medical practices with a $1,000 subsidy paid in two installments. The first payment, typically $500, is provided after the system is installed, training is complete and the practice has submitted 10 e-prescriptions. The balance is paid after the practice has used e-prescribing for six months. "By structuring the incentive this way, we not only encourage adoption but also encourage utilization," Schueth tells HPW. "We wanted physicians to cover a fair amount of the install costs so they will have 'skin in the game' and place a value on the process." Schueth says that if the technology is provided free or at minimal cost, physicians will be more apt to abandon the system once they encounter glitches. While the eRx Collaborative provides subsidies to medical practices to help support the cost of the technology, licensing fees, training and six months of Internet connectivity, the Massachusetts Blues plan also offers e-prescribing primary care physicians $1.50 per member per month as part of its larger PFP program. Steve Fox, vice president of provider network management, says that the plan also worked with the Massachusetts Medical Society to create a Continuing Medical Education program for physicians on e-prescribing.
(3) Use physician champions. Using physician "true believers" to help persuade their peers to adopt e-prescribing also helps, says Wodecki. "We started working with larger medical practices during the second phase of SEMI, and at that point we identified a cadre of physician champions to reach out to the groups, participate in training, speak at workshops and lead demonstrations. We found that it makes a tremendous difference."
(4) Involve the entire office staff. Because a significant amount of patient data must be inputted from launch forward, physicians often feel overwhelmed when it comes to using e-prescribing system. One solution: Help the medical practice conduct a work-flow analysis to identify multiple contact points where data can be collected and inputted by office staff. Wodecki says that the Michigan Blues plan helps practices identify key staff who can "pre-ramp" the data for the physician. "Front desk staff can collect information from patients when they sign in, as can the nurse when the patient is being pre-examined," Wodecki says. "That way the physician isn't bearing the entire load."
Top 10 e-Prescribing States
The 10 states where physicians transmit the highest percentage of prescriptions electronically, according to data released this month by the National Association of Chain Drug Stores, National Community Pharmacists Association and SureScripts, are:
(1) Massachusetts
(2) Rhode Island
(3) Nevada
(4) Delaware
(5) Michigan
(6) Maryland
(7) North Carolina
(8) Arizona
(9) Connecticut
(10) Washington
Source: Reprinted from HEALTH PLAN WEEK, the industry's leading source of business, financial and regulatory news of health plans, PPOs and POS plans.
March 10, 2008
RxHub’s CAQH CORE Rules Certification Aids Data Exchange Coordination
Washington, DC (March 10, 2008) − CAQH announced today that RxHub, a leader in
e-prescribing, has completed the testing process required to certify its PRN™ clearinghouse product operates in compliance with the Committee on Operating Rules for Information Exchange (CORE) Phase I operating rules. This achievement represents an important step toward synchronizing interoperability efforts in the medical and pharmacy sectors.
“Aligning medical and pharmacy insurance eligibility standards is a natural extension of the work being done by CAQH and RxHub,” said Robin J. Thomashauer, CAQH executive director. “Coordination is an essential part of our vision for administrative simplification. RxHub’s PRN certification means providers will now have even more consistent access to both medical and pharmacy patient eligibility and coverage information at the point of care.”...
Source: http://www.rxhub.net/images/pdf/press_releases/2008/FINAL_
RxHub_CORE_Rules_Certification_Press_Release_030608.pdf or FINALRxHubCORErulesCertificationPressRelease030608.pdf (86.54kb)
March 6, 2008
ACS Launches Medicaid Cost Savings Initiative
New Program Offers Millions in Potential Savings
DALLAS, TEXAS: March 6, 2008 – State Medicaid programs can potentially save millions of dollars annually through an innovative initiative of Affiliated Computer Services, Inc. (NYSE: ACS) and RxHub, LLC. The proprietary program helps ACS’ healthcare clients avoid costly, manual recovery of drug claims from commercial insurers.
The new program enables pharmacies to immediately identify pharmacy benefit coverage at the point-of-sale. This eliminates the costly, inefficient “pay and chase” programs state Medicaid agencies currently use to recover monies when other insurance coverage is discovered.
“The potential savings identified through this new program is another way in which ACS provides innovative technology to our state partners to help reduce the costs of administering their Medicaid programs,” said Christopher T. Deelsnyder, ACS senior vice president and managing director, Government Healthcare Solutions...
Source: http://www.rxhub.net/images/pdf/press_releases/2008/ACS-RxHub_NewsRelease_030608.pdf
March 4, 2008
Medical Groups Launch E-Prescription Advocate Site
GetRxConnected.com helps doctors switch from paper-based prescriptions to online forms that pharmacies can access directly.
Grant Gross, IDG News Service
Five doctors organizations have launched a Web site and campaign designed to persuade physicians to switch from paper-based prescriptions of medications to electronic prescribing.
The Get Connected campaign, along with the GetRxConnected.com Web site, are focused on helping doctors move from prescriptions written on paper pads or entered into a computer and faxed to pharmacies. The Web site, launched Tuesday, includes a technology guide to help doctors move to e-prescribing. It also provides perspectives of other doctors on the benefits of e-prescribing, and points to connected pharmacies.
The effort, with support from such groups as the American Academy of Family Physicians and the American Academy of Pediatrics, is aimed at the 94 percent of doctors in the U.S. who still do not write prescriptions electronically, said Dr. William Jessee, president and CEO of the Medical Group Management Association.
In many cases, doctors who are entering prescription data into an electronic health record are then faxing those prescriptions to pharmacies, where the data has to be re-entered into a computer, Jessee said during an event called the Safe-Rx Awards in Washington, D.C. Re-entering the data increases the risk that a prescription error will occur, he said.
About 150,000 doctors across the U.S. now fax prescriptions, but as of Jan. 1, 2009, the U.S. government Medicare program will require that prescriptions it covers be sent electronically, Jessee said.
"We need to pick up the pace," he said.
Backers of electronic prescribing say it can save lives and reduce medical errors. About 8,000 people in the U.S. die every year because of prescription errors, said Newt Gingrich, founder of the Center for Health Transformation and former Republican speaker of the U.S. House of Representatives. Some doctors are still fighting the move to e-prescribing and suggesting the U.S. government shouldn't mandate the change, he said.
"Their argument is, 'I reserve the right to issue paper prescriptions and kill people,'" Gingrich said at the awards event. "'It's wrong for you to require me to be safe'."...
Source: http://www.pcworld.com/article/id,143106-pg,1/article.html
March 3, 2008
MediVoice LLC Selects Nuance Voice
Control To Power New E-Prescription Application
Physicians Can Create Electronic Prescriptions
From Mobile Devices Using Only Their Voice
HIMSS 2008, ORLANDO, Fla., February 25, 2008 — Nuance
Communications, Inc. (NASDAQ: NUAN), a leading supplier of speech and
imaging solutions, today announced that MediVoice, LLC has selected Nuance®
Voice Control to provide speech-driven access to a broad range of mobile
healthcare applications. As part of the preferred partnership agreement, Nuance
Voice Control Healthcare Edition will power a new e-prescription service that
enables physicians to create and send an electronic prescription from a broad range
of mobile devices using only their voice. Nuance and MediVoice will demonstrate
the new technology in booth #5846 at the HIMSS 2008 conference, being held this
week in Orlando, Fla.
MediVoice offers a complete enterprise mobility solution that places all the tools
healthcare workers need at the point of care. The voice-activated e-prescriber
platform gives MediVoice customers voice access to electronic medical records...
Source: http://www.nuance.com/news/pressreleases/2008/20080225_medi.asp
February 28, 2008
Leavitt Wants Medicare E-Rx Mandate
U.S. Health and Human Services Secretary Michael Leavitt has called for mandated electronic prescribing for Medicare patients. At the 2008 HIMSS Conference in Orlando on Feb. 26, he also indicated mandates on use of electronic health records under Medicare are a distinct possibility.
Electronic prescribing can enable physicians to access formulary data at the point of care and prescribe appropriate but less expensive drugs. “The time has come to make the change to e-prescribing,” Leavitt said in his keynote address. “We can no longer afford to pay reimbursements for people to prescribe in the most expensive way.”
And he added this caveat for provider organizations that have been slow to adopt EHRs: “The day is not long off until we do the same for electronic health records..."
Source: http://www.healthdatamanagement.com/news/legislation_rules25773-1.html
HHS chief supports mandatory e-prescribing in Medicare
Congress should make e-prescribing a condition of participation in Medicare by 2011, said Health and Human Services Secretary Michael Leavitt at a Feb. 6 Senate Finance Committee hearing. "It saves lives. It saves money. And it's time," he said in response to a question by Sen. John Kerry (D, Mass.).
Kerry is a sponsor of the Medicare Electronic Medication and Safety Protection Act. The bill would reduce by 10% the payment for Medicare evaluation and management services provided in connection with a medication prescription that the physician could have made electronically but did not. On the flip side, the measure also would give E&M bonuses to doctors who e-prescribe.
Source: http://www.ama-assn.org/amednews/2008/02/25/gvbf0225.htm
February 26, 2008
Tampa Bay Area Health Care Leaders Partner with National ePrescribing Patient Safety Initiative to Deliver Free Electronic Prescribing to Area Physicians
ORLANDO, Fla., Feb. 26 /PRNewswire-FirstCall/ -- Direct from the 2008 HIMSS Annual Conference and Exhibition, Allscripts, the leading provider of clinical software, connectivity and information solutions that physicians use to improve health care, announced today a partnership between the National ePrescribing Patient Safety Initiative(TM) (NEPSI(TM)), and two of the Tampa Bay area's largest health care organizations to improve patient safety through electronic prescribing.
BayCare Health System and USF Health together will lead the deployment of free, web-based electronic prescribing to all physicians in the Tampa Bay area as the regional sponsors of NEPSI, a coalition of technology and health care companies led by Allscripts and Dell. Both Florida organizations are proven leaders in quality and safety improvement, and have partnered successfully on several initiatives. They join more than a dozen other major health care provider organizations across the nation in leading the delivery and support of NEPSI technology to physicians in their states and regions by providing education, training, incentives and local physician support.
"BayCare Health System is pleased to play a role in reducing preventable medication errors through participation in the NEPSI initiative," said Bruce Flareau, MD, Chief Informatics Officer of BayCare Health System, the largest full-service, community-based health care system in the Tampa Bay area, comprised of the nine leading not-for-profit hospitals and 11 community-based outpatient centers. "Our support of free e-prescribing will help the Tampa Bay area's physicians automate their prescription process for accuracy and speed, and will also make available easy-to-use drug reference to support their medication choices."
The University of South Florida has found that educational programs including medical students and residents help practicing physicians adopt electronic prescribing quickly, said Stephen Klasko, MD, MBA, Dean of the USF College of Medicine and Vice President of USF Health. "The culture change has to span all age groups and specialties," said Dr. Klasko. "By partnering with BayCare Health System, we believe we can significantly accelerate acceptance of electronic prescribing in both the USF academic setting and BayCare's community care environment."...
Sources: http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/02-26-2008/0004762614&EDATE= and
http://investor.allscripts.com/phoenix.zhtml?c=112727&p=irol-newsArticle&ID=1112418&highlight=
February 11, 2008
E-prescribing proves beneficial for payors
A growing number of payors are using e-prescribing, and one expert said the technology is "becoming a required component of a growing number of programs to stay in consideration for the business." It can also help payors with P4P programs and can serve as a first step to the adoption of other health IT tools. Source: Healthcare IT News
DEA submits long-awaited proposal on e-prescribing
eHealth SmartBrief | 02/11/2008
A proposal from the Drug Enforcement Administration to allow doctors to use electronic prescribing for controlled substances, such as pain medications and antidepressants, has been submitted to the Department of Justice. The agency said it could not estimate how long the Justice Department would need to evaluate the proposed rule.
Source: Health Data Management
February 10, 2008
E-prescriptions gain popularity
In 2007, 35 million prescriptions traveled electronically between health care providers and U.S. pharmacies, according to SureScripts, operator of the Pharmacy Health Information Exchange. Advocates of the system assert that e-prescribing improves efficiency and reduces potential errors, but many doctors do not yet have the software required to send electronic prescriptions.
Source: The Journal Gazette (Fort Wayne, Ind.)
February 7, 2008
"Heath Ledger might be alive today if e-Prescribing were more widespread and we had e-rx for controlled substances. This never would have happened. Plus, note the major public health effects of this situation, as more elderly get pain killers and are at risk for unknown adverse reactions. E-Prescribing can help address this trend, as medication history becomes apparent to the range of prescribers who treat the elderly, and will help prevent adverse reactions and addiction (refills monitored)..." Source: Public Comment
When Mixing
Medications
Can Be Deadly
By SHIRLEY S. WANG
Actor Heath Ledger's death from a combination of prescription painkillers and sedatives underscores the potential dangers of mixing medicines at a time when medication use is rampant in the U.S.
Patients are often woefully unaware of the potential serious consequences of the additive effects of prescription medications. Although it is often unclear from toxicology reports whether a death by prescription drugs was intentional or not, "frequently, medical examiners find multiple drugs in toxicology reports of people that died of drug overdoses," says Leonard Paulozzi, a medical epidemiologist at the Centers for Disease Control and Prevention's Injury Center who researches prescription-medication poisonings.
 Whether the drug levels are at therapeutic levels is one indication, says Ellen Borakove, a spokeswoman for the Office of the Chief Medical Examiner, City of New York, which investigated Mr. Ledger's death. In Mr. Ledger's case, the medical examiner concluded that "the manner of death is accident, resulting from the abuse of prescription medications," according to a press release. Oxycodone and hydrocodone (painkillers), diazepam (anti-anxiety, insomnia), temazepam (insomnia), alprazolam (anti-anxiety) and doxylamine (antihistamine) were found in his system.
Prescription-drug abuse -- using a medication for nonmedical reasons -- is on the rise in the U.S. across all age groups. In 2006, more than 16 million Americans aged 12 or over reported nonmedical use of prescription pain relievers, tranquilizers, stimulants or sedatives, up from 14 million in 2004, according to the Substance Abuse and Mental Health Services Administration.
Nearly 600,000 emergency-room visits in 2005 involved nonmedical use of prescription or over-the-counter pharmaceuticals or supplements, according to SAMHSA, and the majority of those involved patients taking more than one drug.
The most commonly abused groups are strong opioid or narcotic painkillers such as OxyContin or Vicodin, stimulant medications such as Adderall and Concerta, and sedatives for sleep or anxiety, such as Xanax.
Fatal poisonings resulting from high concentrations of prescription medication are also increasing. From 1999-2002, for instance, such poisonings by opioid painkillers rose more than 90% to 5,592 deaths, and in 2002 there were more deaths from painkiller poisoning than from heroin or cocaine use, according to a study released in 2006 by the CDC...
Source: Wall Street Journal - http://online.wsj.com/public/article/SB120235084872749567-9U16w5mE5ydDe0OjRFLZtp7Timw_20080307.html
January 22 , 2008
Editorial: E-prescriptions merit support
Handwritten Rxs should go the way of the 8-track tape.
For many patients, illegible writing on prescription slips has been a source of wonder and some amusement. How in the world can anyone make out those chicken scratches? Turns out even pharmacists sometimes wonder, too. But prescription mistakes are no joke.
According to the national Institute of Medicine, prescription medication mixups kill nearly 7,000 people each year and injure about 1.5 million.
That's why Congress should pass a proposed measure that would expedite the use of electronic prescribing technology, or e-prescriptions. Some providers have already moved to more electronic record keeping, but others have been dragging their feet. This bill, authored by Sen. John Kerry, D-Mass., would move the conversion process along by offering grants to help with startup costs to help pay for the technology. The measure would:
• Provide Medicare funding for one-time grants to help doctors offset the costs converting to electronic prescriptions.
• Require all doctors to use e-prescriptions beginning Jan. 1, 2011. As an incentive to switch earlier, the bill funds a 1 percent bonus for every Medicare e-prescription issued. Providers who continue to write Rxs by hand would face a per-claim financial penalty.
• Allow the federal Department of Health and Human Services to grant one- to two-year hardship waivers for rural, one-doctor shops or others with special circumstances that make conversion difficult.
Studies have also shown that of the more than 3 billion prescriptions written each year, roughly a third -- that's 1 billion prescriptions -- require some type of follow-up between providers and doctors for clarifications...
Source: http://www.startribune.com/opinion/editorials/13998746.html
January 16 , 2008
Allscripts tops list of e-prescription providers
by Rupa Shenoy
An analysis of the 35 million electronic prescriptions written in 2007 shows that healthcare professionals used Chicago-based Allscripts Healthcare Solutions Inc.'s technology to prescribe more than any other software.
"This validates their efforts to dominate the market," Morningstar equity analyst Rafael Giagarcia said.
SureScripts Inc., operator of the electronic Pharmacy Health Information Exchange which comprised 139 vendors last year, reported that the number of e-prescriptions sent in 2007 was more than 50 times the amount transmitted in 2004, the year the Exchange began...
...Allscripts is poised to make the most of that growth, Giagarcia said.
One version of Allscripts e-prescription software is free, and as doctors warm to it, they will buy other versions, he said. And as the economy continues to be rough and the healthcare industry focuses on reducing expenses, more doctors will turn to the e-prescription system, which saves money, Giagarcia said.
The technology eliminates errors caused by pharmacists misinterpreting the poor handwriting of physicians. Such mistakes cause 1.5 million injuries and 7,000 deaths each year, according to the non-profit Institute of Medicine.
"Electronic prescribing should be the rule not the exception," Allscripts CEO Glen Tullman said in a statement...
Source: http://news.medill.northwestern.edu/chicago/news.aspx?id=74821
January 7 , 2008
Congress considers mandate for Medicare e-prescribing
Bipartisan bill would boost E&M payments for doctors who prescribe electronically but cut these reimbursements for physicians who don't.
By Dave Hansen, AMNews staff. Jan. 7, 2008.
Washington -- Congressional patience with the pace at which physicians are adopting electronic prescribing seems to be wearing thin. House and Senate lawmakers have introduced legislation that would mandate e-prescribing for Medicare beginning in 2011.
At a Dec. 4, 2007, Senate Judiciary Committee hearing, lawmakers also expressed frustration with the lack of movement toward allowing e-prescribing of controlled substances.
Sponsors of the two electronic prescribing bills tried to fold the legislation into a measure to prevent next year's 10.1% Medicare physician payment cut. But the language was not included in a last-minute Medicare package...
http://www.ama-assn.org/amednews/2008/01/07/gvsb0107.htm
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