Electronic Prescribing Increasing Office Efficiency

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Electronic PrescribingIncreasing Office
Efficiency
VITL Summit 09 Vermont Information Technology
Leaders Burlington, VT September 24, 2009

• Tim Burdick MD
• Berlin Family Health
• PRISM Ambulatory Lead Physician
• Fletcher Allen Health Care

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Why is this so important?Institute of Medicine
Reports

• Individuals average one medication error every
  day they stay in a hospital1.5 million
  medication errors every year
• Up to 98,000 Americans are killed every year by
  preventable medical errors.
• More than 7,000 Americans are killed every year
  from preventable medication errors.

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So, altough

• this presentation focuses on ways to achieve
  operational efficiencies,
• We must not forget the greater issues
• Patient safety
• Healthcare costs
• Patient satisfaction
• Staff job satisfaction
• Provider job satisfaction

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What is Electronic Prescribing?Medicare D
Definition

• E-prescribing means the transmission, using
  electronic media, of prescription or
  prescription-related information between a
  prescriber, dispenser, pharmacy benefit manager,
  or health plan, either directly or through an
  intermediary, including an e-prescribing network.
  E-prescribing includes, but is not limited to,
  two-way transmissions between the point of care
  and the dispenser.
• A Clinicians Guide to Electronic Prescribing.
  White Paper from the eHealth Initiative and The
  Center for Improving Medication Management. 2008.

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Inefficiency Costs of Paper Rx

• Three billion prescriptions written each year
• one billion require a follow-up between
  providers and pharmacies for clarification
• the average practice fields up to 50 calls per
  day from pharmacies
• administrative complexity related to
  prescriptions costs
• 15,700 per year physician
• 9 billion per year nationally
• Does not account for costs to pharmacy, PBM, and
  patient!

(studies cited in the Center for Health
Transformation Electronic Prescribing White
Paper 2008)
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Why do paper scripts fail?

• Miscommunications
• Verbal order misunderstood
• Written order misread
• Wrong date or patient name
• Wrong dose
• Not current dose for patient
• Weight-based dose calculated wrong
• Dose not manufactured
• amoxicillin 850mg and metformin 875mg
• Wrong medication
• Off-formulary
• Patient with allergy
• Drug-drug interaction
• Refill requests are staff-intensive
• Front office, medical records, nursing, providers

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Solutions for the Paper Rx

• Automation of frequent processes
• Clinical Decision Support (CDS)
• Optimal office workflows for refill requests

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Automation

• Preference lists for common medications
• By specialty
• By clinic
• By provider
• Diagnosis-driven order sets
• Prescription defaults
• dispense
• refills
• Record-keeping without duplicate effort
• Medication, dose, start date, prescriber,
  dispense date,
• dispensed, refills, receiving pharmacy

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Clinical Decision Support

• Completeness
• Automatic check for complete Rx information
• Automatic check for internal consistency
• Accuracy
• Standardized drug database with doses and tablet
  strengths
• Dose adjustments (weight, BSA, GFR)
• Formulary adherence
• Real-time check against insurance formulary
• Suggestions for step therapy
• Interaction review
• Other medications
• Allergies
• Medical conditions
• Lab values

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Optimal Office Workflows

• Refill requests
• Office visits
• Nurse visit
• Provider visit
• Telephone calls
• To refill line
• To staff
• Pharmacies
• Fax
• Telephone call
• Electronic request
• Patient portals

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Does it work? Yes.

• Southeastern Michigan e-Prescribing Initiative
• Massachusetts eRx Collaborative
• (Yes, there are other examples of systems which
  did not have similar success.)

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Massachusetts eRx Collaborative

• Partnership
• Blue Cross Blue Shield of Massachusetts, Tufts
  Health Plan and Neighborhood Health Plan
• deployed e-Rx tools to thousands of healthcare
  providers
• hardware, software, set-up, training and ongoing
  support
• no cost to the prescribers.
• overwhelming support among physicians
• More than 81 percent of prescribers would
  recommend e-prescribing to a colleague
• 71 percent of physicians said the technology
  saves them time
• (Center for Health Transformation Electronic
  Prescribing White Paper 2008)

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Southeastern Michigan e-Prescribing Initiative
(SEMI)

• Public-private partnership since 2005
• Chrysler, Ford and General Motors
• Health Alliance Plan, Blue Cross Blue Shield of
  Michigan, and Henry Ford Health System
• 3,000 physicians
• More than one million prescriptions have been
  modified or cancelled due to adverse drug alerts.
  
• Financial success
• Recouped startup costs
• savings of more than 3 million each year
• (Center for Health Transformation Electronic
  Prescribing White Paper 2008)

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The System 1) Rx Hub

• A secure link for more than 60 key technology
  partners
• pharmacy benefit managers
• health insurance plans
• Medicare Part D
• Medicaid
• Master Person Index
• information on more than 200 million commercial
  lives in the United States
• Providers can retrieve patient data
• eligibility,
• medication history
• drug formulary information

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The System 2) SureScripts

• Bidirectional networking interfaces
• Connects
• certified e-prescribing systems
• SureScripts Pharmacy Health Information Exchange
  (PHIE)
• Connected to more than 95 percent of the nations
  pharmacies
• Patient Medication History includes aggregate
  data from
• health plans
• pharmacy benefit managers
• pharmacies

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Correct RxHub and SurScripts maybe separate
links
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Automation Preference lists for common
medications
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Automation Preference lists for common
medications
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Automation Preference lists for common
medications
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Automation Diagnosis-driven order sets
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Automation Record-keeping without duplicate
effort
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Clinical Decision Support 1) Proper
medication proper dose 2) Rx completeness
internal consistency
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Clinical Decision Support Formulary check and
step-therapy recommendations
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Clinical Decision Support Interactions drug,
duplicate tx, allergy, disease, labs
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Clinical Decision Support Interactions drug,
duplicate tx, allergy, disease, labs
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Nurse refills per protocol
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Nurse order entry, route
to provider.
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Nurse order entry, route
to provider.
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Electronic Prescribing Readiness Assessment

• Partnership
• American Academy of Family Physicians
• Medical Group Management Association
• Center for Improving Medication Management
• other medical and professional societies
• www.getrxconnected.com

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References

• Electronic Prescribing Building, Deploying and
  Using E-prescribing to Save Lives and Save Money
  White Paper. Center for Health Transformation
  2008.
• A Clinicians Guide to Electronic Prescribing.
  White Paper from the eHealth Initiative and The
  Center for Improving Medication Management. 2008.
• Lyman D. Stand-Alone E-Prescribing Ready or Not?
  White Paper from the Healthcare Information and
  Systems Society. 2007.
• eRx Readiness Assessment www.getrxconnected.com
• SureScripts-RxHub www.surescripts.com