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Electronic Prescriptions

Can we make it work? Mrunal Shah, MD, ABFM Vice President, Physician Technology Services, OhioHealth. Electronic Prescriptions. Agenda. What it is How it works Why we should do it Barriers Incentive programs. What It Is. Prescribing and information Sent electronically

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Electronic Prescriptions

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  1. Can we make it work? Mrunal Shah, MD, ABFM Vice President, Physician Technology Services, OhioHealth Electronic Prescriptions

  2. Agenda • What it is • How it works • Why we should do it • Barriers • Incentive programs

  3. What It Is • Prescribing and information • Sent electronically • Prescriber, dispenser, PBM/Health plan • Formulary decision support

  4. What It Isn’t • Printed prescriptions • Faxed prescriptions • Scanned and transmitted hand-written prescriptions

  5. How It Works

  6. How It Works • Surescripts transactional interface • Stand-alone online tools • RxNT • DrFirst • RelayHealth • Quicker startup, lower cost • Separate documentation and workflow

  7. 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

  8. How It Works • Patients are either • Manually entered into the tools • Interfaced directly from practice management system • Already in EMR

  9. 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

  10. Screenshot of RxNT

  11. Screenshot of GE

  12. Workflow • Who can do this • Physician • NP/PA • RN, MA • Each practice considers their policy • Assignments are given accordingly

  13. Device Choice • When using stand-alone tool • Internet connected PC • Desktop • Laptop/Tablet • PDA/Smartphone • Blackberry • iPhone • Windows Mobile • Others

  14. 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!

  15. 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

  16. Office Efficiency • Paper rarely generated • Phone calls virtually eliminated • Workflow directly to physician • Refills are clicks away • Risk mitigation • Patient confidence and satisfaction

  17. 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)

  18. 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

  19. 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”

  20. Barriers • Pharmacy/pharmacist resistance • Impending decision to go with EMR • Compatibility with practice management or future use of EMR

  21. 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

  22. ERx Incentive Payment

  23. 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

  24. 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

  25. Reporting • Submit standard office CPT code • Consults, new/established visits, Preventive • Add appropriate G-code

  26. 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

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