E-prescribe With EMR

1. E-prescribe With EMR By Sandra Herr, RN

2. E-prescribing • -electronically generated prescription • -ability to utilize EMR (electronic medical record) • -accurate, error-free and understandable • -improving the quality of patient care • -reducing medication errors • -use of palm pilot or computer

3. Nursing Role in E-prescribing • -patient safety • -renew prescriptions • -time management • -accurate medication reconciliations • -recognize drug interactions • -more interaction with patients

4. Advantages vs. Disadvantages • -time saving -expensive software • -integrated EMR -limited usage • -fast -extensive training • -legible -complexity (Kilbridge and Gladysheva 2001)

5. Hardware in E-prescibing - PC with internet access - DSL or Cable Modem - Palm Pilot - Two way internet linkage

6. DslmODEM“digital subscriber line” • - transceiver • - connects a computer to a fax or phone line • - high speed internet access • - ability to use a phone while e-prescribing • - can use exisiting phone line connection

7. E-prescribe Software • - All scripts • - Dr. First • - MedPlus, Inc • - Surescripts • - ZixCorp • - RxNT • - Prematics • - Misys eScript (AMCP.org)

8. SURESCRIPTS • - used daily in all 50 states • - merger of RxHub / Surescripts • - formed with CVS Caremark Corp, Express Scripts Inc and MedCo Health Solutions, Inc • - connects over 10,000 pharmacies nationwide

9. Usability of E-prescribe software • - user centered design and focus • - ongoing education • - simplicity • - safe • - secure • - fast

10. Information system for e-prescribe AND emr Reflect on any experiences you may have had recently…thoughts?

11. E-Prescribe and EMR:CLINICAL INFORMATION SYSTEM(cis) -Patient centered -Integrated health care -Comprehensive

12. Users and functions Used By: -Physicians and nurses -Billing/financial -Administration -Clinics -Pharmacy -Laboratory -Radiology -Clergy (hospital based) -Social Service Functions: -Accurate Medication Reconciliation -Documentation -Billing -Continuity of Care -Discharge planning -Patient centered care -Error reduction -Increased patient safety -Spiritual/social

13. Configuration for the cis MAINFRAME -interface between hardware and user -sharing of resources -simplifies development of applications -multitasking system -saves data to memory -shared data

14. Datastandardsanddisease/procedureclassificationsystem Data Standards: -Healthcare level 7(HL7) -American Society for Testing and Material -Healthcare Informatics Standards Planning Panel -Workgroups for Electronic Data Exchange -American National Standards Institute (ANSI) (Goedert 2006) Disease/Procedure Classification System(s): -International Statistical and Classification of Diseases and Related Health Problems (ICD-9 or ICD-10) -Systematized Nomenclature of Medicine (SNOMED) (Devine, Hansen, Hollingworth, Sullivan 2007)

15. Thoughts - recommendations • -patient safety • -decrease in medication errors • -continuity of care • -team collaboration • -time saving • -cost effective • -patient centered HIGHLY RECOMMEND EMR AND E-PRESCRIBE FUTURE OF HEALTHCARE

16. ADVANTAGES AND DISADVATAGES OF E-PRESCRIBE AND EMR A HEATHCARE WAVE FOR THE FUTURE

17. ADVANTAGES vs. Disadvantages • Prevents medication prescription errors • Eliminates illegible prescriptions • Provides for real-time communications between doctors, pharmacies and patients • Provides critical drug alerts • Patient specific information –readily available • Provides drug pricing information • Provides payer coverage and preferred drug information • Complete patient medication history • Reduces fraud and crime • Increases health care professional work efficiency and reduces administrative costs • Speedy refills • Lack of integration with patient • record • Likelihood that it will be replaced when EMR is adopted • Reduced staff time spent on refill process • Lack of integration with patient record • Initial cost to implement • Implementation and extensive training of staff • Educational costs to train staff • Need for extensive training time for all staff and outside vendors • Unwillingness of staff compliance and/or acceptance to change • Selection based on criteria and need • Development of an integration system with outside vendors and pharmacies (Aspen, Wolcott, Bootman, Cronenwett, 1996) (Bizzarro, 2009)

18. Ethical / legal issues regardinge-prescribe -potential revenue sources from partnering with device vendors -objective outcome by E-prescribing vendors -vendors ties to the pharmaceutical industry - Will HIPAA regulations limit what can be done with data

19. Nursing competencies for e-prescribe • -registered nurse • -computer skills • -informatics knowledge • -informatics skills

20. Functions and responsibilities • -education and training • -mentoring for new/seasoned staff • -super user in EMR (electronic medical record) • -community liaison for pharmacy and physician practices • -accessibility to staff • -continued research and education

21. References • California Health Care Foundation. (2001). Retrieved September 17th, 2009 from http://quality.chcf.org/documents/hospitals/EPrescribing.pdf • U.S. Department of Health & Human Services (2009). Retrieved September 18th, 2009 from http://www.cms.hhs.gov/eprescribing/ • Centers for Medicare and Medicaid Services (2008). Retrieved September 18th, 2009 from http://www.medicare.gov/Publications/Pubs/pdf/11382.pdf

22. REFERENCES • - FREE electronic prescribing…for every physician in America. (2008). Retrieved October 9th, 2009 from http://www.nationalerx.com • Bringing high-speed e-medicine to Pa. physicians. (2008). Retrieved October 8th, 2009 from http://www.physiciansnews.com/spotlight/808pa.html • Dermatology Online Journal Volume 7 Number 1. (2001). Retrieved October 11th, 2009 from http://dermatology.cdlib.org/DOJvol7num1/media_review/ephysician/goldblum.html • Surescripts. (2009). Retrieved October 11th, 2009 from http://www.surescripts.net/the-company.html • Indiana University – University Technology Services (2005-2009). Retrieved October 11th, 2009 from http://kb.iu.edu/data/ajfr.html

23. REFERENCES: • -Electronic Health Record . (2009). Retrieved October 29th, 2009 from http://en.wikipedia.org/wiki/Electronic_health_record • -Operating Systems. (2009). Retrieved October 29th, 2009 from http://en.wikipedia.org/wiki/Operating_system • -The Evolution of EMR Standards. (2006). Retrieved October 30th, 2009 from http://www.healthdatamanagement.com/issues/20060501/13354-1.html • - Implementing an Ambulatory e-Prescribing System: Strategies Employed and Lessons Learned to Minimize Unintended Consequences . (2007). Retrieved from http://www.ahrq.gov/downloads/pub/advances2/vol4/Advances-Devine_83.pdf

24. references • Guideposts to the Future—An Agenda for Nursing Informatics. (2007). Retrieved November 19th, 2009 from http://www.jamia.org/cgi/content/abstract/14/1/. • e-Prescribing Technology: Issues and Policy Implications in a Dynamic Market. (2001). Retrieved November 20th, 2009 from • http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102273470.html. • Integrating evidence into clinical information systems for nursing decision support. (2007). Retrieved November 21st, 2009 from http://www.ijmijournal.com/article/S1386-5056(07)00162-1/abstract. • AMA announces partnership with e-prescribing vendor. (2009). Retrieved November 22nd, 2009 from http://www.ama-assn.org/amednews/2009/07/27/bisd0730.htm • Preventing Medication Errors: Quality Chasm Series. (1996). Retrieved November 22nd, 2009 from http://www.nap.edu/catalog.php?record_id=11623 • e-Prescribing Briefing Managed Care Pharmacy 101 New York Health Plan Association (2009). Retrieved November 22nd, 2009 from www.hixny.org .