E-Prescribing for Dummies

E-Prescribing for Dummies

V1.3 02.09

E-Prescribing for Dummies       

What is E-Rx? To E-Rx or Not to E-Rx- Pros/Cons Medicare Incentives How does E-Prescribing Work?

Making the Adoption Decision Selecting a Vendor Resources

E-Prescribing Tools at Your Fingertips Clinician's Guide to E-Prescribing

Medicare's E-Prescribing Guide

http://www.ehealthinitiative.org/assets/Documents/ e-Prescribing_Clinicians_Guide_Final.pdf

http://www.cms.hhs.gov/partnerships/downloads/ 11399.pdf

Surescripts- Rx Hub http://www.surescripts.com/getconnected.aspx?ptype=physician

E-Prescribing for Dummies       

What is E-Rx? To E-Rx or Not to E-Rx- Pros/Cons Medicare Incentives How does E-Prescribing Work?

Making the Adoption Decision Selecting a Vendor Resources

What is E-Prescribing? ď ą

ď ą

Electronic generation, transmission and filling of a prescription (replacing paper and faxed forms) Allows MD, NP, or PA to electronically transmit a new prescription or renewal authorization to a community or mail order pharmacy

What are My Choices for E-Prescribing Systems? 

Stand-alone system 





In house, software acquired and downloaded to onsite computer system Through the internet, connecting to an application service provider (ASP)

E-Prescribing as part of an EMR system

E-Prescribing for Dummies 

What is E-Rx?



To E-Rx or Not to E-Rx- Pros/Cons



Medicare Incentives How does E-Prescribing Work?

Making the Adoption Decision Selecting a Vendor Resources

   

To E-Rx or Not to E-Rx- Pro •

Increase Safety and Quality of Care • • •

•

Illegibility-decrease medical errors Oral miscommunication- Pharmacy/Office Warning/Alert System- Drug/Drug Interactions Access Patient Medical and Medication History

To E-Rx or Not to E-Rx- Pro •

Decrease Phone calls • • •

Handwritten legibility Mistaken manual prescription choices Formulary benefits

To E-Rx or Not to E-Rx- Pro •

Automate the renewal/authorization process • • • •

Pharmacy generated renewal Prescriber reviews approves/denies Responds electronically All steps documented

To E-Rx or Not to E-Rx- Pro •

Increase patient convenience, compliance • • •

Decrease amount of unfilled prescriptions Decrease waiting time Prescribers can view patient compliance in seeing when patients pick up prescriptions

To E-Rx or Not to E-Rx- Pro •

Improve formulary adherence, low cost •

•

Generic/ Low cost substitutions can be encouraged Low cost can improve compliance

To E-Rx or Not to E-Rx- Pro •

Prescribing Mobility • • •

Mobile Devices Wireless Network Ability to write prescriptions anywhere

To E-Rx or Not to E-Rx- Pro •

Improved drug surveillance • • •

Ability to do queries and reports Find patients during drug recalls See frequency/types of medication the providers are prescribing

To E-Rx or Not to E-Rx- Con •

Return on Investment • •

•

Even free E-Rx may face costs Large practices see positive ROI is less time Lack of a clear ROI

To E-Rx or Not to E-Rx- Con •

Change/Workflow • • • •

Staff Compliance Time Adequate planning, training, support Understanding the staff roles may change

To E-Rx or Not to E-Rx- Con •

Controlled Substances •

•

DEA currently prohibits electronic transmission of Schedule II drugs Forces prescribers to use different workflow

To E-Rx or Not to E-Rx- Con •

Hardware/Software Selection • •

Busy practices Not all staff know enough about IT

To E-Rx or Not to E-Rx- Con •

Connectivity •

•

•

Not all pharmacies are connected to Surescripts-RxHub Pharmacies reluctant to switch on until more prescribers on board Not all payers are connected to give patient formulary and eligibility or information is not complete

To E-Rx or Not to E-Rx- Con •

Medication History •

•

Not all systems contain patient medical history EMR could supplement this material

To E-Rx or Not to E-Rx- Con •

Patient Acceptance • • •

Patients that travel want paper Afraid of change Comfort factor of paper prescriptions

E-Prescribing for Dummies       

What is E-Rx? To E-Rx or Not to E-Rx- Pros/Cons Medicare Incentives How does E-Prescribing Work?

Making the Adoption Decision Selecting a Vendor Resources

What is the Medicare E-Rx Incentive? ď Ż

For 2009, e-prescribing incentive amounts will be 2% of the total estimated allowed charges for professional services covered by Medicare Part B and furnished by an eligible professional during the reporting period (one calendar year).

Incentive Requirements 





To be eligible, the estimated allowed Medicare Part B charges for the eprescribing measure codes are at least 10% of the total Medicare Part B allowed charges.

To be a “successful e-prescriber,” report the e-prescribing measure on at least 50% of the applicable cases during the reporting year.

Have a Qualified E-Prescribing System.

How to Report the E-Rx Program Measure: Step 1 Bill on one of the following denominator codes: 90801 90806 92002 96150 99202 99211 99215 99244 G0109

90802 90807 92004 96151 99203 99212 99241 99245

90804 90808 92012 96152 99204 99213 99242 G0101

90805 90809 92014 99201 99205 99214 99243 G0108

These codes need to make up at least 10% of the total Medicare Part B allowed charges to receive the incentive

How to Report the E-Rx Program Measure: Step 2 Then report one of the three G-codes listed below on more than 50% of applicable cases for the numerator.

G8443- used a qualified e-rx system for all of prescriptions G8445- had a qualified e-rx system, but didn’t generate any prescriptions during this encounter G8446- had a qualified e-rx system, but either prescribed narcotics/controlled substances, law requires phone or print prescription, patient asked for phone or print, pharmacy can’t receive electronic transmission.

Medicare Incentive Payment: Carrot and Stick Approach Carrot

Stick

2009-2010 2% incentive 2011-2012 1% incentive 2013 0.5% incentive 2014 unclear

2009-2011 no penalty 2012 1% penalty 2013 1.5% penalty 2014 and beyond 2% penalty

E-Prescribing for Dummies       

What is E-Rx? To E-Rx or Not to E-Rx- Pros/Cons Medicare Incentives How does E-Prescribing Work?

Making the Adoption Decision Selecting a Vendor Resources

Exchange of Health Information: Surescripts Rx-Hub Surescripts-RxHub is a network that securely links e-prescribing systems to the major health plans, pharmacy benefit managers, and pharmacies.

It provides two-way electronic connectivity to 95% (online or in process) of pharmacies for the transmission of new prescriptions, refill authorizations and denials and change requests

How Does E-Prescribing Work?

Rx

Surescripts/RxHub Network

Health Plans 2. Formulary/History brought to provider

Prescriber 1. Select drug and connect to Payer to determine eligibility

3. Once Rx written, drug interactions are checked.

How Does E-Prescribing Work?

Surescripts/RxHub Network Rx

Rx

Prescriber 4. Send Rx to patient’s pharmacy of choice

Pharmacy 5. Renewal sent back to provider

E-Prescribing for Dummies       

What is E-Rx? To E-Rx or Not to E-Rx- Pros/Cons Medicare Incentives How does E-Prescribing Work?

Making the Adoption Decision Selecting a Vendor Resources

Making the Adoption Decision 

Assess your Practice Readiness:    

Staff willingness Past technological implementations Time available Past and current staff communication

Making the Adoption Decision 

Define Practice Needs      

Vision, objectives Establish a team and pick a leader Plan ahead for challenges List and Prioritize needs Workflow changes Hardware/Software needs

Making the Adoption Decision 

Understanding Costs 

Costs for Provider 



Anywhere from free to $2500 per yr per prescriber

Costs for Patient 

Same or less because formulary available to allow physician to prescribe a lower copay medication

SDCMS Adoption Worksheet E-Prescribing Adoption Worksheet I. Practice Readiness

Are you and your staff ready? Everyone needs to agree with the workflow, technology, and management or the benefits of eprescribing will be limited. a. Staff/Leadership open to change (1-no one is interested, 5-everyone is on board) 1 2 3 4 5 b. Past technological implementations (1-completely flopped, 5-easy as pie) 1 2 3 4 5 c. Current practice projects (1-too many to count and no time, 5-free and open) 1 2 3 4 5 d. Staff/Leadership thoughts on E-Rx (1-pointless and waste, 5-useful and important) 1 2 3 4 5 e. Current Practice Communication (1-non existent, 5-all staff voice opinions equally) 1 2 3 4 5

II. Defining Practice Needs

What improvements do you hope to gain with e-prescribing? Needs must be specifically defined. If any of these are unclear, eprescribing will be difficult. a. Project Vision (1-I don’t know, 5-established with measurable results) 1 2 3 4 5 b. Project Team (1-No one has time, 5-Variety of staff nominated/volunteer) 1 2 3 4 5 c. Project Leader (1-Person with least work, 5-Knowledgeable, respected person) 1 2 3 4 5 d. Medication Management Needs (1-minimum/easy, 5-robust, complete safety) 1 2 3 4 5 e. Technological Needs (1-Basic/fool-proof, 5- Complex, External/multiple access) 1 2 3 4 5 d. Current IT Maintenance (1-no one, will rely on vendor, 5- IT employee on staff) 1 2 3 4 5

III. Understanding Costs and Financing Options

How much is the practice will to spend on an EMR? Become familiar with the current state and federal e-prescribing incentives. a. Familiarity with National/Federal Incentives (1-not sure, 5-very familiar) 1 2 3 4 5 b. Know Medicare reimbursement (1-not sure 5-calculated projected reimbursement) 1 2 3 4 5 c. Understanding Costs (1-Basic/Minimum, 5- Eventually go to an EMR 1 2 3 4 5

E-Prescribing for Dummies       

What is E-Rx? To E-Rx or Not to E-Rx- Pros/Cons Medicare Incentives How does E-Prescribing Work?

Making the Adoption Decision Selecting a Vendor Resources

Selecting a Vendor 

What are you getting for your money  

 

 

Maintenance, training fees Fees to back out of contract

Vendor Communication/Support Variety of modules for current and future needs Stepping Stone to EMR? Write an Request for Proposal (RFP)

Selecting a Vendor 

SureScripts Certified Solution Providers 



GoldRx is the highest E-prescribing certification.

It focuses on benchmarks that signal a vendor’s commitment to interoperability, customer support, and successful customer implementations.

Gold Certified Products

(from http://www.surescripts.com/get-connected.aspx?ptype=physician)

GoldRx Certified Product Capabilities:    



E-Prescriptions E-Refills Rx History- view patient’s history Eligibility-access to patients’ drug plan information Formulary-weigh patient economic considerations

E-Rx Vendors with Uncertified Products ABEL Soft

BMA Enterprises

Doc-U-Chart

Glenwood Systems

iMedX

ACS Heritage

Cerner

Doctations, Inc

goStream, Inc

InstantDx

Agastha

ChartConnect

E-MDs

gMed

Integrated Health care Solutions

Allscripts

Clinipath

Eclipsys Corp.

Gold Standard

InteGreat

AlphaSante

Clinix, LLC

Eclipsys Practice Sol.

H2H Solution, Inc.

Integritas, Inc

ASP.MD

CPSI

eHealthSolutio ns

Health Admin.

Systems

iSALUS

Athenahealth

CureMD

EHS

HealthPort

iScribe

Bizmatics

Daw Systems

EcounterPRO

Henry Scheind Medical System

Kryptig

Blue Cross/ Blue Shield of Alabama

digiChart OBGYN

Epic

iMedica

LighthouseMD

E-Rx Vendors with Uncertified Products Cont’ Lille Corp.

MedConnect, Inc.

NaviMedix

Pulse Systems

SSIMED

LSS Data Systems

Medent

Netsmart-infoscriber

OA Systems

STI Comp Services, Inc

MD Web Solutions

Medi-EMR

NewCorp

Regenstrief

SynaMed

Marshfield Clinic

Medical Communication Sys.

Nightingale

RelayHealth

US Health Record Systems

MAShare

MedicaLinx

Noteworthly

RXNT

VipaHealthSoluti ons

McKesson

MedicSoft

MedPlus

SafeMed

Waiting Room Solutions

MDI Achieve

Meditech

Polaris-Epichart

SAGE

Wellogic

MDOffice

MediVoice

Practice Partner

Sequel Systems

Workflow

MedAppz

MedNet System

Prematics

SOAPware

ZixCorp

MedComSoft

MedPlexus

Prime Clinical Sys

Sonix Healthcare Sol

E-Prescribing Gold Certified Products Company

Stand-Alone

Set up Fees

Cost per DEA

Allscripts

No

Depends

Depends

Allscripts/NESPI

Yes

None

Free

DrFirst

Yes

$300

$550/yr

eClinicalWorks

Yes

$250

$300/yr

NextGen速

No

Depends

Depends

RxNT

Yes

None

$650/yr

Electronic Health Record E-prescribing Allscripts Enterprise EHR come with E-rx capability built in and interfaced with the full patient record.

Pro 

  

Larger company: merge Misys and Allscripts Variety of modules Customizable EHR/ E-Rx transition at one time

Con   

Expensive Complex Big transition

ePrescribe Allscripts ePrescribeTM is a web-based, standalone ePrescribing application that can be downloaded in minutes

Pro 

  

Larger company: merge Misys and Allscripts Free and easy Stepping stone to EMR Fast installation, no hardware fees

Con  

 

Customer Support Hidden Fees (Want to extract Medical Records, Customize interface) Lack variety of modules You get what you pay for

Rcopia

DrFirst Rcopia can be used as a standalone application and also link with practice management software and EMR applications to automate the exchange of information

Pro  

Easy to contact No hidden fees

Con  Long term viability unknown

eClinicalWorks’ unified system for Electronic Medical Records, Practice Management and Document Management streamlines workflow and increases efficiency resulting in positive ROI for your practice.

Pro 

  

Variety of options and modules Local contact Can upgrade to EMR schedule demos

Con 

Not a lot of information on E-Prescribing on website

EMR Pro  Variety of modules  Stable company

Con  No standalone  Expensive

Pro 

    

Offer online demos/webinars all day Friendly Easy to reach Customizable interface No hidden fees Offer free 30 day trial

Con 



Does not have full EMR (only EMR lite) Long term viability

One Final Step: Deployment 

    

Significant technological, practice readiness Commitment and patience Appropriate Training Communicate with Vendor Communicate with Pharmacy Communicate with Patients

E-Prescribing for Dummies       

What is E-Rx? To E-Rx or Not to E-Rx- Pros/Cons Medicare Incentives How does E-Prescribing Work?

Making the Adoption Decision Selecting a Vendor Resources

Resources 

  

AMA Clinician’s Guide to Electronicprescribing SureScripts Rx Hub Medicare E-Prescribing Guide eHealth Initiative free webinars

SDCMS Office Manager Advocate

Lauren Wendler (858) 300-2782 LWendler@SDCMS.org

The SDCMS Website

www.sdcms.org