E-prescribing should be implemented with an understanding of both the potential benefits it brings as well and the needs and workflows of your practice. When fully adopted and merged into practice, e-prescribing will enhance patient safety, improve office efficiencies, and increase both provider and patient satisfaction.
Business case for e-prescribing
For the provider looking to adopt an e-prescribing system in clinical practice, the business case for acquiring and implementing the system will vary according to the:
Size of practice
Type of practice
Participation of health plans
Participation of local pharmacies
Practice setting
Availability of IT infrastructure and support
Stand alone e-prescribing vs. EHR
Availability of incentives and ability to take advantage of them
There is no one perfect system that will work for every practice, so it is important to identify your current practice prescribing workflow and needs.
A needs assessment is the core task in establishing your plan and should include the identification of practice requirements ( such as staffing, change management and training, and incentive benefits eligibility), hardware and software needs (such as PDA’s, software, and server and security requirements), and infrastructure needs (such as connectivity/interoperability).
Beginning your e-prescribing system selection process with these needs in mind will certainly reduce the time spent securing a system and increase the likelihood that you will find a system that is the right fit for your practice. With the right system, you can expect to realize the potential savings associated with increased practice efficiency handling medication renewal requests and increased prescriber accuracy resulting in fewer call-backs from pharmacies for legibility issues, drug incompatibility or ineligibility.
You should anticipate initial costs to include software licensing fees, hardware, network and internet access and training and technical support. Additional expenses that may add to your complete costs to include temporary decreases in productivity resulting from training and workflow redesign; practice management, lab and other interfaces; customization for practice specialty and other factors; maintenance of system; upgrades; and data conversion (from different practice management system or from stand alone e-prescribing system to EHR).
Several resources have been developed to help providers navigate their way to e-prescribing success. For more information on developing your business case for securing and implementing the right system for your practice, visit the ACR’s e-prescribing resources page for links to sites that will help you in creating your customized e-prescribing action plan. These sites will help you narrow the vendor field and provide you with a buying guide that includes questions to ask and functionalities to identify.
Is There Financial Assistance Available to Help Me Secure an E-Prescribing System?
Many incentives and assistance opportunities are available to help physicians in securing an e-prescribing system and to recoup the expense associated with e-prescribing adoption. Active programs include grant and loan programs, reimbursement for utilization, pay for performance, malpractice insurance premium reductions, and health care IT suppliers discounts.
Beginning January 1, 2009, Medicare will offer physician payment incentives of 2 percent for using e-prescribing in 2009 and 2010 – with this amount declining slightly over the next three years. For more information on this program, visit the CMS E-Prescribing Incentive page found under the ACR’s Electronic Prescribing site.
A number of national and state level incentive programs that provide for everything from software and/or hardware to direct incentive payments for e-prescribing are open to physicians across the U.S. For more information of the opportunities available, a listing of prescribing initiatives can be found on the SureScripts Web site at http://www.surescripts.com/Initiatives/default.aspx?ptype=physician.
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There are parameters for technology donations so that, under certain conditions, providers can accept free donations of e-prescribing hardware, software, and related services without violating the Stark law or Anti-Kickback Statute. Check with your local hospital or health care system to see what opportunities may be available. For more information about the Stark law and Anti-Kickback Statute, please visit either of the two Web sites below:
www.cms.hhs.gov/PhysicianSelfReferral/01_overview.asp
www.oig.hhs.gov/fraud/safeharborregulations.asp
There are a number of free web-based e-prescribing systems available to every provider.
Stand-alone vs. EHR
E-prescribing systems can be implemented as either a stand-alone system, or as a system embedded within an EHR. Stand-alone systems are significantly less costly than full EHRs and do not force your office to change as many of its work patterns (making it much faster to implement), but for your office to see the full benefit of e-prescribing in terms of safety, quality and efficiency, the ultimate goal should be movement toward or integration with an EHR.
Stand-alone systems store and manage patient data specific to the prescribing process. They are available either as a software package downloaded to your office computer, or as an application hosted through the Internet. Stand-alone systems allow providers to order medication electronically, but are limited in decision support as they have limited patient data available. These systems can be enhanced through integration with practice management systems, billing systems, and scheduling software. Without this integration, your practice will face redundant data entry which may slow productivity. Successful implementation of a stand-alone e-prescribing system will require that your practice develop a parallel workflow that makes use of both the e-prescribing system and paper chart.
To maximize patient safety and quality through electronic prescribing, the system should be truly integrated into the practice workflow and should host more information than just patient prescription history. This can only be accomplished through integration with an EHR system, which will combine prescription drug information with immediate access to patient demographics, clinical notes, problem lists, allergies, side effects, lab results and other elements of the patient’s medical history.
How do I know what pharmacies in my area are connected for e-prescribing?
Many e-prescribing programs provide you with an up to date list of those pharmacies in your area that have the ability to receive electronic prescriptions. It is important to verify that this list is current so that you are not faxing prescriptions to those pharmacies that are not connected for e-prescribing. Your e-prescribing/EHR software vendor is responsible for maintaining your pharmacy directory and keeping it up to date. Contact your vendor for more information on their processes.
You can also identify the pharmacies that are connected in your area by visiting GetRxConnected or the SureScripts Web site. Both sites will allow you enter your location by state or zip code to view a listing of pharmacies connected for electronic prescribing.
For more information on securing an electronic prescribing system, contact Itara Barnes at .
