E-prescribing is gaining more momentum than ever! I’m happy to report that the DEA has published a set of proposed rules for electronic prescribing.

On June 27, 2008 the DEA released its proposed rules for electronically prescribing controlled substances. Specifically, the document is titled “21 CFR Parts 1300, 1304, et al. Electronic Prescribing for Controlled Substances; Proposed Rule.” (http://edocket.access.gpo.gov/2008/pdf/E8-14405.pdf) This rule affects prescribers, e-prescribing systems, intermediaries, and pharmacies. When you look at the rule, you will see it is rather long and complex. However, a nice summary is found on page 36751 and the actual proposed rule starts around page 36769.

The DEA has established a comment period that ends on 9/25/08. I encourage everyone to take a look at the rule and participate in commenting. This is a rule that is going to affect us individually and collectively and we want to make sure our voices are heard.

These are exciting times for electronic prescribing. We have definitely entered and are playing in the political arena’s sandbox. And so far, everyone seems to be playing well together. As I mentioned in an earlier blog, on July 9, 2008 the Senate approved a Medicare bill that, among other things, will provide financial incentives for physicians to use electronic prescribing. The bill is called the Medicare Improvements for Patients and Providers Act of 2008 (HR 6331). According to the bill, physicians who use electronic prescribing for their Medicare patients will be eligible for incentive payments of 2% in 2009 and 2010, 1% in 2011 and 2012, and 0.5% in 2013. Doctors who do not use electronic prescribing by 2012 will see a pay cut of 2%.

A major part of the bill was a halt to a scheduled pay cut of 10.6% to Medicare physicians. The President vetoed the bill stating that he supported rescinding the pay cut, but objected to the way lawmakers would finance the plan, largely by reducing spending on private health plans serving the elderly and disabled. However, the Senate voted 70-26 to override a presidential veto of the bill and the House voted 383-41 to override it.

To listen to a podcast discussing the Medicare e-prescribing incentives and what e-prescribing is all about, go to http://prwebpodcast.com/releases/pod1105664.htm.

Have you heard?! On Wednesday (July 9, 2008) the Senate approved a Medicare bill that, among other things, will provide financial incentives for physicians to use electronic prescribing. The bill is called the Medicare Improvements for Patients and Providers Act of 2008 (HR 6331). According to the bill, physicians who use electronic prescribing for their Medicare patients will be eligible for incentive payments of 2% in 2009 and 2010, 1% in 2011 and 2012, and 0.5% in 2013. Doctors who do not use electronic prescribing by 2012 will see a pay cut of 2%.

Another part of the bill halts a scheduled 10.6% Medicare physician pay cut. Although the President has threatened to veto the bill, it was passed with enough votes to override a veto, paving the way for it to become law.

For the electronic prescribing community, I think this is the best thing since sliced bread. I think it’s great the government is providing incentives for using technology rather than punishment for not.

For those still not convinced of the return on investment of using an e-prescribing system, these incentives certainly should help.

As many of you may have heard, there is a new Medicare/Medicaid law that is scheduled to go into effect January 1, 2009. (Actually, it’s an existing law that has been deferred until now.) The law states that prescriptions cannot be faxed directly from any e-prescribing application (like InfoScriber) to a pharmacy’s fax machine. Rather, if the prescriber wants to fax a prescription to a pharmacy, he must first print it and then manually fax it to the pharmacy. If you’re scratching your head at this point in disbelief, join the gang. It seems like a step backwards. The intent of Medicare is to get prescribers to send more prescriptions via eRx and not by fax. This intent, I believe, while noble, is impractical.

To make matters worse, in response to this upcoming law, it appears that some major pharmacy chains like are beginning to change their fax lines to tie into their main telephone switchboard lines and require users to press a button to choose to fax. What this does is prevents electronic prescribing applications to fax directly to a fax machine (i.e., it will now require human intervention to know what number to press based on each pharmacy’s menu options).

If you are using an electronic prescribing application that currently faxes directly to fax machines, you may begin experiencing increased fax failures.

In response to these changes, we encourage you to send your prescriptions electronically whenever possible and avoid faxing. When you do have to fax (eg, controlled substances, etc.), it may be necessary to print out the prescription and manually fax (depending on the pharmacies to which you are sending).

Some exciting news came out today that will positively affect our world of e-prescribing. The nation’s retail pharmacies and leading pharmacy benefit managers (PBMs) today announced a merger of the country’s two leading health information networks.

The groups have merged two organizations: RxHub, founded in 2001 by the nation’s three largest PBMs – CVS Caremark Corporation, Express Scripts, Inc. and Medco Health Solutions, Inc.; and SureScripts, also formed in 2001 by the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA).

Their press release states that the organizations will consolidate their operations, forming a single, secure, nationwide network for e-prescriptions and the exchange of health information.

RxHub’s expertise in patient identification and delivering drug benefit information to the physician at the point of care complements SureScripts’ focus on electronic prescription routing from the physician’s office to the pharmacy. The merger combines these strengths with a shared focus on more access to patient medication history to form a single suite of comprehensive services. Among other things this merger will allow prescribers to transmit electronic prescriptions and renewal requests to both retail and mail-order pharmacies. E-prescribing is on the move!

It was only a matter of time before it happened. The drug companies have been doing it for years…putting ads for medications on television and instructing us to tell our doctor what medicine we want them to prescribe for us. Well, now the campaign to get doctors to start using eprescribing applications has been put into the hands of the consumers. Not a bad idea, not bad at all…

A nationwide campaign has very recently been launched by thousands of independent pharmacies, CVS/pharmacy, Duane Reade, Giant Food Pharmacy, Kerr Drug, Longs Drugs, Osco Drug, Rite Aid, Sav-On Pharmacy, Stop & Shop, Walgreens, Wal-Mart and other chain pharmacies designed to inform patients and their physicians on the benefits of electronic prescribing.

According to SureScripts (the operators of the Pharmacy Health Information Exchange, 40,000 healthcare providers in the United States are writing and sending prescriptions electronically. At a glance that number may be impressive, but when you dig deeper you realize it only represents a very small number of total practitioners. Sadly, today, although 70 percent of pharmacies can receive electronic prescriptions, only six percent of practitioners have the ability to send them. However, I think things are going to change due to some governmental initiatives that are on the table (I’ll discuss these in a future segment). It is anticipated by SureScripts that by the end of this year, about 85,000 practitioners will use e-prescribing.

The nationwide campaign instructs us to visit www.learnabouteprescriptions.comand find out if our doctors can e-prescribe. If they can’t, we’re instructed to recommend it to them. According to Tammy Lewis, the Chief Marketing Officer of SureScripts, “In 2007, patients in the U.S. left their doctors office with at least one prescription on 550 million separate occasions. The next time you or anyone you know goes to the doctor's office and the doctor takes out their pad and pen to write a prescription, take the opportunity to ask your doctor for an e-prescription instead.”

I think it’s a good idea. After all, the benefits to eprescribing are well established and all of them benefit us as consumers.

Computer Fluency of Users

Do designated users of the e-Prescribing application have basic computer knowledge? Experience has shown that users familiar with using a computer, whether at home or at work, tend to learn the application at a faster rate than those who do not. To accommodate staff members that are not computer-savvy, your e-Prescribing application should have an intuitive, user-friendly interface, and should offer as much consumer-specific data as is possible to the prescribing physician.

Nursing Staff

How many nursing staff will be using the system? What is their receptivity to adopting electronic prescribing? Nurses should be made aware that organizational efficiency may not immediately rise at the point of transition, but over time, e-Prescribing can greatly assist them in a variety of areas, including reducing the number of call-backs from pharmacies, eliminating the need to transcribe medication orders, and improving risk management efforts.

Hardware Setup

Does your organization have adequate computer and printing resources for the project to be successful? There should be a computer available for each prescriber to use during appointments. Computer monitors should be positioned so that it is not necessary for the prescriber to turn his/her back on the consumer to issue a prescription. Also, a printer must be stationed nearby to instantly produce prescriptions or collateral information. Experience tells us that the first thing users will complain about during the introduction of new applications is the hardware (e.g., “The printer doesn’t have ink in it so I can’t use the new program”).

IT Support

Do your information technology leaders and staff endorse the project? Are your IT specialists working on other projects concurrently? The effort required to implement new systems should not be underestimated, especially in a setting that will bring technology to the desktops of all clinic staff. Assignment of adequate internal IT resources is mandatory to assure project success. 

Current Consumers on Medications

How many of your active consumers are on medications? A typical estimate is 60-70% of active charts. Your organization will need to determine the most efficient way to input consumers’ current paper-based medication information into the new system. Many organizations use data entry to do this; but keep in mind that it takes an average of three minutes to enter each consumer’s current medication information.

Pharmacy Communication

Have you let all routinely-used community pharmacies know your organization will begin e-Prescribing?  Notifying pharmacies in advance will reduce the number of phone calls that may originate from inquiries regarding the new prescription formats (e.g., confirming authenticity).

In Conclusion

More and more behavioral health providers are adopting e-Prescribing as technological advancements and government regulations drive the healthcare industry towards wholly automated processes. Early experience indicates that the benefits of e-Prescribing are real, and by far outweigh the risks and costs of implementation. Transitioning to an electronic prescribing system requires a dedicated investment of your organization’s time, money and resources. Good planning and proactive communication with all internal and external stakeholders will help assure a successful implementation, which, in turn, will result in higher quality care for your consumers.