Electronic Prescribing:Progress and Promise October 3, 2011 David A. Knapp 1Electronic prescribing: fundamentals Secure, real-time, bidirectional, electronic connectivity between prescribers and pharmacies. 2E-prescribing enables prescriber to electronically: • Access patient’s prescription benefit • Access patient’s medication history • Transmit prescription to pharmacy of patient’s choice 3Benefits to prescribers • Efficiency improves • Accuracy improves 4…prescribers… • Improves safety • Ties to payment plans and PBMS 5…prescribers • Aids communication with pharmacies 6Benefits to patients • Increased convenience • Decision-support review at prescriber’s office • Adjudication at prescriber’s office 7Benefits to pharmacists • Improves dispensing operations 8Benefits to health plans and PBMs • Studies show decreases in drug costs and improved plan performance 9Benefits to all Improves safety and quality of care IOM, CMS endorsement 10How does it work? • Various provider software systems • Pharmacies 11PBMs, Payers • Private and public payers – Eligibility information – Formulary restrictions 12Connectivity? • Disparate systems 13Surescripts • Country’s largest e-prescribing network • A network of networks • Clinical interoperability 14Surescripts • Formed by a cooperative effort of – NACDS – NCPA • And large chains – PBMs – Mail Service Pharmacies 15Surescripts • Does not develop or sell software • Works with IT vendors • Prescribers, patients, pay nothing 16Prescribers must • Buy, install and maintain their own IT system • E-prescribing may be stand alone or integrated into EMR or EHR 17Pharmacies must • Work with IT vendors to connect to Surescripts network • Same for private payers, Medicaid, PBMs, etc 18Use and Adoption of e-prescribing • ~234,000 active prescribers (of about 550,000 physicians in office-based practice in U.S.) • 91% community pharmacies connected 19Transmitting only part of story • Prescribers can request benefit information from payers 20Prescriber requests for medication history information • 24% of patient visits in 2010 involved an electronically-delivered medication history. 21By December 2010 • 25% of new prescriptions sent electronically 22Vendor statistics • 83% included e-prescribing with EHRs; 17% standalone 23Prescriber statistics • 34% of office-based prescribers transferred prescriptions electronically by the end of 2010 • 81% of these were doctors 24E-prescribing physicians • 42% of physicians in practices with 2-10 physicians are active e-prescribers • Compared with 30% of solo physicians • … and 32% of physicians in groups of 11-100 • Physicians in practices over 100 lag--22% 25Surescript use by pharmacies • 98 % of chains and mail order pharmacies connected by end of 2010 • 73% of independents. 26Current situation • Pharmacy network is largely in place • Prescriber access 50% or higher • Prescriber use is low ~25%Key drivers of e-prescribing • Medicare Part D – standards • IOM reports • 2007 – e-prescribing legal in all states • 2010 – DEA permits e-prescribing of controlled substances 28…Key drivers of e-prescribing • Federal incentives – Medicare Part D requires e-prescribing capability – Health Information Technology for Economic and Clinical Heath Act (HITECH) (ARRA) – Medicare Improvements for Patients and Providers Act (MIPPA) 29Impact of health care reform 30 million additional insured lives 30Errors associated with e-prescribing • Missing data • Unclear or conflicting information • Primarily related to vendor differences in software 31Next steps • Focus on utilization – Prescribers that have access to electronic systems but don’t use them 32…next steps • Close gaps in adoption – By solo practitioners – Independent pharmacies – Some state Medicaid programs 33…next steps • Support emerging models of collaborative care – Accountable care organizations – Patient-centered medical homes 34Summary • Definition • Benefits • Mechanics • Surescripts • Adoption and Use • Next Steps: drivers of change