Reducing Barriers to eprescribing Adoption

Transcription

1 Reducing Barriers to eprescribing Adoption A White Paper 11 September 2013 Kristy C. Woodard, PhD Co-Founder & COO, DocDox LLC kwoodard@docdox.net DOCDOX The Problem. Traditional methods of prescription writing are time consuming, fraught with error, and often require validation by pharmacies who either cannot read handwriting, have a question about dosing, or want to clarify prescriber-specific information like National Provider Identifier (NPI) numbers. This requires a significant investment in time by both providers and staff, who are involved in a process which happens largely over the phone and via fax. The push for electronic prescribing (eprescribing) began in the early 2000s. However, it was not until the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) identified eprescribing as a service with important patient safety and financial impacts, that larger steps were made towards adoption, due in part to new financial incentives. Additionally, the formation and certification of Surescripts as a health information exchange as selected by the Certification Commission for Healthcare Information Technology (CCHIT), as well as their current connection to over 95% of pharmacies in the United States, has allowed for a more rapid expansion of eprescribing options. This has led to an increase in adoption by hospitals and physicians, but eprescribing has not reached complete saturation in the market. Despite recent gains in eprescribing, with approximately 48% of physicians now using some form of eprescribing service 1, this leaves more than half of all physicians are still using older methods of prescribing. However, a larger number of these electronic prescribers are in outpatient offices, rather that in a hospital setting. This leaves these doctors, hospitals, and other facilities and providers ineligible for valuable meaningful use bonus payments, defined in the HITECH Act of 2009, and these same providers may be penalized for not having adopted or using eprescribing solutions beginning in Mosquera, M. e-prescribing nears halfway mark. Healthcare IT News. 28 Nov Available at Accessed 9 Sep Washington, DC Page 1 of 5

2 A report released in January of 2013 by Markets and Markets, a prominent market research firm, notes that although eprescribing buy-in has increased, there are major factors preventing growth: the high cost of adoption and ownership; resistance by physicians to transition to often cumbersome or non-intuitive systems; and a lack of qualified, technically skilled developers who understand end user expectations and goals 2. In October of 2006, the Office of the Assistant Secretary, Health and Human Services (HHS) identified that financial, technical and practical barriers were the primary reason for non-adoption of electronic systems by physicians 3. This white paper will discuss ways in which these hurdles can be reduced, and how existing problems can be solved. Financial Barriers. Numerous eprescription services exist, both as standalone products and integrated into existing electronic medical record (EMR) systems. The American Medical Association (AMA) estimates that adoption costs of these systems ranges from up to $2,500 per provider per year for standalone systems, and up to $40,000 per provider for a comprehensive EMR system 4. For a facility with several hundred prescribers, costs could easily escalate to several hundred thousand dollars for a non-integrated, standalone system. Technical Barriers. The complexity and sheer volume of medical data is difficult to distill into easy-to-use solutions. Add this to differing expectations from end users whether nursing and allied health staff, physicians, hospital administrators and it is difficult or impossible for IT staff with little or no health care experience to achieve an intuitive, straightforward interface and management system for patient data. Even when systems are in place, users typically utilize only those features which are immediately obvious or require as few steps as possible 5. 2 Markets and Markets. E-Prescribing Market (Electronic Prescription/Erx) By Hardware, Software, Services, End- Users (Medical Group Practice & Hospitals), Products (Integrated & Standalone Systems) & Deployment (Licensed, Web-Hosted & Cloud) Global Forecasts To Jan Available at Accessed 9 Sep Rippen H, Vigilante, K, Higgens A. Summary of the Findings Assessing the Economics of EMR Adoption and Successful Implemention in Physician Small Office Settings. US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evalution; American Medical Association. Zero-In Rx, eprescribing Learning Center. Available at ams/pub/eprescribing/how-much-does-eprescribing-cost.shtml. Accessed 9 Sep Center for Healthcare Research and Transformation. E-Prescribing: Barriers and Opportunities. 24 Aug Available at Accessed 9 Sep Washington, DC Page 2 of 5

3 Practical Barriers. Unfortunately, switching to electronic prescribing is generally not as simple as purchasing a prescribing system and destroying paper prescriptions. Physicians and staff first have to be committed to the transition to eprescribing, have the support to do so, and have realistic expectations about technical difficulties or changes in workflow. Typically, less successful transitions are complicated by unnaturally high expectations for time savings, poor understanding of workflow associated with eprescribing, and the potential for increased cost over the implementation period 5. The Solution. Financial Barriers. Little incentive exists for eprescribing vendors to lower the cost of implementation and maintenance of their systems. With the incentives and impending penalties to prescribe electronically as part of meaningful use measures, vendors know that health care facilities and physicians see a looming an economic burden for noncompliance. Consequently, any cost of eprescribing is typically viewed in light of overall cost of ownership with any incentives subtracted from these costs. This allows vendors, with some creative accounting, to present their products to potential clients as cost savers, when in fact they may even dramatically increase overall operational costs., the parent of a cloud-based, Surescripts-certified 6 electronic prescription solution called DocDoxRx, believes the cost of ownership should not be hidden within clever accounting tricks or dependent on a facility meeting meaningful use criteria to maintain profitability. After all, despite valiant attempts on the part of stakeholders, even early adopters of eprescribing met meaningful use measures only 60% of the time 7. Therefore, DocDoxRx has lowered overhead by reducing the largest non-employee expenditures typically encountered by software firms. By using easily scalable, cloudbased servers and simplifying the eprescribing process with an intuitive interface, these expense categories can be reduced. Even while cloud-based, dedicated servers remain secure within Virtual Private Clouds (VPCs), these are easily scalable to match user demand, providing additional speed, bandwidth, and processing power. In addition, offering end users an enhanced user experience (UX) and improving workflow lowers support costs by decreasing support requests, allowing DocDox to prioritize requests and provide enhanced support at a lower cost. 6 Certification pending. 7 Healthcare Informatics. Through Meaningful Use, eprescribing Grows. 17 May Available at Accessed 9 Sep Washington, DC Page 3 of 5

4 Lowering vendor overhead is the most straightforward way to lower overall cost to the purchaser. In addition, DocDox is committed to maintaining a nimble business architecture, responding quickly to both market environment and user demands, allowing for updates to be pushed to the user without repeat purchases, additional training, or use of limited facility support time. Technical Barriers. Unlike traditional EMR and healthcare software firms rooted in a software mindset, DocDox s executive staff consists of a physician developer and a doctoral social scientist, both of whom understand the needs of a user in the healthcare setting and the best way to present data in a simple format. Ease of use was a priority for the firm even before considering the market. With a physician developer at the helm, physician-centric products are the priority. Purchasers may care about cost and return on investment (ROI), but physicians care about simplicity of use, low training requirements, and a simple workflow. With this in mind, DocDoxRx was created with the express purpose of speed and intuitiveness: quick identity verification; streamlined prescribing, benefits, and lookup processes; and a dramatic reduction in duplication of work are paramount. The advent of eprescribing has also seen a move from telephone or fax requirements often seen with older prescribing methods. For providers currently prescribing on paper, pharmacies require verification of prescriber identifiers, handwriting, or refills. eprescribing reduces this manual verification, and DocDoxRx offers the novel solution of online prescription verification, the first in the industry. By printing unique identifiers on each prescription, the holder or pharmacy can verify the data included on the prescription to ensure that prescriber identifiers match, DEA forgery criteria are met, and drug/dosing data are accurate. In addition to moving toward meeting meaningful use criteria, purchasers have the added benefit of having their prescribers spend one-to-two more hours each day seeing patients, documenting, or administrating, rather than spending time on the phone or at the fax machine responding to pharmacy requests. This equates to the addition of approximately one (1) full-time equivalent (FTE) employee for every ten prescribers transitioned to eprescribing from an older system. Practical Barriers. Implementation of a new software product, especially within a healthcare organization with multiple stakeholders and an inherent political organism, is a challenge. Successful Washington, DC Page 4 of 5

5 implementation requires buy-in from all stakeholders and sufficient education regarding the goals of the product and its role within the organization. Not all EMR companies support eprescribing, and some of the largest are only now considering or actively adding eprescribing into their portfolio. These systems, however, typically require server installation and maintenance by the healthcare institution, and system upgrades are not automatic. Additional user training is then required to support this additional offering, requiring the return of contractors, a potentially painful Go Live, and a period of uncertainty among users while the new system is learned. With this in mind, DocDoxRx was designed to fit a gap in the existing market. Designed to complement, rather than replace, existing workflows and EMR systems, DocDoxRx can be easily integrated with EMR systems, but offers the utility and lightweight implementation of a straightforward, standalone product. Additionally, comprehensive integration can even be timed to occur during or after Go Live, allowing users to start using a simple, intuitive process without the added burden of forcing awkward or difficult transitions in workflow. Because DocDoxRx fits within this gap, user expectations can be easily managed, reducing support requirements and allowing for an agile transition to a new product. And since DocDoxRx resides within the cloud, updates can be released the user with little or no support requirements, server downtime, or facility investment. Summary. Several barriers to eprescription adoption prevent adoption among even facilities and providers who are subject to impending penalties from CMS. Of these, financial, technical, and practical barriers are the greatest. DocDoxRx reduces these barriers by dramatically lowering overall cost of ownership and increasing ROI; providing users with a straightforward, intuitive interface and workflow; and bridging the expectation/reality gap by lowering the implementation burden and enhancing the overall user experience. Washington, DC Page 5 of 5