THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE

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1 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011

2 neutrality transparency physician and patient choice open standards collaboration privacy

3 THE EVOLUTION OF E-PRESCRIBING - -

4 INTRODUCTION A Letter from the President and CEO Harry Totonis 2

5 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 CONTENTS Introduction Part 1: Electronic Prescribing Use Part 2: Electronic Prescribing Adoption Part 3: About Surescripts IBC IBC 3

6 INTRODUCTION Executive Summary National Progress Report Year 2011 At-A-Glance More Than One in Two Office-based Physicians E-Prescribed in 2011, Up from One in Ten in 2008 (Figure 1) Figure 1: 57 million 269 million 75% 96 million 474 million 570 Million Prescriptions Were Routed Electronically - (Figure 2) , Figure 2: 156,000 Before % 85% 91% 91% 69.5 Rx 69.5 Rx Picked Up Picked Up 234, , With 76.5 Rx 76.5 Rx Picked Up Picked Up E-Prescribing Is Helping to Improve First Fill Medication Adherence. Savings Are Estimated Up to $240 Billion over 10 Years - (Figure 3) Figure 3: 4

7 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 ESTIMATED MEANINGFUL USE ACHIEVEMENT AS OF Q Number of Prescribers in 2008 Total 39, to 60% High and Lowest Meaningful Use Estimates by Specialty (Highest) Family Practitioner (Lowest) Ophthalmologist EHR vs. Standalone E-Prescribing EHR Standalone E-Prescribing Figure 4: Percent of Prescribers Meeting Meaningful Use for E-Prescribing Measure (Stage 1)* Close to 60 Percent of Physicians Who Started E-Prescribing in 2008 Meet the Stage 1 Meaningful Use E-Prescribing Measure. 38 Percent Would Meet the Proposed Stage 2 E-Prescribing Measure Internist Internist Internist Internist 45% 45% 81% 81% E-Prescribing Adoption Rates Register Significant Growth by Physician Specialty and Practice Size Family Practice Family Practice Family Practice Family Practice Specialty INTERNIST In 2011, Approximately 47% 47% Two-Thirds of Internists, 75% 75% Internist Internist Internist Family Practice Physicians and Cardiovascular Disease Physicians Were E-Prescribers 45% 45% 81% 81% Internist Internist Internist Gastroenterology Gastroenterology 45% 45% 38% 38% The Three Smallest Practice Sizes Led E-Prescribing 31% 31% Adoption in Year to Year 2011 Practice Size 2010 Year to Year 2011 Internist Internist Gastroenterology Gastroenterology 81% 81% 76% 76% Solo Solo Solo Solo SOLO PRACTITIONER 31% 31% 42% 42% Family Practice Family Practice Family Practice Family Practice Solo Solo Solo Solo 31% 31% Solo Solo Solo Solo 53% 53% FAMILY PRACTICE Family Cardiovascular Practice Family Cardiovascular Practice 47% 47% Family Cardiovascular Practice Family Cardiovascular Practice 75% 75% 2 TO 5 42% 42% 53% 53% CARDIOVASCULAR DISEASE Gastroenterology Gastroenterology 47% 49% 47% 49% Gastroenterology Gastroenterology 75% 76% 75% 76% 6 TO 10 42% 42% 44% 44% 53% 53% 55% 55% Figure 5: 38% 38% Gastroenterology Gastroenterology Gastroenterology Gastroenterology 38% 38% 76% 76% 76% 76% 44% 44% Figure 6: 44% 44% 34% 34% 55% 55% 55% 55% Cardiovascular Cardiovascular Cardiovascular Cardiovascular 49% 49% 76% 76% 34% 34%

8 INTRODUCTION E-Prescriber Growth in the U.S in 10 Physicians E-Prescribe 1 in 4 Physicians E-Prescribe 1 in 3 Physicians E-Prescribe

9 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 In 2011, 58 Percent of Office-Based Physicians Used E-Prescribing 2011 More than 1 in 2 Physicians E-Prescribe

10 PART 1: ELECTRONIC PRESCRIBING USE The Three Components of E-Prescribing 1. P rescription benefit and formulary information 2. Medication history 3. E lectronic routing MEDICATION HISTORY BENEFIT INFORMATION ELECTRONIC ROUTING 8

11 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 The Impact of E-Prescribing on Medication Adherence E-Prescribing Improves First Fill Adherence 10 Percent When Compared to Paper Prescriptions E-Prescribing Can Produce Significant Health Care Savings Without With 69.5 Rx Picked Up 69.5 Rx Picked Up 76.5 Rx Picked Up 76.5 Rx Picked Up Ken Majkowski, PharmD, $140 $240B William H. Shrank, MD, MSHS 9

12 PART 1: ELECTRONIC PRESCRIBING USE PRESCRIPTION BENEFIT INFORMATION - OPPORTUNITY FOR PRESCRIBERS TO USE BENEFIT INFORMATION INCREASED 87 PERCENT KEY STATISTICS Prescription Benefit Responses 87% 789 million 125% 422 million 348% 188 million 54 million Contributing Factors: Active Prescribers (pg. 20) 74, , , ,000 Number of E-Prescribing Applications Certified for this Service (pg. 15)

13 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 The Value of Prescription Benefit Information - PATIENT ENCOUNTER 1 2 Request for patient information sent to payer & pharmacy Response to request for information sent to physician 3 PBM/PAYER Provides Patient: PHYSICIAN PHARMACY Processes: 6 Prescription routed to pharmacy Prescription renewal and request response Benefit Information Enables: 11

14 PART 1: ELECTRONIC PRESCRIBING USE MEDICATION HISTORY - MEDICATION HISTORY WAS AVAILABLE FOR ONE IN THREE OFFICE VISITS IN 2011 KEY STATISTICS Medication Histories Delivered % 395 million % 230 million % 81 million million Contributing Factors: Active Prescribers (pg. 20) 74, , , ,000 Number of E-Prescribing Applications Certified for this Service (pg. 15)

15 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 PRESCRIPTION ROUTING MORE THAN 570 MILLION PRESCRIPTIONS WERE ELECTRONICALLY ROUTED IN 2011, A 75 PERCENT INCREASE OVER 2010 KEY STATISTICS Prescription Routing Transactions NEW PRESCRIPTIONS PRESCRIPTION RENEWAL RESPONSES 75% 96 million 474 million 57 million 269 million 13 million 35 million 156 million 55 million Contributing Factors: Active Prescribers (pg. 20) 74, , , ,000 Number of E-Prescribing Applications Certified for this Service (pg. 15) Connected Community Pharmacies (pg. 23) 76% 85% 91% 91% - 13

16 PART 1: ELECTRONIC PRESCRIBING USE How to Improve the Use of Prescription Renewals PRESCRIBERS Take advantage of the efficiency of electronic prescription renewal requests. Respond to electronic renewal authorization requests promptly. PHARMACIES Report issues with electronic renewals or e-prescriptions to your pharmacy software vendor. Ensure that information in your pharmacy system about local prescribers is up-to-date. - 14

17 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 EHR VS. STANDALONE E-PRESCRIBING SOFTWARE - EIGHTY-TWO PERCENT OF ACTIVE PRESCRIBERS USE EHR TO E-PRESCRIBE KEY STATISTICS - Vendor Software Certified and Deployed for E-Prescribing EHR STANDALONE Medication History Prescription Benefit Prescription Routing All Three Services Percentage of Active Prescribers Using EHR vs. Standalone E-Prescribing Software % EHR % EHR % EHR % EHR 15

18 PART 1: ELECTRONIC PRESCRIBING USE Industry Collaboration Drives Continuous Improvement in Electronic Prescription Quality QUALITY TIP 1: To avoid confusion and reduce pharmacy call backs for clarification, prescribers should not split directions between Sig and Notes Fields. Issue: - 1 PO DAILY, Take one tablet twice a day. QUALITY TIP 2: Most drug descriptions should typically include the complete drug name, strength, strength units and dosage form (if applicable) QUALITY TIP 3: Quantity qualifiers must be correctly associated with drug descriptions. Where possible, quantity along with the quantity qualifier should reflect the actual metric quantity. Example of Improper Use: Use Amoxicillin 250mg/5ml, 150 ml For more information about Surescripts efforts to raise industry quality, contact the Surescripts Quality Office and visit our blog at 16

19 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 Future of E-Prescribing - EPCS: Electronic Prescriptions for Controlled Substances Prescribers must: Software vendors and pharmacies that have developed their own software systems must: Pharmacies must: Electronic Prior Authorization for Prescription Drugs Collaboration on Standardized Procedures and Proper Use of epa Needed for all Stakeholders Provider Pharmacy Payers Alignment on Standards Will Help Move Clinical Interoperability Forward

20 PART 2: E-PRESCRIBING ADOPTION The Class of 2008: Tracking the Growth of Meaningful Use 2008 E-PRESCRIBING ADOPTION BY QUARTER Q ,626 Q ,074 Q ,092 Q ,006 Total 39,798 Figure 1: E-PRESCRIPTIONS PER ACTIVE E-PRESCRIBER (AVERAGE PER MONTH) Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Figure 2: SUMMARY - BACKGROUND - - METHODS RESULTS - 18

21 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 ESTIMATED PERCENT OF EARLY USERS OF E-PRESCRIBING BY PHYSICIAN SPECIALTY WHO HAVE SUCCESSFULLY MET THE STAGE 1 MEANINGFUL USE E-PRESCRIBING MEASURE Specialty Number of Prescribers Average Utilization (Monthly) Percent of Prescribers Meeting Meaningful Use (Stage 1) Family Practitioner 316 Internist 303 Pediatrician 157 General Practitioner 139 Cardiovascular Disease 135 Obstetrician/Gynecologist 91 Ophthalmologist 62 Psychiatrist Gastroenterologist Obstetrician/Gynecologist Other 95 EHR vs. Standalone E-Prescribing EHR 222 Standalone E-Prescribing 144 Figure 3: DISCUSSION - 19

22 PART 2: E-PRESCRIBING ADOPTION PRESCRIBERS - FIFTY-EIGHT PERCENT OF OFFICE-BASED PHYSICIANS E-PRESCRIBE KEY STATISTICS - Prescribers Routing Prescriptions 67% 390, % 156,000 50% 234,000 74, Contributing Factors: % of Active Prescribers Using EHR (pg. 15) 63% 70% 79% 82% 20

23 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 Family Practice Family Practice Family Practice Family Practice E-PRESCRIBING PHYSICIANS BY SPECIALTY* Top three specialty groups have adoption and use rates at or above 75 percent. 47% 47% 75% 75% Internist Internist Internist Internist 45% 45% Specialties with Highest Rates of E-Prescribing Adoption 81% 81% Specialty Internist Internist 2010 Year-to-Year Internist Internist 2011 Gastroenterology Gastroenterology Gastroenterology Gastroenterology INTERNIST 45% 45% 38% 38% 81% 81% 76% 76% Family Practice Family Practice Family Practice Family Practice FAMILY PRACTICE Family Cardiovascular Practice Family Cardiovascular Practice 47% 47% Family Cardiovascular Practice Family Cardiovascular Practice 75% 75% CARDIOVASCULAR DISEASE Gastroenterology Gastroenterology 47% 49% 47% 49% Gastroenterology Gastroenterology 75% 76% 75% 76% Specialty Group % E-Prescribing in % 38% Dentist/Oral Surgeon 44 Dermatologist 62 Endocrinology & Metabolism Gastroenterology Gastroenterology Gastroenterology Gastroenterology 78 Gastroenterology 69 General Practitioner 43 38% 38% General Surgeon 36 Nephrologist 67 Neurologist 57 Cardiovascular Cardiovascular Cardiovascular Cardiovascular Non-Alleo/Osteopaths 39 Obstetrician/Gynecologist 52 49% 49% Oncologist/Hematologist 58 Optometrist/Ophthalmologist 67 Orthopedic Surgeon 43 Other Pediatrics Cardiovascular Cardiovascular Cardiovascular Cardiovascular 43 Other Specialty 34 Other Surgery 31 49% 49% Otolaryngologist 61 Pediatrician 59 Podiatrist 55 Psychiatrist 35 Psychologist 68 Urologist 68 76% 76% 76% 76% 76% 76% 76% 76% 21

24 Solo Solo 31% 31% Solo Solo 22 PART 2: E-PRESCRIBING ADOPTION 31% 31% Solo Solo 42% 42% E-PRESCRIBING PHYSICIANS BY PRACTICE SIZE* 31% 31% Solo Solo 42% 42% Three smallest practice sizes lead adoption in Practice Size Solo Solo 2010 Year-to-Year Solo Solo 2011 SOLO PRACTITIONER 2 TO 5 6 TO TO TO % 31% 42% 42% 44% 44% 31% 31% 42% 42% 44% 44% 42% 42% 44% 44% 34% 34% 42% 42% 44% 44% 34% 34% 44% 44% 34% 34% 31% 31% 44% 44% 34% 34% 31% 31% 34% 34% 31% 31% 22% 22% 34% 34% 31% 31% 22% 22% 31% 31% 22% 22% 31% 31% 22% 22% Solo % 53% 53% 53% Solo Solo Solo 53% 53% 55% 55% 53% 53% 55% 55% 53% 53% 55% 55% 53% 53% 55% 55% 55% 55% 35% 35% 55% 55% 35% 35% 35% 35% 27% 27% 35% 35% 27% 27% 35% 35% 27% 27% 35% 35% 27% 27%

25 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 PHARMACIES COMMUNITY AND MAIL ORDER NINETY-ONE PERCENT OF THE NATION S COMMUNITY PHARMACIES ACCEPT E-PRESCRIPTIONS KEY STATISTICS - Community Pharmacies Connected for Precription Routing CHAINS INDEPENDENTS 14,000 16,000 17,600 10,000 36,000 39,000 39,600 39, Contributing Factors: Community Pharmacies Connected 76% 85% 91% 91% Independent Pharmacies Connected 46% 62% 73% 79% - 23

26 PART 2: E-PRESCRIBING ADOPTION PAYERS - TWENTY-FOUR STATES SHOWED INCREASES IN ACCESS TO PRESCRIPTION INFORMATION IN 2011 WHEN SELECTING MEDICATION THERAPY KEY STATISTICS PERCENTAGE OF PATIENTS FOR WHOM PAYERS CAN PROVIDE PRESCRIPTION BENEFIT AND MEDICATION HISTORY INFORMATION % 81 90% 71 80% 61 70% 51 60% 41 50% 31-40% 21-30% OR WA CA NV ID UT AZ MT WY CO NM ND SD NE KS OK TX MN IA MO AR LA WI MS IL MI IN OH KY TN AL GA WV SC NC VA PA NH VT NY NJ DE MD DC ME RI CT MA AK HI FL PR 24

27 THE NATIONAL PROGRESS REPORT ON E-PRESCRIBING AND INTEROPERABLE HEALTH CARE YEAR 2011 PART 3: ABOUT SURESCRIPTS About Surescripts The Surescripts Electronic Prescribing Network - Acknowledgements - For more information about Surescripts, visit and follow us at twitter.com/surescripts. Designed by Curran & Connors, Inc. /

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