Ready or Not: Gearing Up for the Expansion of e-prescribing. Kevin Hutchinson President & CEO SureScripts

Transcription

1 Ready or Not: Gearing Up for the Expansion of e-prescribing Kevin Hutchinson President & CEO SureScripts

2 How is the Industry Doing Today?

3 The number of prescriptions in the US is rapidly increasing 823 million visits to physician offices in out of 5 patients who visit a physician leave with at least one prescription 2 65% of the US population use a prescription medication each year 3 About 3 billion prescriptions are written each year 4 The number is expected to rise to 4 billion by Unfilled 0.4 B Renewals 0.5 B 1.4 B New Scripts Refills 1.5 B 3.5 Billion Total Filled Prescription Transactions in ) Pastor PN et. al. Chartbook on trends in the health of Americans. Health, United States, National Center for Health Statistics ) The chain pharmacy industry profile. National Association of Chain Drug Stores ) Agency for Healthcare Research and Quality. MEPS Highlights #11: distribution of health care expenses, ) NACDS estimates

4 The efficiency of the total prescription system is challenged by hundreds of millions of phone calls and faxes One study estimates that indecipherable or unclear prescriptions result in more than 150 million calls from pharmacists to physicians asking for clarification 1 Others estimate the number of prescriptionrelated telephone calls annually at 900 million, citing practices reporting almost 30% of prescriptions required pharmacy callbacks 2,3 Requesting and receiving approval for refills alone, estimated at nearly 500 million per year, adds to the telephone and fax burdons 4 1) Institute for Safe Medicine Practices. A Call to Action: Eliminate Handwritten Prescriptions Within Three Years, ) Forrester Research, ) Medco Health, 1/29/03, via epharmaceuticals 4) NACDS and SureScripts estimates

5 Many resulting errors can be prevented More than 8.8 million adverse drug events (ADEs) occur each year in ambulatory care, of which over 3 million are preventable 1 1 out of 131 ambulatory patient deaths can be attributed to medication error 2 According to the Institute for Safe Medication Practices, many errors result from: Miscommunication due to illegible handwriting Unclear abbreviations and dose designations Unclear telephone or verbal orders Ambiguous orders and fax-related problems Gurwitz, JAMA, % of patients had ADEs 13% were serious 39% of total were either ameliorable or preventable Gandhi, NEJM, % of ADEs preventable 42% of the most serious 1) Center for Information Technology Leadership. The Value of Computerized Provider Order Entry in Ambulatory Settings, 2003 Institute of Medicine, Committee on Quality in Healthcare in America. To Err is Human: Building a Safer Health System, Washington, DC, National Academy Press; ) Gurwitz JH et al. Incidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory Setting, JAMA, 2003; 289: ) Gandhi TK et al. Adverse Drug Events in Ambulatory Care, N Engl J Med, 2003; 348:

6 Electronic Prescribing: Process or Application???

7 What do you think of When You Hear the Term ( e-prescribing )? Who Uses It? What Is It, & What Do You Need?

8 The Number One Problem with Historical Approaches to e-prescribing They did not consider or address the problems and opportunities associated with the overall prescribing process

9 Electronic Prescribing: It s About Improving the Prescribing Process A Closer Look at the Current Prescribing Process, Workflow and Automation Within Physician Practices and Pharmacies

10 The Overall Prescription is Often Overlooked when Thinking About Electronic Prescribing PHYSICIAN PHARMACIST BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart ACQUIRE PRESCRIPTION Drop Off, Phone, Fax, IVR Insurance ID Card Data Input Into Computer AT ENCOUNTER Interview Patient Determine Therapy Write Prescription PROCESS PRESCRIPTION Pharmacy DUR Claim Transmission Order Fulfillment/Dispense Document Prescription in Notes AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues Renewal Authorizations COMMUNICATE Review of Payor DUR Handling of Payor Issues Patient Counseling Renewal Requests

11 The Overall Prescribing Process is Much More Complex Than Writing the Prescription and Dispensing BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart PHYSICIAN PHARMACIST ACQUIRE PRESCRIPTION Drop Off, Phone, Fax, IVR Insurance ID Card Data Input Into Computer AT ENCOUNTER Interview Patient Determine Therapy Write Prescription PROCESS PRESCRIPTION Pharmacy DUR Claim Transmission Order Fulfillment/Dispense Document Prescription in Notes AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues Renewal Authorizations COMMUNICATE Review of Payor DUR Handling of Payor Issues Patient Counseling Renewal Requests

12 The Prescription Workflow in the Physician s Practices is still Predominantly Paper Based Today PHYSICIAN BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart ENCOUNTER Interview Patient Determine Therapy Write Prescription Document Prescription in Notes AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues The majority of practice automation is around patient scheduling (and billing) activities According to ehi, current studies show between 5% 18% of physicians and other clinicians are using electronic prescribing Renewal Authorizations

13 Although A Small Number of Physician s Use e-prescribing, the Act of Writing the Prescription is Mostly Paper Based PHYSICIAN BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart ENCOUNTER Interview Patient Determine Therapy Write Prescription Document Prescription in Notes AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues Renewal Authorizations Automation of prescription writing is estimated by Forrester Research at: 11% in 1-2 physician practices 17% in 3-10 physician practices 38% in 11+ physician practices According to Manhattan Research, 7% of all physicians currently use an electronic prescribing system Source: Brown E. EMRs for Small Physician Groups. Forrester. December, 2003

14 EMR Adoption is Increasing Rapidly Figure 3 Forecast: US PMS and EMR Adoption, 2003 to 2008 Total Revenue (US $ Millions) $1,500 $1,200 $900 $600 $300 PMS systems Total EMR systems (both large and small practices) EMR systems for large groups and institutions EMR systems for small groups $ (US $ Millions) PMS systems $998 $948 $901 $856 $813 $772 $733 $696 EMR systems for large groups $229 $330 $450 $532 $585 $599 $581 $544 EMR systems for small groups $158 $244 $366 $491 $622 $736 $809 $829 Total EMR systems $387 $574 $816 $1,023 $1,207 $1,335 $1,390 $1,373 Source: Forrester Research, Inc. Grand total $1,385 $1,522 $1,717 $1,879 $2,020 $2,107 $2,123 $2,069

15 The majority of e-prescribing still has NO connection to the pharmacy strictly a one-way fax communication Among Those Using an erx System: Do You Currently Use Any Type of Electronic Prescribing System? Does Your Electronic Prescribing System Link Directly to the Pharmacy? 100% 100% 75% No Yes 75% 59% No Yes 67% 50% 93% 89% 50% 25% 25% 41% 33% 0% 7% 11% All Physicians Essential Integrator 0% All Physicians Essential Integrator Data used courtesy of

16 Physicians Indicate a Strong Interest in Using an Electronic Prescribing System in the Next 12 Months Future Intenders All Physicians Essential Integrators 50% 40% 30% 27% 23% 27% 20% 10% 7% 11% 18% 19% 18% 16% 12% 8% 14% 0% "Already Use erx" "Very Interested" "4" "3" "2" "Not Interested" Data used courtesy of

17 Future Drivers* of Electronic Prescribing are Largely Based on Increased Safety & Efficiency Among Those Not Currently eprescribing and Interested in Using erx in the Future: Increased Accuracy 47% Reduced Pharmacy Callbacks 46% Commonly Used Rx in Lists 42% Better Order Entry Devices 40% Verified Formulary Coverage 38% Financial Incentives From Payers Better Interface Between erx and Other Office Systems Ability to Charge Transaction Fee Decreasing Over Time 34% 37% 36% Data used courtesy of *4 or 5 on a 5-Point Scale

18 In Contrast to Physician Practices, Much More Automation Exists in the Pharmacy Today PHARMACIST Pharmacies by law, all perform a Drug Utilization Review (DUR) that queries internal databases to assess the medication prior to dispensing ACQUIRE PRESCRIPTION Drop Off, Phone, Fax, IVR Insurance ID Card Data Input Into Computer Pharmacies are connected to virtually 100% of the payers Check member eligibility and member-specific pharmacy benefits ( formulary management ) Another DUR against payer medication history PROCESS PRESCRIPTION Pharmacy DUR Claim Transmission Order Fulfillment/Dispense COMMUNICATE Over 50% of the pharmacies, or pharmacy software vendors that serve them, have upgraded their systems to exchange prescription information electronically Review of Payor DUR Handling of of Payor Issues Patient Counseling Renewal Requests

19 In fact, some aspects of automation are largely duplicative PHARMACIST Rx Rx Rx Rx Rx Rx Rx Rx Rx Rx OK 1 in 10 Payor DUR result in an alert 88% are immediately overridden by the Pharmacist ACQUIRE PRESCRIPTION Drop Off, Phone, Fax, IVR Insurance ID Card Data Input Into Computer PROCESS PRESCRIPTION Pharmacy DUR Claim Transmission Order Fulfillment/Dispense COMMUNICATE Review of Payor DUR Handling of of Payor Issues Patient Counseling Source: Evaluation of Online Prospective DUR Programs in Community Pharmacy Practice, Journal of Managed Care Pharmacy, Vol. 6, No. 1, Jan./Feb Renewal Requests

20 It s at the Encounter when the Process is Most at Risk for Error and Inefficiencies PHYSICIAN BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart ENCOUNTER Interview Patient Determine Therapy Write Prescription Document Prescription in Notes AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues Renewal Authorizations Illegible handwriting Incorrect medication choice Incorrect dosing regimen Failure to account for drug interactions Failure to account for contraindications Unappreciated allergy history

21 It s at the Encounter when the Process is Most at Risk for Error and Inefficiencies PHYSICIAN BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart Interview Patient ENCOUNTER Determine Therapy Write Prescription Document Prescription in Notes Re-File Chart AFTER ENCOUNTER Clarification Calls Handle Drug Coverage Issues Renewal Authorizations When monitoring the current medication list, prescribers may wonder, What medications don t I know about? When thinking about drug interactions and complex dosing, prescribers might benefit from a resource that understands all the latest knowledge Prescription drug coverage is getting increasingly complex: 3 4 Tier Formularies Multiple Carriers in a Typical Geography 1000s of Plan Variations per Payer And right after the visit, for certain patients, prescribers may wonder, Have they picked up the prescription?

22 It s After the Encounter that Communication Hassles Cause Inefficiencies and Impact Prescriber and Staff Satisfaction PHYSICIAN BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart ENCOUNTER Interview Patient Determine Therapy Write Prescription Document Prescription in Notes AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues Renewal Authorizations Most prescribers and staff rank the renewal authorization process as the most time-consuming, sometimes taking hours of staff time in a small office to handle the phone calls and faxes Chart pulls and re-filling are required for every pharmacy call concerning a prescription Nurses report spending most of their time handling administrative issues when they would rather be in direct patient care More than 80% of clarifications are attributed to: Directions unclear or missing Refill quantity unclear or missing Dosage unclear Drug name/strength unclear Source: Mail-Order Prescriptions Requiring Clarification Contact With the Prescriber: Prevalence, Reasons, and Implications, Richard A. Feifer, Md; Linda M. Nevins, Rn, Mba; Kimberly A. Mcguigan, Phd; Les Paul, Md, Ms; And Jacob Lee, Mba, Rph

23 Physicians and Pharmacists can Establish True Electronic Prescribing Connectivity & Improve the Prescribing Process PHYSICIAN PHARMACIST BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart AT ENCOUNTER Interview Patient Determine Therapy Write Prescription Document Prescription in Notes With a direct two-way exchange of prescription information, physicians and pharmacists can collaborate to improve the prescribing process ACQUIRE PRESCRIPTION Drop Off, Phone, Fax, IVR Insurance ID Card Data Input Into Computer PROCESS PRESCRIPTION Pharmacy DUR Claim Transmission Order Fulfillment/Dispense AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues Renewal Authorizations eprescribing becomes truly electronic - providing significant value to all COMMUNICATE Review of Payor DUR Handling of Payor Issues Patient Counseling Renewal Requests

24 Computer-to-Computer Connectivity between Physicians & Pharmacists Provide the Foundation for Process Improvements PHYSICIAN PHARMACIST BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart AT ENCOUNTER Interview Patient Determine Therapy Write Prescription Document Prescription in Notes AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues Renewal Authorizations Eliminates: Illegible Prescriptions Computer Entry at Pharmacy Transcription Errors Potential Sound-Alike Meds Lost Fax Orders/Paper Jams Undeliverable Prescriptions Prescription Arrives at the Pharmacy Before Patient Leaves the Office ACQUIRE PRESCRIPTION Drop Off, Phone, Fax, IVR Insurance ID Card Data Input Into Computer PROCESS PRESCRIPTION Pharmacy DUR Claim Transmission Order Fulfillment/Dispense COMMUNICATE Review of Payor DUR Handling of Payor Issues Patient Counseling Renewal Requests

25 Computer-to-Computer Connectivity between Physicians & Pharmacists Provide the Foundation for Process Improvements PHYSICIAN PHARMACIST BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart AT ENCOUNTER Interview Patient Determine Therapy Write Prescription Document Prescription in Notes AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues Renewal Authorizations Eliminates phoning and faxing for: Change Requests Prior Authorization Drugs Not Covered Formulary Issues ACQUIRE PRESCRIPTION Drop Off, Phone, Fax, IVR Insurance ID Card Data Input Into Computer PROCESS PRESCRIPTION Pharmacy DUR Claim Transmission Order Fulfillment/Dispense COMMUNICATE Review of Payor DUR Handling of of Payor Issues Patient Counseling Renewal Requests

26 Computer-to-Computer Connectivity between Physicians & Pharmacists Provide the Foundation for Process Improvements PHYSICIAN PHARMACIST BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart ACQUIRE PRESCRIPTION Drop Off, Phone, Fax, IVR Insurance ID Card Data Input Into Computer AT ENCOUNTER Interview Patient Determine Therapy Write Prescription Document Prescription in Notes Drastically Reduce Phone Calls and Faxes Complete Renewals in Seconds, Not Hours More Time for Patient Care and Counseling PROCESS PRESCRIPTION Pharmacy DUR Claim Transmission Order Fulfillment/Dispense AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues Renewal Authorizations COMMUNICATE Review of Payor DUR Handling of Payor Issues Patient Counseling Renewal Requests

27 Computer-to-Computer Connectivity between Physicians & Pharmacists Provide the Foundation for Future Advancements PHYSICIAN PHARMACIST BEFORE ENCOUNTER Schedule Patient Pull Patient s Chart Review Chart AT ENCOUNTER Interview Patient Determine Therapy Write Prescription Document Prescription in Notes Imagine the Two-Way Exchange of Additional Clinical Data Including: Lab Results Medication History Immunizations ACQUIRE PRESCRIPTION Drop Off, Phone, Fax, IVR Insurance ID Card Data Input Into Computer PROCESS PRESCRIPTION Pharmacy DUR Claim Transmission Order Fulfillment/Dispense AFTER ENCOUNTER Re-File Chart Clarification Calls Handle Drug Coverage Issues Renewal Authorizations The Possibilities for Continued Collaboration Once Connected are Endless COMMUNICATE Review of Payor DUR Handling of Payor Issues Patient Counseling Renewal Requests

28 The Medicare Bill and Electronic Prescribing Where do We go From Here?

29 So What are the Critical Next Steps? The design of efficient ways to exchange information between Physicians and Pharmacies that leverage existing technology Ensure we leverage the skills, experience, and knowledge of the healthcare professionals involved in the prescribing process the pharmacist and the physician Close involvement with Standards Setting Committee (NCVHS) during next 2 years Development of affordable technology solutions for physicians, focused on easy to implement applications Preservation of physician and patient choice and prohibition of commercial messaging that would interfere with decision making Funding public and private of technology solutions not only for physicians, but also for pharmacists The development of a long-term, incremental approach to building and delivering medication history

30 How Far Along is e-prescribing Today? SureScripts Strategy, Guiding Principles and Current Focus

31 SureScripts was Formed to Improve the Prescribing Process in Ways that Serve the Collective Interest of Patients, Physicians and Pharmacists Incorporated in August 2001 Formed by the two associations that represent the 55,000 pharmacies in the US: NCPA (independents) NACDS (large chains) Organized to support a strategic industry alliance to: Improve the overall prescribing process: Safety Efficiency Quality of Care Enable true electronic connectivity between physicians and pharmacies Over 50% of the nation s pharmacies have completed the certification process required to connect SureScripts Messenger Services and by summer that number is expected to exceed 75%

32 SureScripts Guiding Principles Ensure Enhance Promote Neutrality Work in collaboration with industry stakeholders Don t endorse a particular approach Don t compete with end user applications Open Access Adherence to industry standards including NCPDP Process for Certified Solutions Providers Implementation Guide Patient Safety Deliver prescriptions in a legible format Eliminate duplicate entry of prescription information Eliminate telephone orders for similar sounding medication names Professional Relationship: Physicians and Pharmacists Enhance DUR based on roles of physicians and pharmacists Medication therapy is increasingly complex Benefits demonstrated in partnerships with other healthcare professionals (i.e., lab techs, radiologists) Choice Provide patient choice of pharmacy Ensure physician choice of therapy Allow application systems of choice Innovation Foster unique alliances Create an infrastructure for secure communications Drive innovation through education Adoption Provide research on trends, processes, and effective approaches for the use of electronic prescribing Act as cross industry coordinator of community-based adoption efforts

33 Certification Requirements are the Focus of Discussion Aggregator shall not, nor permit any person or entity, directly or indirectly, to use, alter, or modify SureScripts Messenger Service in any manner that would encourage a physician or a patient to prescribe or use a specific pharmaceutical, or to use a specific pharmacy, as compared to other pharmaceuticals or pharmacies. Aggregator shall not use any means, program, or device, or permit any other person to use any means, program or device, including, but not limited to, advertising, instant messaging, and pop up ads, to influence or attempt to influence, through economic incentives or otherwise, the prescribing decision, as defined below, of a physician at the point of care, as defined below, if (i) such means, program, or device (as described above) is triggered by, initiated by, or is in specific response to, the input, selection, and/or act of a physician or his/her agent prescribing a pharmaceutical or selecting a pharmacy for a patient and (ii) that prescription will be delivered via SureScripts Messenger Service. Prescribing decision means a physician s decision to prescribe a certain pharmaceutical or direct the patient to a certain pharmacy. Point of care shall mean the time that a physician or his/her agent is in the act of prescribing a pharmaceutical for a patient. Notwithstanding the above, Aggregator or its affiliates may show information regarding a payer s formulary so long as (i) all pharmaceuticals and pharmacies available are disclosed to the physician, and (ii) nothing is designed to preclude or make more difficult the act of a physician or patient from selecting any particular pharmacy or pharmaceutical. Any violation of this Paragraph shall be deemed a material breach of this Agreement, and SureScripts shall have a right of termination under Paragraph 4.b. hereof. SureScripts shall have the right to audit Aggregator s use of SureScripts Messenger Service in order to ensure compliance with this Paragraph. manner that would encourage a physician or a patient to prescribe or use a specific pharmaceutical, or to use a specific pharmacy, as compared to other pharmaceuticals or pharmacies. advertising, instant messaging, and pop up ads, to influence or attempt to influence, through economic incentives or otherwise, the prescribing decision, as defined below, of a physician at the point of care, response to, the input, selection Notwithstanding the above, Aggregator or its affiliates may show information regarding a payer s formulary so long as (i) all pharmaceuticals and pharmacies available are disclosed to the physician, and (ii) nothing is designed to preclude or make more difficult the act of a physician or patient from selecting any particular pharmacy or pharmaceutical.

34 SureScripts does NOT develop, sell, or endorse electronic prescribing software, but works with existing technology vendor to certify and connect their solutions to the network Rx Rx What the Physician Needs: 1. Electronic Prescribing Software that has been certified by SureScripts 2. An Internet connection SureScripts provides the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information possible What the Pharmacy Needs: 1. Pharmacy management software has been certified by SureScripts

35 Over 50% of the nation s pharmacies are certified and connected to the network, and are at various stages of pharmacy activation SureScripts Messenger Services, is the Nation s Largest Electronic Prescribing Network

36 Physician Activation is Progressing Physician Software Vendors Now Contracted with or Connected to SureScripts: S A4 Health Systems Allscripts Axolotl DrFirst MediNotes Lighthouse McKesson MDanywhere Technologies MedicWare HealthVision InstantDx MedPlus MobiHealth HealthRamp Spring Medical Synamed As of April 30, 2004

37 SureScripts has a Unique Collaborative Community Approach to Raise Awareness & Encourage Adoption of Electronic Prescribing by Working With Local Stakeholders Community Adoption Program (CAP) Overview Local Market Assessment Stakeholder Partnerships Prescriber Adoption Program Pharmacy Implementation Communications And Outreach Impact Study, Results, Measurement The CAP is a community-based, grassroots program that seeks to involve all local healthcare stakeholders: Medical societies/associations Healthcare systems Health quality organizations Payors Legislators Regulators

38 Health Systems, Quality Groups, and Medical Societies are getting increasingly involved in the rollout process for physicians Cleveland Clinic, Johns Hopkins, Lifespan, MedStar AAFP, Massachusetts Medical Society, San Diego County Medical Society Foundation Rhode Island Quality Institute ( RIQI ), North Carolina Healthcare Information and Communications Alliance ( NCHICA )

39 *As of April 22, 2004 The SureScripts Regulatory Assessment & Intervention Process has cleared the way for SureScripts and its partners in 30 states*

40 Community Adoption Programs & SureScripts network will be active in over two dozen states by the end of 2004 Geographies are selected based on the regulatory environment pharmacy connectivity and prescription volume.

41 Physician & Prescription Volume Distribution across 2004 Target CAP Markets Dec 10 6 Physicians Total Dec 10 3 MDs Total Physicians Number of physicians in 2004 CAP markets 40, , ,000 Total Prescription Volume in 2004 CAP Markets 930M 1.5B 1.8B Key Decile 10 6 physicians generate 50% of all Rxs Decile 10 3 physicians generate 80% of all Rxs

42 There is Still Much to Learn About e-prescribing SureScripts Prescription Process Validation Research (PPV)

43 Prescription Process Validation 2003 Snapshot Summary 100% interest in a neutral gateway approach to electronic prescribing Significant staff and physician time savings were anticipated with automation of renewals There is a value for automating new scripts based partially on time savings to busy physicians Renewals and new scripts should be pitched together but could be rolled out in series Drug interaction checking against practice data will enhance adoption Formulary management information at the plan level will enhance adoption An understanding of future services will enhance adoption Physicians judged a fair price expressing value ( $75 median / $97 average per provider per month ) Physicians want to hear about electronic prescribing from other physicians and from pharmacists

44 Prescription Process Validation 2004 Big Questions Physician / Pharmacist Collaboration: What opportunities exist for collaboration between physicians and pharmacists to improve the prescription process? Explore new areas for communications and services How can technology help move pharmacy closer to the clinical process? Beyond the Basics: How should advanced electronic prescribing functions be implemented to improve the prescription process? Consider patient compliance, medication history, formulary management, others Work with physicians, community pharmacy, technology vendors and other stakeholders

45 Prescription Process Validation 2004 Big Questions ( cont d ) Total System Impact: How does electronic prescribing impact efficiency, safety and care quality? Quantify ROI and quality impacts for basic and advanced functions Focus on pharmacies and physician practice ( health plans and health systems opportunistically ) Enabling and Integrating the EHR: How can automating the prescription process best be integrated with the electronic health record and other clinical technologies? Identify the implementation roadmap and customer migration strategies from basic prescribing to EHR Identify EHR features that can improve the prescription process

46 Summary Takeaways

47 Why now? The problems of past prescribing automation efforts have been addressed In the past Very few pharmacies were directly connected to physician practices Electronic communications meant faxes Only half the problem was being addressed writing new scripts Software didn t support the workflows in the practice There were few real benefits for most practices There wasn t a future path to additional benefits Automation was being driven by a few small software vendors But now By year s end, over 75% of US pharmacies will be connected into a single network and growing Computer applications can communicate directly with each other Renewals can be automated in addition to new scripts Software integrates with existing practice systems and smoothes office workflow Most practices will save physician and staff time as well as improve patient safety Collaborate with pharmacies on patient compliance and other future functions State-wide initiatives involving all major stakeholders seek to improve the Rx process

48 Electronic Prescribing: Much has been accomplished Pharmacies are connected 50%+ connected for electronic prescribing growing to 75% by mid-year Near 100% of pharmacies are connected electronically to PBMs and Payers for the Drug Utilization Review (DUR) and electronic Claims Adjudication process. Pharmacy participation working with SureScripts to drive physician adoption is exceeding original expectations. Physician adoption is at the tipping point Physician Technology Vendors representing thousands of physicians are establishing connectivity to the same national electronic prescribing network EMR use and the rate of adoption rapidly increasing, ERx use is highest about smaller practices - Forrester Research, Dec States are removing roadblocks to electronic prescribing Few problem areas remaining (30 states cleared to date) Neutrality and Choice are critical to ensure the successful adoption and use of electronic prescribing Physician choice of therapy and patient choice of pharmacy