B A R B A R A J. L I M A N D R I, D N S C, A P R N, B C

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1 B A R B A R A J. L I M A N D R I, D N S C, A P R N, B C L I N F I E L D C O L L E G E P O R T L A N D D I A L E C T I C A L B E H A V I O R T H E R A P Y P R O G R A M

2 LEARNING OUTCOMES By the completion of this program the participants will be able to: 1. Identify standards and federal requirements for electronic prescribing. 2. Describe elements of electronic prescribing that meet the health care reform initiative. 3. Describe the limitations of electronic prescribing. 4. Compare selected electronic prescribing programs for efficacy, safety, convenience, and cost.

3 OVERVIEW Approximately 3 billion prescription written annually in the US with 30% pharmacy call backs and 20% never taken to the pharmacy Approximately 7000 deaths each year due to medication errors due to: Handwriting illegibility Missed drug-drug interactions Unrecognized drug allergies

4 WHAT IS E-PRESCRIBING? The electronic transmission of prescriptions from prescriber to pharmacy Usually involves an Internet application that may articulate with or be a part of the electronic health record or may be a stand alone product Application is provided by a qualified prescribing system

5 HISTORY OF EPRESCRIBING Institute of Medicine To Err is Human, 1999 activated interest in technology to improve safety Medicare Prescription Drug Improvement and Modernization Act of 2003 (MIPAA) Required electronic prescribing as part of Medicare Part D Established the National Council for Prescription Drug Programs SCRIPT standards for electronic prescribing

6 HISTORY OF E-PRESCRIBING Economic Stimulus Plan 2009 Medicare Improvements for Patients and Providers Act established incentives for Will convert to penalties in 2012 Multiple vendors for Electronic Health Records articulated with prescribing

7 EXEMPTIONS FROM E-PRESCRIBING Having limited prescribing activity during the sixmonth time frame; Living in an area where regulations prevent e- prescribing; E-prescribing only for types of patient visits that do not count toward the 10-order requirement; and Delaying the purchase of an e-prescribing system because of plans to participate in the incentive program for the meaningful use of electronic health records.

8 QUALIFIED PRESCRIBING SYSTEM Accomplishes the following functions Generating a list of active medications from pharmacy Selecting, prescribing, printing and transmitting prescriptions after conducting a safety check Providing information about lower cost alternatives Providing formulary or tiered products for the client s insurance plan & authorization requirements

9 STANDARDS FOR E-PRESCRIBING Certification Commission for Health Information Technology (CCHIT): non profit to certify electronic health records systems SureScripts certifying eprescribing products and vendors

10 BENEFITS OF EPRESCRIBING Eliminates handwriting and abbreviation issues with resultant errors Creates electronic records to insure availability of information Provides safety checks: allergies, interactions, dosing errors, therapeutic duplication, pregnancy issues Maintains accurate, comprehensive drug database & insurance info

11 BENEFITS CON T Provides formulary and insurance information Improves accuracy of exchange between prescribers & pharmacists Expedites prescription refill requests Reduces healthcare costs by improving efficiency & choices Permits multiple prescribers to share information

12 BARRIERS TO E-PRESCRIBING Cannot use for controlled drugs No feedback that prescription received by the pharmacy Complex formulary rules Difficulty maintaining medication history Costs Technical support in learning & maintenance

13 FUTURE DEVELOPMENT Built in prior authorization request Secure controlled drug transmission Improved decision support Pharmacy confirmation of prescription Ability to determine if client filled the prescription

14 CERTIFIED VENDORS AdvanceNet AdvancedMD Allscripts* DrFirst First DataBank GE Healthcare *Free versions available Gold Standard MacPractice NEPSI* Practice Fusion* RxNT SigmaCare SureScripts*

15 WHAT TO LOOK FOR IN A PROGRAM? Is it a stand alone or does it require an EMR? Is it compatible with any EMR or does it require a particular product? How often is the system maintained and how often does the system go down? What are the provisions to the provider when it is down? How financially stable is the vendor? If it goes out of business, how will records be transferred?

16 WHAT TO LOOK FOR IN A PROGRAM? How fast an Internet connection is necessary? How fast does the program upload? If there is a cost for the system, will the efficiencies outweigh the costs over time? Is it Sure-Scripts/RxHub compatible? Is it a qualified program for Medicare? Does the system generate personal favorites and remember common sigs?

17 WHAT TO LOOK FOR IN A PROGRAM? Does the system permit splitting prescriptions to retail pharmacies and mail order? How often is the database updated for new medications, drug-drug interactions, formulary changes, etc? Can a provider use in different office locations? Can providers securely share information for call coverage?

18 WHAT TO LOOK FOR IN A PROGRAM? What is the common learning curve for the program and how does it compare in ease of entry and use to other programs? (How many clicks to complete the task?) Is there a pharmacopeia included in the program? Does it cost extra? Is there an estimated cost of medication included?

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