All About E-Prescribing V

Transcription

1 All About E-Prescribing V

2 E-Prescribing What is E-Rx? To E-Rx or Not to E-Rx- Pros/Cons Medicare Incentives How does E-Prescribing Work? Making the Adoption Decision Selecting a Vendor Resources

3 E-Prescribing Tools at Your Fingertips Clinician's Guide to E-Prescribing e-prescribing_clinicians_guide_final.pdf Medicare's E-Prescribing Guide pdf Surescripts- Rx Hub

5 What is E-Prescribing? Electronic generation, transmission and filling of a prescription (replacing paper and faxed forms) Allows MD, NP, or PA to electronically transmit a new prescription or renewal authorization to a community or mail order pharmacy

6 What are My Choices for E-Prescribing Systems? Stand-alone system In house, software acquired and downloaded to onsite computer system Through the internet, connecting to an application service provider (ASP) E-Prescribing as part of an EMR system

8 To E-Rx or Not to E-Rx- Pro Increase Safety and Quality of Care Illegibility-decrease medical errors Oral miscommunication- Pharmacy/Office Warning/Alert System- Drug/Drug Interactions Access Patient Medical and Medication History

9 To E-Rx or Not to E-Rx- Pro Decrease Phone calls Handwritten legibility Mistaken manual prescription choices Formulary benefits

10 To E-Rx or Not to E-Rx- Pro Automate the renewal/authorization process Pharmacy generated renewal Prescriber reviews approves/denies Responds electronically All steps documented

11 To E-Rx or Not to E-Rx- Pro Increase patient convenience, compliance Decrease amount of unfilled prescriptions Decrease waiting time Prescribers can view patient compliance in seeing when patients pick up prescriptions

12 To E-Rx or Not to E-Rx- Pro Improve formulary adherence, low cost Generic/ Low cost substitutions can be encouraged Low cost can improve compliance

13 To E-Rx or Not to E-Rx- Pro Prescribing Mobility Mobile Devices Wireless Network Ability to write prescriptions anywhere

14 To E-Rx or Not to E-Rx- Pro Improved drug surveillance Ability to do queries and reports Find patients during drug recalls See frequency/types of medication the providers are prescribing

15 To E-Rx or Not to E-Rx- Con Return on Investment Even free E-Rx may face costs Large practices see positive ROI is less time Lack of a clear ROI

16 To E-Rx or Not to E-Rx- Con Change/Workflow Staff Compliance Time Adequate planning, training, support Understanding the staff roles may change

17 To E-Rx or Not to E-Rx- Con Controlled Substances DEA currently prohibits electronic transmission of Schedule II drugs Forces prescribers to use different workflow

18 To E-Rx or Not to E-Rx- Con Hardware/Software Selection Busy practices Not all staff know enough about IT

19 To E-Rx or Not to E-Rx- Con Connectivity Not all pharmacies are connected to Surescripts-RxHub Pharmacies reluctant to switch on until more prescribers on board Not all payers are connected to give patient formulary and eligibility or information is not complete

20 To E-Rx or Not to E-Rx- Con Medication History Not all systems contain patient medical history EMR could supplement this material

21 To E-Rx or Not to E-Rx- Con Patient Acceptance Patients that travel want paper Afraid of change Comfort factor of paper prescriptions

22 E-Prescribing for Dummies What is E-Rx? To E-Rx or Not to E-Rx- Pros/Cons Medicare Incentives How does E-Prescribing Work? Making the Adoption Decision Selecting a Vendor Resources

23 What is the Medicare E-Rx Incentive? For 2009, e-prescribing incentive amounts will be 2% of the total estimated allowed charges for professional services covered by Medicare Part B and furnished by an eligible professional during the reporting period (one calendar year).

24 Incentive Requirements To be eligible, the estimated allowed Medicare Part B charges for the e- prescribing measure codes are at least 10% of the total Medicare Part B allowed charges. To be a successful e-prescriber, report the e-prescribing measure on at least 50% of the applicable cases during the reporting year. Have a Qualified E-Prescribing System.

25 How to Report the E-Rx Program Measure: Step 1 Bill on one of the following denominator codes: G0101 G0108 G0109 These codes need to make up at least 10% of the total Medicare Part B allowed charges to receive the incentive

26 How to Report the E-Rx Program Measure: Step 2 Then report one of the three G-codes listed below on more than 50% of applicable cases for the numerator. G8443- used a qualified e-rx system for all of prescriptions G8445- had a qualified e-rx system, but didn t generate any prescriptions during this encounter G8446- had a qualified e-rx system, but either prescribed narcotics/controlled substances, law requires phone or print prescription, patient asked for phone or print, pharmacy can t receive electronic transmission.

27 Medicare Incentive Payment: Carrot and Stick Approach Carrot % incentive % incentive % incentive 2014 unclear Stick no penalty % penalty % penalty 2014 and beyond 2% penalty

29 How Does E-Prescribing Work? Rx Prescriber 1. Select drug and connect to Payer to determine eligibility SureScripts/ RxHub Direct Connections Health Plans 2. Formulary/History brought to provider 3. Once Rx written, drug interactions are checked

30 How Does E-Prescribing Work? Rx Prescriber SureScripts/ RxHub Direct Connections Rx Pharmacy 4. Send Rx to patient s pharmacy of choice (The network Rx s are routed for online pharmacies) 5. Renewal sent back to provider SureScripts provides two-way electronic connectivity to 95% (online or in process) of pharmacies for the transmission of new prescriptions, refill authorizations and denials and change requests

32 Making the Adoption Decision Assess your Practice Readiness: Staff willingness Past technological implementations Time available Past and current staff communication

33 Making the Adoption Decision Define Practice Needs Vision, objectives Establish a team and pick a leader Plan ahead for challenges List and Prioritize needs Workflow changes Hardware/Software needs

34 Making the Adoption Decision Understanding Costs Costs for Provider Anywhere from free to $2500 per yr per prescriber Costs for Patient Same or less because formulary available to allow physician to prescribe a lower copay medication

35 RCMA Adoption Worksheet E-Prescribing Adoption Worksheet I. Practice Readiness Are you and your staff ready? Everyone needs to agree with the workflow, technology, and management or the benefits of e- prescribing will be limited. a. Staff/Leadership open to change (1-no one is interested, 5-everyone is on board) b. Past technological implementations (1-completely flopped, 5-easy as pie) c. Current practice projects (1-too many to count and no time, 5-free and open) d. Staff/Leadership thoughts on E-Rx (1-pointless and waste, 5-useful and important) e. Current Practice Communication (1-non existent, 5-all staff voice opinions equally) II. Defining Practice Needs What improvements do you hope to gain with e-prescribing? Needs must be specifically defined. If any of these are unclear, e- prescribing will be difficult. a. Project Vision (1-I don t know, 5-established with measurable results) b. Project Team (1-No one has time, 5-Variety of staff nominated/volunteer) c. Project Leader (1-Person with least work, 5-Knowledgeable, respected person) d. Medication Management Needs (1-minimum/easy, 5-robust, complete safety) e. Technological Needs (1-Basic/fool-proof, 5- Complex, External/multiple access) d. Current IT Maintenance (1-no one, will rely on vendor, 5- IT employee on staff) III. Understanding Costs and Financing Options How much is the practice will to spend on an EMR? Become familiar with the current state and federal e-prescribing incentives. a. Familiarity with National/Federal Incentives (1-not sure, 5-very familiar) b. Know Medicare reimbursement (1-not sure 5-calculated projected reimbursement) c. Understanding Costs (1-Basic/Minimum, 5- Eventually go to an EMR

37 Selecting a Vendor What are you getting for your money Maintenance, training fees Fees to back out of contract Vendor Communication/Support Variety of modules for current and future needs Stepping Stone to EMR? Write an Request for Proposal (RFP)

38 Selecting a Vendor SureScripts Certified Solution Providers GoldRx is the highest E-prescribing certification. It focuses on benchmarks that signal a vendor s commitment to interoperability, customer support, and successful customer implementations.

39 Gold Certified Products (from

40 GoldRx Certified Product Capabilities: E-Prescriptions E-Refills Rx History- view patient s history Eligibility-access to patients drug plan information Formulary-weigh patient economic considerations

41 E-Rx Vendors with Uncertified Products ABEL Soft BMA Enterprises Doc-U-Chart Glenwood Systems imedx ACS Heritage Cerner Doctations, Inc gostream, Inc InstantDx Agastha ChartConnect E-MDs gmed Integrated Health care Solutions Allscripts Clinipath Eclipsys Corp. Gold Standard InteGreat AlphaSante Clinix, LLC Eclipsys Practice Sol. ASP.MD CPSI ehealthsolutio ns H2H Solution, Inc. Health Admin. Systems Integritas, Inc isalus Athenahealth CureMD EHS HealthPort iscribe Bizmatics Daw Systems EcounterPRO Henry Scheind Medical System Blue Cross/ Blue Shield of Alabama digichart OB- GYN Kryptig Epic imedica LighthouseMD

42 E-Rx Vendors with Uncertified Products Cont Lille Corp. MedConnect, Inc. NaviMedix Pulse Systems SSIMED LSS Data Systems Medent Netsmart-infoscriber OA Systems STI Comp Services, Inc MD Web Solutions Medi-EMR NewCorp Regenstrief SynaMed Marshfield Clinic Medical Communication Sys. Nightingale RelayHealth US Health Record Systems MAShare MedicaLinx Noteworthly RXNT VipaHealthSoluti ons McKesson MedicSoft MedPlus SafeMed Waiting Room Solutions MDI Achieve Meditech Polaris-Epichart SAGE Wellogic MDOffice MediVoice Practice Partner Sequel Systems Workflow MedAppz MedNet System Prematics SOAPware ZixCorp MedComSoft MedPlexus Prime Clinical Sys Sonix Healthcare Sol

43 E-Prescribing Gold Certified Products Company Stand-Alone Set up Fees Cost per DEA Allscripts No Depends Depends Allscripts/NESPI Yes None Free DrFirst Yes $300 $550/yr eclinicalworks Yes $250 $300/yr NextGen No Depends Depends RxNT Yes None $650/yr

44 Electronic Health Record E-prescribing Allscripts Enterprise EHR come with E-rx capability built in and interfaced with the full patient record. Pro Larger company: merge Misys and Allscripts Variety of modules Customizable EHR/ E-Rx transition at one time Con Expensive Complex Big transition

45 eprescribe Allscripts eprescribetm is a web-based, standalone eprescribing application that can be downloaded in minutes Pro Larger company: merge Misys and Allscripts Free and easy Stepping stone to EMR Fast installation, no hardware fees Con Customer Support Hidden Fees (Want to extract Medical Records, Customize interface) Lack variety of modules You get what you pay for

46 Rcopia DrFirst Rcopia can be used as a standalone application and also link with practice management software and EMR applications to automate the exchange of information Pro Easy to contact No hidden fees Con Long term viability unknown

47 Pro eclinicalworks unified system for Electronic Medical Records, Practice Management and Document Management streamlines workflow and increases efficiency resulting in positive ROI for your practice. Variety of options and modules Local contact Can upgrade to EMR schedule demos Con Not a lot of information on E-Prescribing on website

48 EMR Pro Variety of modules Stable company Con No standalone Expensive

49 Pro Offer online demos/webinars all day Friendly Easy to reach Customizable interface No hidden fees Offer free 30 day trial Con Does not have full EMR (only EMR lite) Long term viability

50 One Final Step: Deployment Significant technological, practice readiness Commitment and patience Appropriate Training Communicate with Vendor Communicate with Pharmacy Communicate with Patients

52 Resources AMA Clinician s Guide to Electronicprescribing SureScripts Rx Hub Medicare E-Prescribing Guide ehealth Initiative free webinars

53 Health Information Technology Resource Center