Step 1 - Assessing Your Practice Readiness
1. Are there other tools that will help me determine my practice readiness?
There are a number of tools available that allow you to assess your practice
readiness. The American Medical Association provides a readiness
assessment tool. Texas Medical Association also offers an
assessment tool.
2. I am not sure if I can determine my practice readiness unless I know
more about e-prescribing. Where can I find more information about what
e-prescribing is and what changes it might require?
Earlier this summer the Health Initiative and the Center for Improving Medication Management
released a comprehensive report on e-prescribing. The report describes what
e-prescribing is, why it is important and the major e-prescribing initiatives. To
access the report go to: http://www.ehealthinitiative.org/assets/
Documents/eHI_CIMM_ePrescribing_Report_6-10-08_FINAL.pdf.
3. What should I do next if my practice is not ready?
If after reading this guide
you determine your practice is not ready to successfully implement e-prescribing
you should focus first on fixing those areas of concern. These issues are not
insurmountable, but they will take time and effort to correct.
Step 2 - Defining Your Practice Needs
1. What are the attributes of a successful practice leader?
Instilling and
creating prescriber and staff behavioral change in a medical practice is difficult.
It is extremely helpful when a respected physician, other clinician or practice
administrator steps up as a champion and educates his or her fellow colleagues. An
e-prescribing practice leader should possess the following qualities: 1) be a
willing innovator, 2) somewhat technology savvy, 3) active, high volume
e-prescriber, 4) strong e-prescribing advocate, 5) comfortable serving as leader
and facilitator amongst his or her peers and 6) dedicated to committing time on a
weekly basis for physician and staff training.
2. What are the key considerations when redesigning my prescribing
process for e-prescribing?
The following issues should be discussed at this
stage. Although you might not have a final strategy for each issue at this time, you
should consider strategies for each:
– How to define the role of the front desk, medical assistants, and prescribers in
a redesigned prescribing process
– How to effectively implement prescriber preferences in the system
– How to provide appropriate hardware based on the prescribing roles and
responsibilities of the practice
– How to communicate with patients about electronic prescribing
– How to maintain and monitor error logs
– How to monitor electronic renewal requests from the pharmacy
– How to best engage with local pharmacies in mutual problem solving
3. What is the basic technology I need to begin e-prescribing?
Office configurations will vary depending on the e-prescribing system chosen. However,
regardless of the e-prescribing system, practices must have a good Internet
connection (preferably high speed) and desktop, laptop or tablets computers,
hand-held PDAs, or a combination. If PDAs or tablets will be the primary
technology used by prescribers, setting up a wireless network is recommended.
4. What if my practice’s needs go beyond improving the prescribing process?
Some practices decide that the prescribing process is too dependent on other
clinical information to isolate. If that is the case, you should consider
implementing an EHR system with e-prescribing capability. Most EHR systems have
e-prescribing capability and provide more functionality than stand-alone
e-prescribing systems. But EHR systems are more expensive and disruptive to the
practice. Again, you have to decide what your practice is ready for and what
operational and clinical needs you want to address.
Step 3 - Understanding Costs and Financing Options
1. How much does e-prescribing cost?
Costs vary depending on which kind of
hardware and software (EHR system versus a stand-alone e-prescribing system) a
practice chooses. Stand-alone e-prescribing applications range from free to
approximately $2,500 per year per prescriber. Be sure to look for local or state
initiatives that subsidize the cost of e-prescribing systems. There may be
additional fees to integrate patient demographic information from your practice
management system into the e-prescribing application; however, the alternative
means you will need to enter each patient into the system as you prescribe for
them, which can be time consuming and may be a barrier to using the system.
As mentioned in Section I, EHR systems offer more comprehensive functionalities,
but are more costly, complex and time consuming to implement. According to the
Congressional Budget Office, office-based EHR systems are about $25,000 to
$45,000 per physician. Estimated annual costs to operate and maintain an EHR
system (e.g., software licensing fees, technical support, and updating and
replacing used equipment), range from $3,000 to $9,000 per physician per year.
Be sure to ask vendors specific questions about any incremental fees related to
e-prescribing functionality as well as training.
These figures do not include initial costs for the hardware required to support
either an e-prescribing or EHR system, temporary decreases in productivity
resulting from training or workflow redesign, practice management interfaces,
customization, maintenance, upgrades, or data conversation. Whether you choose
a stand-alone e-prescribing application or an EHR system with integrated
e-prescribing, cost is only one part of the equation. You should compare the cost –
both direct and indirect, start-up and ongoing – with the expected benefits – such
as improved efficiency and productivity, decreased administrative expenses and
staff utilization – to fully understand the value of e-prescribing to your practice.
2. Are there transaction fees for e-prescribing?
Pharmacies pay transaction fees
based on the number of electronic prescriptions and electronic prescription
renewals received, and payers/PBMs pay transaction fees to deliver formulary and
pharmacy benefits information. The only time your practice would incur transaction
fees for e-prescribing is if the vendor you select charges your practice a transaction
fee. Most vendors do not charge practices a transaction fee, but be sure to ask
your potential vendors about this during system selection.
3. Are there subsidy programs available to help with e-prescribing costs? Yes.
There are a number of e-prescribing and EHR initiatives available at the national
and state level. Information about some of these programs is provided in
Appendix II.
4. Does e-prescribing cost patients more money?
Patients pay the same amount
in the same way for electronic prescriptions as they do for traditional paper ones.
With e-prescribing, however, prescribers will likely have information about the
patient’s formulary at the time of prescribing, which may allow prescribers to
prescribe a medication with a lower co-pay or cost to the patient if paying out of
pocket.
Step 4 - Selecting a System
1. Is there a certification system for e-prescribing systems?
Yes. E-prescribing
applications and EHR systems with e-prescribing are certified by SureScripts-Rx
Hub – the infrastructure that technology vendors, pharmacies, and payers/PBMs
connect to in order to exchange medication information electronically according
to industry standards. The current certification is based on compliance with
industry standards, specifically the NCPDP Script Standard. A complete list of
SureScripts-RxHub certified products can be found at http://www.surescripts.com/
certified. This list shows the functionality and connectivity of e-prescribing
systems. If your practice is looking for an EHR system with integrated
e-prescribing functionality, the Certification Commission for Heath Information
Technology (CCHIT) certifies EHR systems based on a large number of functional
criteria, including e-prescribing capability. CCHIT has plans underway to certify
e-prescribing systems. For more information on CCHIT, go to www.cchit.org.
2. Are there specific questions I should ask a potential e-prescribing system
vendor?
Yes, ask questions such as: 1) What is the cost? 2) What do I need to
purchase? 3) What are the monthly maintenance fees? 4) What type of training is
provided? 5) Will your system be able to access demographic information from my
practice management system? 6) Does your system allow you to manage both new
prescriptions and renewal authorizations electronically? 7) What is the support
process, and how long does it typically take for issues to be addressed? For a
complete Buyer’s Guide, see Appendix I.
Step 5 – Deployment
1. How do I know which local pharmacies accept electronic prescriptions?
A quick
resource to find this information is www.rxsuccess.com. Simply click on the “Find
your connected pharmacy” tab to find the list of pharmacies in your state or zip
code that are enabled to receive electronic prescriptions and send electronic
renewal requests to your practice. You still should contact the pharmacies in your
area directly to notify them when your practice will be e-prescribing and confirm
that they have actually started using e-prescribing and are prepared to accept the
prescriptions.
2. How will I know if pharmacies are properly loaded in my system?
It is best to
provide your vendor with a comprehensive list of pharmacies that your patients
frequently use. The vendor can then match this list with the pharmacy records
from the Pharmacy Health Information Exchange while loading pharmacy
information in your application. This will help ensure that your frequently used
pharmacies are appropriately matched to the master pharmacy file from the
beginning and thus enabled for electronic prescriptions. If your practice application
allows you to create customized pharmacy records (customized name, address
or phone and fax number) then it is also important to ensure that the application
system matches such records with the master pharmacy list provided by the
Pharmacy Health Information Exchange.
3. How can I prepare for training?
Personalized one-on-one training using a variety of
common scenarios seems to work best for most prescribers. It is important to ask
detailed questions during your training sessions, including:
– What happens if the patient is not matched in the system when a pharmacy
sends a renewal requests?
– Can I cover for my colleagues when they are on leave and under whose name
will the prescriptions be sent to the pharmacy?
– How does the system handle controlled substance prescriptions and pharmacy
renewal requests for controlled substances?
– How do I write prescriptions to the pharmacy when a patient calls in a request
via phone?
– How do I know whether the prescription was successfully sent to the pharmacy?
– How do I handle mail order prescription writing?
– How do I create my favorite medication list?
– How do I search pharmacies within the practice database?
4. May I work offline using my e-prescribing system?
Some e-prescribing programs
allow access offline, which would enable prescribers to prepare multiple scripts and
then transmit then when they have Internet access again. However, queuing or
“batching” prescriptions before sending them to pharmacies electronically is not
recommended. Sending prescriptions to pharmacies as soon as possible after they
are prepared ensures that the pharmacy has adequate time to receive the
prescription before a patient arrives to pick it up.
5. Will the pharmacy send me electronic renewal requests?
Pharmacies will start
sending e-refills once individual prescribers send five new prescriptions
electronically via the Pharmacy Health Information Exchange. This is to help
ensure that your practice has been trained on your e-prescribing or EHR system
and is ready to receive and respond to refill requests electronically.
6. Can I e-prescribe controlled substances?
Prescriptions for Schedule II drugs can
never be sent electronically or by fax. Hand-signed hard copies of prescriptions for
Schedule III through V drugs can be sent using manual fax technologies. Neither
computer-generated faxes containing electronic signatures nor totally electronic
prescriptions for controlled substances can be sent to pharmacies at this time.
Some pharmacies will continue to send refill requests for controlled substances by fax.
7. How do I communicate e-prescribing to my patients?
Communicating with patients
regarding e-prescribing and its benefits and implications is important. Some
patients may express initial reluctance in response to a new system; prescribers
can make patients more comfortable by explaining how e-prescribing works and
what its benefits to patients, providers, and pharmacies.
In the initial phases it is important for you and your practice staff to educate and
reinforce the benefits of e-prescribing with your patients. Talking points include:
• Fast - E-prescribing allows you to electronically send prescriptions directly to
the patient’s choice of pharmacy. The prescription travels from your
computer to the pharmacy’s computer before the patient leaves the exam
room, giving their prescription a “head start.”
• Convenient – The patient no longer has to make an additional trip to the
pharmacy to drop off their prescriptions.
• Safe and Secure - Prescription information is not sent over the open Internet
and is not sent via an e-mail. E-prescriptions are sent electronically through a
private, secure, and closed network – the Pharmacy Health Information
Exchange®.
• Legible – The staff in the pharmacy no longer has to spend time interpreting
your handwriting.
• Informed – Availability of formulary information from health plans allows
choice of medications that are more affordable and e-prescribing allows drugdrug
interaction checking and allergy-drug interaction checking for safer
choices.
