An economical journey from paper to electronic prescription

Recent Trend
The rate of electronic prescribing in upstate New York increased from 12% in 2009 to 17% in the first quarter of this year, a new report by Excellus BlueCross BlueShield found, Healthcare IT News reports (Merrill, Healthcare IT News, 7/15). The report also concluded that the percentage of physicians across the U.S. who use the technology doubled from 2008 to 2009, the Rochester Democrat and Chronicle reports. So why is there this growing trend of digitalizing patient prescriptions?
The answer lies not only in the benefits offered by e-prescription (eRx) services but also in the monetary federal incentives available to the practices. The section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a new and separate incentive program for eligible professionals (EPs) who were successful electronic prescribers as defined by MIPPA. This new incentive program, which began on January 1, 2009, was separate from and in addition to the quality reporting incentive program authorized by Division B of the Tax Relief and Health Care Act of 2006 - Medicare Improvements and Extension Act of 2006 (MIEA-TRHCA) and known as the Physician Quality Reporting Initiative (PQRI). Eligible professionals do not need to participate in PQRI to participate in the Electronic Prescribing (eRx) Incentive Program, which was a great flexibility offered to practioners and it has resulted in the recent growing trend to turn electronic.

E-prescription Incentives
Inspite of this trend there are many practices which are either unaware of all the clauses behind this eRx based incentives or are a bit skeptical about this modern way of prescribing. As the target for complete eRx based healthcare vision of the federal government come closer, it is important for practioners to take complete advantage of these services and implement them in an appropriate way or else it could result in some penalties for the practioners. The following table gives an idea of this scenario.

2009 2010 2011 2012 2013 Beyond
Incentive 2% 2% 1% 1% 0.5% None
Penalty None None None 1% 1.5% 2%

For 2009, to be a “successful e-prescriber,” eligible professionals must report the e-prescribing quality measure through their Medicare Part B claims on at least 50 percent of applicable cases during the reporting year.

Standalone eRx systems Vs Fully integrated EHR system ?
Electronic Prescribing is the new and innovative approach to prescription delivery and authorization. The technology, which is based on 100% online electronic transmission, places the power at the doctor's fingertips, instantly delivering information from the practice to the pharmacist and vice versa. No more phone calls, no more faxes, physicians can now develop and transmit a prescription or refill request at the click of a button. To give you a brief description of the unique and mostly unaware features of eRx, would like point out to this blog by Mr. Jason Harwell.

I truly believe that the crucial point in successfully implementing these services will be the decision to implement either a standalone eRx system or use the features provided by your EHR software. A dedicated eRx system is exclusively devoted to e-prescribing. They typically include some demographic information about the patient to facilitate patient identification and systems integration, but do not incorporate the broad variety of clinical patient information typical of an EMR. Lacking full EMR capabilities, dedicated eRx systems are less expensive than EMR systems and simpler to implement in a clinical practice. Dedicated eRx systems typically provide a more comprehensive set of eRx capabilities than eRx embedded in EMR systems. For example, most dedicated systems are SureScripts Gold Certified for offering a wide range of e-prescribing capabilities, while few EMRs have such certification.

Today most offer the fundamental capabilities of creating and transmitting new prescriptions and efficiently handling refills. Although some may currently lack capabilities such as formulary access, eligibility, and prescription history from external sources, EMR systems offer the additional benefits of complete clinical information at the point of care, even if the prescriber is working away from the office.

As mentioned before the quality of EHR solution provided along with a suitable network capabilities plays an important role in the successful eRx implementation. I would suggest a practice to look at e-prescribing services as a stepping stone to large EHR implementation, especially looking at the financial benefits one can earn.