One of the most annoying parts of the US health care system is all the paper work you have to fill out. Every time I visit a new provider, I have to fill out a whole series of paperwork answering questions about my demographics, medical history and current prescriptions. Even when you visit the same provider consistently, you are still asked a series of repetitive questions. For example, every time I visit my primary care physician, both the nurse that checks my vitals and the physician who consults me ask for a list of current medications. If I fail to list one (e.g. the Ambien Rx I requested nine months ago for an international flight), then they query me about any disconnects between their records and my answer. Why is it my responsibility as the patient to know the names and strengths of all the medications I am taking? Why doesn’t the provider track this since they are the ones recommending the medications in the first place? Surely, the process of tracking prescription medications by patients could be simplified. The good news is that there has been an effort underway for almost a decade now to digitize the exchange of prescription data throughout the health care system.
The US e-prescription initiative was originally slowed by regulatory barriers. The ability to send electronic prescriptions had to be approved state-by-state in each domicile’s legislature. However, all 50 states and DC now support e-prescriptions for most pharmaceuticals. In fact, many states have active incentive programs in place via their Medicaid or Health Department organizations to financially reward providers for e-prescription adoption. In addition to the state-sponsored incentives, numerous catalysts such as the American Recovery and Reinvestment Act (ARRA) are combining to accelerate e-prescription usage at an exponential rate. In this post, I will outline how e-prescription networks are used and the benefits to the health care system. There are three primary use case scenarios for e-prescription networks today:
In the first scenario, a doctor in a hospital or physician’s office needs to obtain information about the patient’s health insurance benefits before prescribing a new medication. The patient’s eligibility for prescription drug benefits needs to be confirmed. And in many cases, the physician needs to understand the preferred medications (or formulary) of the patient’s insurance company. Most large health insurers sign contracts with specialized firms called Pharmacy Benefits Managers (PBM) to manage their prescription drug benefit programs. PBMs negotiate discounts with pharmacies on certain brands (or generic versions) of medications, which become the basis for the formulary. As a general rule, PBMs and insurers prefer that prescriptions be for lower cost, generic drugs rather than name brand pharmaceuticals in order to reduce costs. Enabling physicians to access formularies and eligibility data before writing a prescription is a huge victory in the battle to control prescription drug costs.
Can you read this?
A similar, but secondary scenario involves obtaining a patient’s prescription drug history. With a patient’s consent a doctor can obtain a list of current and past medications. The benefits of knowing past and present medications are numerous. Physicians can avoid harmful drug-to-drug interactions; drug-age problems; drug-pregnancy issues and drug-allergy interactions. You may ask – Shouldn’t a doctor know what medications their patients are taking? A study by the Center for Information Technology Leadership (CITL) found that, on average, a primary care physician knows only 70% of their patient’s medications. Older patients or those with a chronic disease may not recall all their past medications when asked. The problem is more challenging for specialists, which typically only know 40% of the drugs used by their patients. Emergency room and urgent care providers may know 0% as they are dependent upon a patient being conscious and capable of providing the list.
Additional value for prescription history comes from the renewal process. A doctor reviewing refill requests can review timing intervals to determine if a pattern of over-use, under-use or misuse exists. The scenarios for prescription histories are expanding rapidly. For example, patients with personal health records can elect to have their prescription histories sent from pharmacies to their online records as well. Additionally, physicians supporting emergency evacuations following an earthquake, hurricane or natural disaster can access prescription histories through online portals.
ARRA – Not just a bunch of road signs
The third scenario is electronic prescription routing between a doctor and a pharmacy (mail order or retail chain). Doctors have notoriously bad handwriting. It is amazing to me that there is not a higher rate of fatalities and hospitalizations due to incorrectly interpreted prescriptions. The CITL study found that 10% of handwritten prescriptions are illegible to pharmacists resulting in a follow up call. Fortunately, not all providers use hand written prescriptions. Some 50% of physicians phone prescriptions in. While the phone calls may be less prone to error than chicken-scratch notes, the process does consume two minutes of time for a nurse or administrative staffer. Perhaps, the biggest benefit comes in the refill process. Instead of pharmacies having to fax or phone in renewal authorizations, the request can be sent from the Physician’s Practice Management System or Hospital Information Management System electronically to the Pharmacy’s Order Management System. Electronic routing eliminates the 15 minutes of a nurse and front desk staff time spent hand writing the scripts.
More on e-prescriptions in my next post…
