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As Medicare struggles to work out snafus behind its new drug coverage, government and business leaders are working to make sure the next big change goes smoothly.
The Medicare Modernization Act requires standards for doctors to submit prescriptions to pharmacies electronically. To make sure that goes off without a hitch, the Department of Health and Human Services has launched pilot programs across the country.
This week, it announced recipients of some $6 million in grants for programs that will run throughout the year.
Medicare is required to adopt uniform standards for e-prescribing by 2008, and the pilot programs will help determine which ones.
Implementing e-prescribing will be completely different from implementing the prescription drug benefit, said Ken Whittemore, VP of regulatory affairs at SureScripts, which allows physicians and pharmacies to exchange electronic information.
With the drug benefit, he said, “You went from no transactions on December 31st to millions and millions of transactions on January 1st. Thats not the optimal way to roll out a new capability.”
E-prescribing is different because several regions are already going ahead with initiatives and because adopters have years, not months, to move into implementation.
E-prescribing vendors involved in the CMS grants include AllScripts, Caremark iScribe, DrFirst, Gold Standard, InstantDx/OnCallData, Medplus/Quest Diagnostics and ZixCorp.
Health IT advocates consider e-prescribing an easy first step to get physicians to adopt technology. Besides eliminating the hassles of processing refill prescriptions and errors from sloppy handwriting, the new standards promise to give doctors information that they consider valuable.
The new e-prescribing standards dont just describe how to send information to a pharmacy. They also let doctors look at drugs recommended by health plans and view a patients medication history.
The pilots will measure how electronic prescribing data transmission systems affect quality of care, such as reducing adverse drug events or getting patients to take medicines appropriately.
The standards are also being tested for interoperability. U.S. Department of Health and Human Services Secretary Mike Leavitt said the pilots would “help to create a new age in efficiency and safety in Americas medical care industry.”
Whittemore said CMS (Centers for Medicare and Medicaid Services) was using the pilots to focus attention on functionalities that might otherwise be overlooked.
Right now, he said, nearly every vendor has its own way of transmitting instructions for how a patient should take drugs, including freetext. That makes it harder to spot dosing issues. Now, he thinks, they will find a common way.
“The fact that CMS identified this as something important has really lit a fire under the industry.”
That kind of push will expand the definition and utility of e-prescribing, said SureScripts CEO Kevin Hutchinson. Physicians will not only know whether a patient has been prescribed a particular medication, but also whether the dose prescribed is high or low.
Because systems at pharmacies, pharmacy benefit managers and physicians will be linked, a physician could know when and whether a patient picks up prescriptions for chronic medications.
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That means that physicians and pharmacists could help make sure patients take medicines as prescribed.
Hutchinson acknowledged that the new capabilities will create new issues to be worked out. For example, some patients go to one doctor for certain health needs and go to another for more sensitive or personal prescriptions.
But, he said, patients have to give consent to let doctors see a medical history, and some states already have laws that block doctors from seeing that a patient is taking HIV medications.
But just blocking information is not an ideal solution. “The challenge with that is that these [drugs associated with mental illness and sex] are some of the most dangerous drugs that have the most dangerous interactions, so its enormously important that someone knows all those medications.”
In any case, he said, the whole purpose of the pilot programs is to find and fix potential problems.
HHS awarded contracts to the following groups.
- RAND Corporation, Santa Monica, Calif., in conjunction with the New Jersey E-Prescribing Action Coalition, an industry-academic partnership involving RAND Health; Horizon Blue Cross Blue Shield of New Jersey; the e-prescribing vendors AllScripts, Caremark iScribe and InstantDx; Caremarks prescription benefit management plans; the electronic prescription routing companies RxHub and SureScripts; Caremarks mail-order pharmacy and Walgreens retail pharmacies will conduct the pilot in New Jersey.
In addition to testing the standards, the project will determine changes in drug use, clinical outcomes and patient satisfaction as a result of e-prescribing.
- Brigham and Womens Hospital, Boston, Mass., in conjunction with physician practices in Massachusetts associated with a hospital network, will use an existing community utility for e-prescribing called the eRx Gateway. The pilot will test the e-prescribing standards and will conduct needed research into ambulatory drug safety and the impact of e-prescribing on physician workflows.
- SureScripts, Alexandria, Va., partnering with Brown University and five vendors (Allscripts, DrFirst, Gold Standard, Medplus/Quest Diagnostics, ZixCorp.) will recruit physicians and pharmacies for participation in Florida, Massachusetts, Nevada, New Jersey, Tennessee and potentially Rhode Island.
The pilot will evaluate how the e-prescribing standards work in a variety of practice settings, geographic areas and e-prescribing technologies. In addition, the project will assess how prescriber and vendor characteristics influence e-prescribing adoption and what “best features” of vendor software improve medication-related safety outcomes.
- Achieve Healthcare Information Technology, Minnesota, in conjunction with nursing facilities in Minnesota associated with the Benedictine Health System and Preferred Choice Pharmacy will be the first program to evaluate how the e-prescribing standards work in certain long-term care settings.
The project also will assess the impact of e-prescribing on the workflow among prescribers, nurses, the pharmacies and payers.