American health care providers write close to 3 billion prescriptions per year, according to a number of estimates, with about 80% of them being written by hand.  A recent study conducted by the Weill Cornell Medical School in New York found that about 4 of every 10 handwritten prescriptions had an error while the rate of errors found in electronic prescriptions is around one-seventh of that, or about 6%.

If those numbers hold true, then almost 1 billion prescriptions each year have an error in them.  Small wonder, then, that the government has enacted legislation to encourage providers to switch to electronic prescribing.

Amid the sea of health technology acronyms like HIPAA, HITECH, HIT and EMR floats one we’ve not addressed so far – MIPPA, the Medicare Improvement for Patients and Providers Act of 2008 (we’re really not making this one up).  The act contains provisions relating to a host of issues such as physician quality reporting, physician payments and – the one we’re addressing here – electronic prescribing.

Structured with incentives to encourage physicians to adopt electronic prescribing, MIPPA provides for payments of up to 2% of qualifying Medicare billings during 2010 by using a qualified e-prescribing or Electronic Health Record system that meets all of the following requirements:

• Generates a complete active medication list
• Selects medications, prints and electronically transmits prescriptions and conducts all alerts
• Recommends available alternatives that are less expensive and therapeutically appropriate
• Provides information on tiered formulary medications, eligibility and insurance authorization
• Meets specified software technical requirements

Incentives will continue at up to 2% through 2010, drop to 1% in 2011 and 2012, and .5% in 2013.  Beginning as early as 2012, penalties for NOT using e-prescribing can and will be assessed by Medicare, rising to as high as a 2% reduction in payments.

As with all government programs, there is a host of fine print to wade through, and there are multiple ifs and ands to deal with, but the overall program does provide incentives to you to adopt electronic prescribing.  To help you navigate all that verbiage, HHS has created a comprehensive FAQ section on its website.

If you expect to qualify for incentive payments offered by the government for the adoption of an EMR/EHR system, you will need to be engaged in e-prescribing, because e-prescribing will be an integral part of the definition of meaningful use.  And grumble all you want about how that implementation of an e-Prescribing system may require work up front, but the benefits that will accrue to you down the line, such as reduced errors and far fewer phone calls using up your staff time to resolve prescribing problems, will more than make up for it.

Above article publish on http://blog.pchealthstop.com/?p=946

Are you a doctor searching for better ways to treat your patients? Do you want to address administrative duties in an efficient and timely manner? E-prescribing software offers a viable solution. The benefits of electronic prescription have been aiding doctors for some time now while more doctors are realizing the benefits of such a system and implementing the software into their practices. What are the benefits of e-prescribing software? Read on to find out more.

Display of pertinent, patient information A patient’s prior and present information is important to the medical process. A doctor needs to know of their prior history and present state in order to treat them properly. Electronic prescribing software indicates if the patient is eligible for care according in regards to the patient’s insurance policies. Furthermore, the software makes doctors aware of patient-medication histories and pharmacy-fill histories.

Real-time support tools Doctors are certain as to how their prescribed medicines will influence the patient, but they also need to know how other medications and patients allergies will react while taking the doctor-prescribed medication. The software serves as a decision-support tool for doctors. In addition, the e-prescribing system can check for appropriate dosages and duplicate forms of therapy.

Efficient communication with pharmacies There are many parties who play a crucial part in the healthcare process. Doctors must maintain good communication with a patient’s pharmacy to ensure they are getting extraordinary care. Using the e-prescription software, a doctor can access renewal requests from pharmacies, renew medications for multiple patients, and write a prescription from an often-used ‘favorite’ list. Furthermore, a doctor can send electronic prescriptions to a patient’s pharmacy of choice (including mail-order pharmacies).

More benefits…

• Satisfies MIPPA requirements, which qualify physicians for annual bonuses

• Clinical information displayed during prescription process

• Real-time clinical decision support tools

• Access renewal requests from pharmacies

• Send prescriptions electronically to the patient’s pharmacy of choice

• Securely share patient data with other treating physicians and send/receive referrals

• Patient information protected by strict privacy and security measures

Above article publish on http://www.goarticles.com/cgi-bin/showa.cgi?C=2482144

Electronic prescribing, often described as the lowest hanging fruit in health IT, could be set to make a big leap forward as organizations in states such as Iowa look to provide free e-prescribing services for physicians and federal legislation starts to drive nationwide adoption of the technology.

The Iowa program, called ePrescribe Iowa, is a Web-based effort launched by Iowa Health System, a community-based integrated health care system, and Allscripts, a major provider of e-prescribing software. It will run on Iowa Health System’s HealthNet connect, a 3,200 mile-long fiberoptic network.

It’s a standalone solution that the partners are touting as a first step in driving the adoption of electronic health records throughout the state. It shares that goal with the federal stimulus funds that will be provided to physicians under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Less than 3 percent of all prescriptions written in Iowa in 2008 used e-prescribing, according to ePrescribe Iowa, citing figures produced by Surescripts, the largest U.S. e-prescribing network.

“By adding significant new capabilities to HealthNet connect, this offering will help accelerate Iowa Health System’s efforts to connect urban and rural health facilities and enable better care,” said Bill Leaver, Iowa Health System’s president and chief executive officer.

Nationwide, things are somewhat better. Even so, less than a quarter of prescription writers currently use e-prescribing, according to Surescripts, though it expects that to improve rapidly to 50 percent or more by 2011.

The key to that is getting small and medium-sized practices, which write the majority of prescriptions, to use the technology, said Rick Ratliff, executive vice president, customers and markets, at Surescripts. Most large medical practices are already on-board with e-prescribing, with the majority of those using electronic medical record systems to write prescriptions.

The answer lies with incentives offered through Medicare and HITECH, as well as support that will be provided through the regional high tech extension centers that will result from the Health IT Technology Extension Program, a grant program authorized under the HITECH legislation.

“For small practices in particular, the key is to find a solution that meets their requirements and then provide them with the ability to get it into the practice,” said Ratliff. “But those smaller practices don’t have any IT staff, so they need the support” that the extension centers will offer.

The ePrescribe Iowa system gets around that by offering its solution over the Web. All users need is a PC and Web browser and Allscripts, which developed the software-as-a-service solution, claims physicians can start e-prescribing with just 30 minutes of training.

As the health IT incentives start to work and meaningful use measures are defined, Surescripts expects a rapid growth in e-prescribing. The 2009 figure will be double the 74,000 users 2008, and Ratliffe said some 30 percent of U.S. prescribers could be writing their scripts electronically by the end of 2010, with 50 percent or more e-prescribing by 2011.

Above article published on http://www.govhealthit.com/newsitem.aspx?tid=77&nid=72207

ALEXANDRIA, VA – The number of physicians using electronic prescribing will have more than doubled in 2009, executives of the e-prescribing network Surescripts said.

More than 140,000 – 23 percent of all office-based physicians, nurse practitioners and physician assistants in the United States – are e-prescribing today, officials said. And at the current pace, Surescripts projects that its active e-prescribers in 2009 will more than double the 74,000 that were e-prescribing at the end of 2008.

Surescripts officials also announced that physicians can choose from more than 200 types of e-prescribing and electronic medical record systems that have been certified and are connected to the Surescripts network – a 38 percent increase over the number available at the start of the 2009. The growth in certified software makes e-prescribing available to more physicians and the communities they serve, officials said.

Physicians and other prescribers use Surescripts-certified software to establish a secure, electronic link to pharmacy benefit managers and thousands of health plans nationwide. The connection makes it possible for them to confirm coverage and look up information such as prescription co-pays and the availability of generic alternatives for two-thirds of all Americans.

With a patient’s consent, prescribers can also access prescription history and use the Surescripts network to send e-prescriptions to any of 51,000 (84 percent) retail pharmacies or six of the largest mail-order pharmacies.

Harry Totonis

The network “benefits patients in every state in the nation,” said Harry Totonis, president and CEO of Surescripts. “Whether it is the convenience of making one trip to the pharmacy or receiving your prescription by mail, or the improved safety of legible prescriptions and providing doctors a more complete prescription history, or the savings that come from a patient and their doctor knowing about and selecting lower cost prescription alternatives, the Surescripts network makes these benefits available to millions of patients cared for by more than 140,000 physicians, nurse practitioners and physician assistants nationwide.”

New logo

Surescripts has also released a revamped company logo featuring the tagline “The Nation’s E-Prescription Network.” Available for restricted use by certified participants on the Surescripts network, the logo is the next step in a comprehensive re-branding and education campaign that seeks to raise the visibility and understanding of the benefits of e-prescribing for all Americans.

“Our brand reinforces the fact that Surescripts is at the center of the nation’s move towards digital healthcare,” said Rick Ratliff, executive vice president for customers and markets and group executive at Surescripts. “We believe that physicians and their patients are ready to leave the paper behind – and it starts with e-prescriptions.”

Above article published on http://www.healthcareitnews.com/news/more-140000-physicians-growing-list-e-prescribers

The new Medicare Part B fee schedule for 2010 is encouraging doctors to adopt EHRs by, for the first time, allowing practices to use real clinical data from EHRs and e-prescribing systems to report quality measures for the Physician Quality Reporting Initiative (PQRI) and e-prescribing incentive programs. The change, according to CMS, is “to promote adoption and use of electronic health records and to provide both eligible professionals and CMS with experience on EHR-based reporting,” Government Health IT reports.

Whether the incentive payments are large enough to spur many practices to switch to EHRs ahead of the 2011 debut of the federal stimulus program is uncertain, however. PQRI participants can earn 2 percent on top of their total Medicare Part B fees for reporting quality data in 2010, and another 2 percent for writing electronic prescriptions. The e-prescribing bonus drops to 1 percent in 2011 and penalties for not e-prescribing begin in 2012. CMS is trying to simplify reporting of e-prescribing by requiring a single code to be eligible for the bonus next year.

To learn more about the PQRI and e-prescribing aspects of the 2010 fee schedule:

Above article published on http://www.fierceemr.com/story/cms-allow-ehr-reporting-pqri-e-prescribing-bonuses-2010/2009-11-05

Electronic prescribing systems that reduce the possibility of human error could cut clinical negligence claims by more than 70 per cent, according to US hospital chain Banner Health.

The company, which has worked with national IT programme supplier Cerner to evaluate the impact of its electronic prescribing system, said systems that reduced the possibility of human errors such as illegible handwriting or misrecorded doses had led to a 72 per cent reduction in the cost of clinical negligence claims at one of the group’s hospitals.

The National Patient Safety Agency has estimated that 9 per cent of patient safety incidents relate to medication errors, which together constitute some 20 per cent of all clinical negligence claims against the NHS.

In 2007-08, the NHS Litigation Authority paid out approximately £64m in damages for cases involving misprescribing.

Banner Health’s system director for care transformation Judy Van Norman told HSJ: “Some clinical leadership in the hospitals are interested and enthused about being involved but the resources at the individual hospital level to really lead the adoption of this is a frustration.”

Above article published on http://www.hsj.co.uk/news/technology/e-prescribing-could-cut-cost-of-human-negligence/5003930.article

The Health and Human Services Department and the Drug Enforcement Administration are reviewing the feedback they have received on DEA proposed rule on e-prescribing for controlled substances, but the final rule might not emerge this year.

DEA published the proposed rule earlier this year, which would impose security requirements for e-prescribing of controlled substances. A public comment period expired Sept. 25. Groups representing physicians, pharmacies and health information technology vendors have expressed concern that the rule as currently written could impede adoption of e-prescribing.

Kerry Weems, acting administrator of HHS; Centers for Medicare and Medicaid Services, said DEA and HHS are reviewing the comments. Speaking at CMS; National E-Prescribing Conference in Boston this week, Weems said the goal is to address DEA concerns while creating a rule that doesn’t provide a barrier to e-prescribing.

Jodi Daniel, director of the Office of Policy and Research in the Office of the National Coordinator for Health IT, said the final rule might not be on DEA to-do list for this calendar year. The presidential election could also push action into next year.

The change in administration…may slow things down; said Daniel, who also spoke at the conference.

Meanwhile, a Medicare incentive program that will initially provide a 2 percent bonus to physicians who adopt e-prescribing goes into effect Jan. 1, 2009.

Some experts say Deal’s current prohibition against e-prescribing controlled substances has blocked broader acceptance of the technology. The situation compels doctors who use e-prescribing to maintain a paper-based system for controlled substances and an electronic system for other drugs.

To help spur use of the technology, the eHealth Initiative released A Clinician’s Guide to Electronic Prescribing at the conference. The organization compiled the guide in cooperation with the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the Medical Group Management Association and the Center for Improving Medication Management

Above article published on http://www.govhealthit.com/newsitem.aspx?tid=77&nid=69406

Electronic prescribing has seen significant growth in adoption and use of critical components, according to the annual National Progress Report on E-Prescribing.

The report, released by Alexandria, Va.-based Surescripts, documents the status of e-prescribing adoption and use in the United States from 2006 through 2008.

According to the report, more than 100,000 prescribers are now routing prescriptions electronically, and the use of three critical components of e-prescribing – electronic prescription benefit, history and routing – jumped 61 percent in the first quarter of 2009. This jump resulted in more than 134 million e-prescribing messages being exchanged among prescribers, payers and pharmacies.

The report credits three factors for influencing e-prescribing growth in 2008:

• the attention e-prescribing received at the federal and state policy level;
• national programs that drove e-prescribing and offered practical tools to assist the industry in moving;
• and the adoption of e-prescribing by key groups – namely, payers  (including PBMs and Medicaid plans), prescribers and pharmacies.

“In the past two years, the U.S. has gone from 19,000 to 103,000 prescribers routing prescriptions electronically – punctuated by 39 percent sequential growth in prescriber adoption in the first quarter of this year,” said Harry Totonis, president and CEO of Surescripts. “The past two years have also witnessed a sevenfold increase in the use of e-prescribing. And while this growth shows clear evidence that the steps taken by policymakers, prescribers, payers, pharmacies and others are having a positive impact, swift and specific action is required for the U.S. to achieve mainstream adoption and use of e-prescribing.”

Surescripts recommends that five actions be taken to continue the growth of e-prescribing use and adoption and  further secure reductions in cost as well as improvements in safety and efficiency:

• Continue to work with the U.S. Drug Enforcement Administration to pass regulations that allow controlled substances to be electronically prescribed in a way that is workable and scalable.
• Work to ensure that “meaningful use” under the American Recovery and Reinvestment Act of 2009 requires the actual use of  e-prescribing.
• Fill gaps in e-prescribing participation among payers, state Medicaid programs and independent pharmacies.
• Raise awareness across the industry and encourage deployment and use of e-prescribing – encompassing prescription benefit, prescription history and prescription routing.
• Provide education, financial incentives and implementation assistance for all prescribers, with a particular focus on addressing the needs of small and medium-sized practices.

Above article published on

http://www.healthcareitnews.com/news/e-prescribing-sees-growth-action-still-required

“E-prescribing saves lives, it saves money, and it’s time we implement it,” according to Health and Human Services Secretary Mike Leavitt.

Streamlining the bloated health care system “is an economic imperative for our country. We have to get down to making the system better, and [e-prescribing] is one piece of a large puzzle,” he stressed at a conference on e-prescribing sponsored by the Centers for Medicare and Medicaid Services.

After acknowledging that “change is hard,” especially change that requires substantial time and money, Secretary Leavitt assured attendees that the benefits of implementing an electronic prescribing system would quickly exceed the costs, thanks in large part to the incentive program provided under the Medicare improvements for Patients and Providers Act of 2008.

Under MIPPA, physicians who use a qualified e-prescribing system for their Medicare patients will be eligible to receive a bonus of 2% of their Medicare revenue in 2009 and 2010. The bonus amount will decrease to 1% of total Medicare revenue in 2011 and 2012, and to 0.5% in 2013. Beginning in 2014, physicians who are not prescribing electronically will see their Medicare payments reduced by as much as 2%.

From the government’s perspective, the business case for e-prescribing is a “no-brainer,” according to acting CMS administrator Kerry Weems, as widespread implementation of the technology could save Medicare $13 million-$146 million between 2009 and 2013. The savings, he said, will be achieved through averted medication errors and the substitution of less-expensive prescription drug alternatives. Specifically, “errors associated with illegible handwriting are eliminated and those linked to oral miscommunications are substantially reduced because the process is automated,” he said.

Additionally, e-prescribing software provides secure electronic access to each patient’s prescription history and automatically alerts physicians to dangerous drug interactions and allergies, thereby minimizing the potential for both.

E-prescribing also promises advantages that will have a positive impact on physician bottom line, Mr. Weems said. Automating the prescribing process reduces time spent on phone calls and faxes to pharmacies, speeds the prescription renewal request and authorization process, increases medication compliance, improves formulary adherence, allows greater prescriber mobility, and improves drug surveillance.

Together with the promised bonuses (and future penalties) for e-prescribing, the argument in favor of technology is gaining steam. “With MIPPA, Congress has helped us solve the business equation side of e-prescribing,” he said.

Without question, the financial incentives improve the case for converting from traditional to electronic prescribing, Mr. Weems said, noting that the average e-prescribing primary care doctor stands to collect between $2,000 and $3,000 in bonuses in 2009 and the cost of an e-prescribing system ranges from $2,500 to $3,000.

The psychological obstacles, on the other hand, may be tougher to knock down, according to Secretary Leavitt.

“There’s always going to be resistance to change, and in this case, some of it is well thought out: ‘I’ve got training costs; there’s likely to be a productivity dip; do I really want my business to go through this?’ Those are the kinds of things that are part of any sort of business process change, and such change doesn’t happen overnight,” he said.

To help facilitate the change, the eHealth Initiative, in collaboration with the American Medical Association, the American Academy of Family Physicians, the Medical Group Management Association, and the Center for Improving Medication Management, has published “A Clinician’s Guide to Electronic Prescribing/’ which offers practical information on planning, selecting, and implementing an e-prescribing system.

The guide “is an invaluable resource [that] provides substantial detail not only on how to get started but what challenges to expect and how to overcome them,” said Dr. Steven E. Waldren, director of the AAFP’s Center for Health Information Technology.

Other challenges hindering widespread adoption of e-prescribing, according to the guide, include work flow changes, continued need for improved connectivity and technology, state regulatory restrictions (such as the New York State Medicaid requirement that the “dispense as written” instruction be handwritten), and the need for reconciled medication histories.

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Tennessee is recognized as one of the top five most improved states in routing prescriptions electronically.

Surescripts, a health information network that operates the country’s largest electronic prescribing network, announced that Tennessee ranked second behind Vermont and just ahead of Kansas, Illinois and Missouri on the top five list. Recognized as the country’s leading states in electronic prescribing were Massachusetts, Rhode Island, Michigan, Nevada and Delaware.

The state was recognized during an event held by Surescripts at Washington’s National Press Club.

Tennessee Gov. Phil Bredesen co-hosted the fourth annual Safe-Rx Awards event as part of the State Alliance for e-Health. Bredesen co-chairs the alliance and co-hosted the event with Vermont Gov. Jim Douglas.

Surescripts created the Safe-Rx Awards to raise awareness of e- prescribing as a way to improve patient safety by providing a secure, accurate and informed prescribing process.

The State Alliance was created by the National Governors Association Center for Best Practices in January 2007 to improve the nation’s health care system by forming a collaborative body that lets states increase the efficiency and effectiveness of the health information technology initiatives they develop.

“The State Alliance recognized early on that encouraging states to make e-prescribing a top priority would have an immense value in our electronic health efforts,” Bredesen said. “Paperless prescribing is making its way into the health care mainstream in Tennessee and across the nation. It’s our hope to see e-prescribing become a natural part of every health care provider’s workflow because of its practical benefits to patients in providing better care.”

In January 2010, Surescripts will release a new state ranking. Using data from 2009, the rankings will measure use of three steps in electronic prescribing: prescription benefit, prescription history, and prescription routing.

In Washington for the State Alliance event, Bredesen was making one of his first public appearances since returning from a trade mission to Europe.

Bredesen said he spent some time calling on economic development prospects for Tennessee.

The trip did not yield any concrete results, “nor did I expect that,” he said.

“Economic development is something you just have to keep plugging away at,” Bredesen said. “You make the trips to see people. Sometimes, you hit a home run. Sometimes, you strike out. But on the whole, I’m very satisfied with the trip.”

Bredesen said he did come back with an idea for the 1,700-acre megasite industrial park in Haywood County in West Tennessee. The state budget approved last week includes $40.3 million to acquire land for the site.

Bredesen declined to provide any other details about his idea for the park, but said it’s something the state should start thinking about.

“There’s enough money there and the site makes sense,” he said. “I doubt we can bring it to closure on my watch, but if you can hand something ready to go to the next governor, so much the better.”

Bredesen’s trade mission included stops in Switzerland, Germany and Poland.

In Munich, the governor paid a courtesy call to the headquarters of Wacker Chemie AG, which is building a $1 billion plant near Cleveland that will make polysilicon, a material used to make photovoltaic cells.

In Birr, Switzerland, Bredesen toured the Alstom Turbine and Generator rotor manufacturing operation and met with a group of Tennesseans employed by Alstom in Chattanooga.

The trade mission concluded with a trip to Warsaw, where the governor met with Victor Ashe, a former Knoxville mayor who is the U.S. ambassador to Poland, and business leaders from the Polish American Chamber of Commerce.

Bredesen said Poland’s rapidly developing economy offers a lot of trade opportunities for Tennessee companies to sell goods there. “I want to keep pursuing that,” he said.

Above article published on

http://www.knoxnews.com/news/2009/jun/23/tennessee-makes-strides-in-electronic-prescribing/