Vermont Board Of Pharmacy
Slow train coming: e-prescribing roadblocks still standJames Frederick The electronic-prescribing train is a local, not an express. And it's going to have to stop at every station along the health care continuum before it arrives at its final destination.
The physician community has yet to embrace the concept fully, but the nationwide conversion to a paperless, standardized e-prescribing system is proceeding steadily. One example of that progress is Walgreen Co., which recently signed on as an active participant in the nationwide electronic conversion campaign promoted by SureScripts, the e-connectivity company established in partnership with the National Association of Chain Drug Stores.
"All of our pharmacies are ready for electronic prescribing from a technical perspective," said Walgreens chairman and chief executive officer David Bernauer. "We work closely with SureScripts to help inform physicians about the benefits of electronic prescribing, including how the process enhances communications between physicians and pharmacists for the patient's ultimate benefit."
More than 85 percent of U.S. pharmacies and pharmacy software vendors have signed agreements and have been certified to connect to SureScripts' network, and more than 50 percent of them are expected to go live on the e-prescribing network by the end of this year, according to the company. And, besides Walgreens, some two-thirds of the industry's chain pharmacies are participating in SureScripts' so-called Membership Program as active collaborators in the nationwide rollout, including CVS, Wal-Mart, Duane Reade, Albertsons and Happy Harry's.
On July 20, Cardinal Health's Medicine Shoppe and Medicap franchise pharmacy divisions became the latest to join that rollout effort.
In addition, all but a handful of states--Georgia, South Carolina and Hawaii among them--now have on the books regulations that are "favorable" to the adoption of e-prescribing or are "in progress" toward adoption of such rules, according to SureScripts.
The real sticking point to an e-prescribing nation, however, isn't chain or even independent pharmacy. It's the nation's 700,000 physicians, many of whom have yet to break the paper prescription habit or even to fully computerize or integrate their patient record-keeping, prescribing patterns, lab results, billing or other data.
That situation also is improving steadily, as big hospitals and physician groups like the Cleveland Clinic link their own patient data platforms with SureScripts and other electronic platforms. New findings from health care marketing firm Manhattan Research also trace a rapid transition among doctors "from the analog to the digital" in their practice settings as the use of hand-held personal digital assistants becomes widespread.
Indeed, noted Erika Fishman, a senior analyst with Manhattan Research: "Physicians using the hand-held platform write an average of 42 more prescriptions per week than physicians using e-prescribing through the desktop or another platform. This represents a significant difference in prescription-writing habits and further demonstrates the enhanced efficiency that PDAs can bring to the physician workday."
Another key force now driving the race to nationwide e-prescribing is the federal government. Spurred by the Bush administration, the Department of Health and Human Services and the agency within that department overseeing the rollout of the Medicare Part D prescription benefit program--the Centers for Medicare and Medicaid Services--are pushing hard for the universal adoption of a standardized, electronic system for health professionals to store, transmit and retrieve patient records.
Early this year, CMS administrator Mark McClellan promised that CMS would "take further collaborative steps to enhance our support for e-prescribing as quickly as possible."
The agency is making good on that promise. According to Larry Kocot, senior advisor to McClellan and former senior vice president and general counsel at NACDS, the conversion to e-prescribing goes hand-in-hand with the long-term success of government health programs like Medicare and Medicaid. And, he said, efforts to promote the paperless prescribing and record-keeping technology have taken on a heightened urgency in advance of the launch of the Medicare Part D drug benefits in January.
"We intend to deliver a modernized Medicare drug benefit using technology to help improve processes for better health outcomes," Kocot said.
Indeed, said the CMS official: "The [Medicare Modernization Act] requires widespread implementation of e-prescribing no later than 2009. We're going to accelerate that schedule."
Few, if any, question the value e-prescribing will bring to health care, both in terms of patient safety and in terms of cost efficiencies. As NACDS president and chief executive officer Craig Fuller testified to a congressional committee, NACDS "has long advocated electronic prescribing by cofounding SureScripts, an enterprise providing true electronic connectivity between physicians and pharmacies.
"Increased electronic connectivity will help improve both the safety and efficiency of the prescribing process, as well as improve the quality of medication decisions," Fuller noted. What's more, he said, paper prescriptions breed medication errors and waste pharmacists' time.
Research backs that up. According to the Institute for Safe Medication Practices, indecipherable or unclear prescriptions result in more than 150 million calls per year from pharmacists to physicians asking for clarification.
Beyond that, an electronic web that links prescribing physicians instantly with local pharmacies will be a boon to community pharmacy. It could foster a far more collaborative and patient-centered relationship between the two sides and could promote a more integrated system of care and disease management for patients by putting pharmacists and physicians on a platform of instantaneous communications. With easily available software that tracks each patient's drug regimen, potential drug interactions could be prevented as soon as a prescription is written and submitted to the pharmacy. Other forms of patient data, including outcomes and response to a particular medicine, lab results, compliance levels, etc., also could go back and forth through secure transmissions.
"Having access to this information at the point of care makes writing, filling and receiving prescriptions quicker and easier, and it also makes it possible for physicians and pharmacies to make informed decisions about appropriate and lower-cost therapeutically equivalent alternative medications," noted CMS in a report.
E-prescribing state-by-state regs
From in-state From out-of-state
prescriber prescriber Between
computer computer in-state
to pharmacy to pharmacy pharmacy
State computer? computer? computers?
Alabama yes (b) yes (b) yes
Alaska N/A N/A N/A
Arizona N/A N/A yes
Arkansas yes yes yes
California yes yes yes
Colorado yes (b) yes (b) yes (b) (e)
Connecticut yes (k) yes (k) yes (k)
Delaware yes yes yes (a)
District
of Columbia no no no
Florida yes yes yes
Georgia no no yes (a)
Hawaii yes yes yes
Idaho no no yes (a)
Illinois yes yes yes (e)
Indiana yes
Iowa yes yes yes * (a) (e)
Kansas yes yes yes
Kentucky yes (b) yes (b) yes (d)
Louisiana yes yes yes *
Maine no no yes (a)
Maryland yes yes yes (e)
Massachusetts yes (f) yes (f) yes (f)
Michigan yes yes (g) no
Minnesota yes yes yes
Mississippi yes yes yes
Missouri yes yes yes
Montana yes yes yes
Nebraska yes yes yes
Nevada yes (l) yes (l) yes
New Hampshire yes yes yes (a) (g)
New Jersey no no no
New Mexico yes yes yes (k) (n)
New York yes (h) yes (h) yes (h)
North Carolina yes yes yes
North Dakota yes yes no
Ohio yes (j) yes (j) yes (e)
Oklahoma yes yes yes
Oregon N/A N/A yes (e)
Pennsylvania N/A ** N/A ** yes
Rhode Island N/A N/A yes (a)
South Carolina yes no yes (i)
South Dakota no no yes (a)
Tennessee yes yes yes
Texas yes (b) yes yes
Utah no N/A no
Vermont yes yes yes
Virginia yes yes yes (m)
Washington yes yes yes (f)
West Viginia yes (k) (l) yes (k) (l) yes (k) (l)
Wisconsin yes yes yes
Wyoming yes yes yes
From out-of-state Recognize
pharmacy electronic
computer signatures for
to in-state non-controlled
pharmacy substance
State computer? prescriptions?
Alabama yes no
Alaska N/A no
Arizona yes yes
Arkansas yes no
California yes no
Colorado yes (b) (e) yes
Connecticut yes (k) yes
Delaware yes (a) yes
District
of Columbia no no
Florida yes yes
Georgia yes (a) no
Hawaii yes yes
Idaho yes (a) yes
Illinois yes (e) yes (k)
Indiana yes
Iowa yes * (a) (e) yes
Kansas yes yes
Kentucky yes (d) yes
Louisiana yes * yes
Maine yes (a) no
Maryland yes (e) yes (c)
Massachusetts yes (f) no
Michigan no yes
Minnesota yes yes
Mississippi yes N/A
Missouri yes yes
Montana yes yes
Nebraska yes no
Nevada yes yes
New Hampshire yes (a) (g) yes
New Jersey no no
New Mexico yes (k) (n) yes
New York yes (h) yes
North Carolina yes yes
North Dakota no yes
Ohio yes (e) yes (j)
Oklahoma yes yes
Oregon yes (e)
Pennsylvania N/A
Rhode Island yes (a) N/A
South Carolina no yes
South Dakota yes (a) yes (o)
Tennessee yes yes
Texas yes no (p)
Utah no N/A
Vermont yes yes
Virginia yes (m) yes
Washington yes (f) yes
West Viginia yes (k) (l) no
Wisconsin yes yes
Wyoming yes yes
Source: National Association of Boards of Pharmacy
* Regulations require pharmacist to perform certain functions
** Regulations currently are being considered and/or drafted
(a) Only by pharmacies with a common electronic file (b) No
Schedule II substances allowed (c) With proper security
precautions (d) Must be online, real-time transmissions
(e) Must satisfy the requirements of state regulations for
prescription transferral. Stores that access the same records
electronically are not required to cancel the original
prescription. (f) If controlled substances, Drug Enforcement
Agency rules must be followed. (g) For non-controlled drugs
(h) With assurances for confidentiality of the electronic
message. No controlled substances. (i) For purpose of
dispensing authorized refills between pharmacies under
common ownership and access prescription information through
common computerized data system (j) Not valide unless
board-approved system (k) Requires same verification as
any oral or telephone prescription (l) Access to prescription
information only by physician and pharmacy (m) With prescription
hard copy (n) Only during normal business hours (o) Pharmacist
must be satisfied with legitimacy of signature
(p) Prescriber signature not required
COPYRIGHT 2005 Reproduced with permission of the copyright holder. Further reproduction or distribution is prohibited without permission.
COPYRIGHT 2005 Gale Group
|
