E-Prescribing use has been increasing, especially with the imposition of the Medicare penalty for the failure to e-prescribe under MIPPA, and the Meaningful Use incentive program. For those not familiar with the e-prescribing penalty I suggest that you read Deadline to Submit Hardship Exemptions to Avoid the 2012 e-Rx Penalty Extended. You still have six months left to avoid the 2013 penalty. However, even with this growth, most physicians use very basic features in order to fill or refill a prescription. Few use more advanced features such as checking patient formulary information. Unfortunately, it is these features that are most likely to increase patient compliance and reduce healthcare costs.
Consider the following tips in order to overcome barriers to using some advanced features:
Drug Interaction and Drug Disease Checking
Drug interaction checking and drug disease checking is likely the most widely used “advanced e-prescribing feature”; however, it is also one that frequently causes providers to grit their teeth due to annoying pop-ups used by some EHR systems and multiple irrelevant alerts. These can frequently cause alert fatigue and may result in practices turning off the alert system completely. Before switching off alerts, make sure to explore with your vendor whether there are other options. For example, can you customize alert sensitivities to your own preferences or limit the display to severe alerts? A number of EHRs allow users to manage their own alert settings rather than requiring everyone to use a single practice setting.
Formulary checking allows a provider to see if a medication is available through a patient’s drug formulary. Many systems can also suggest generic or less expensive therapeutic alternatives. Some systems display the dollar amount of the patient’s payment. Formulary checking has been shown to substantially reduce drug costs and improve patient compliance.
Unfortunately, many providers are neither aware of nor do they know how to use this feature. In the October 2011 AmericanEHR Partners report The Correlation of Training Duration with EHR Satisfaction: Implications for Meaningful Use, additional training was substantially correlated with the use of patient formulary functionality. If you are having trouble enabling patient formulary management features, here are some tips to consider:
- Ensure that eligibility checking is enabled. In some cases the eligibility checking feature resides in the practice management system rather than the EHR system. As such you may need to check for it there instead of within the EHR. If you have an interfaced practice management system, you will need to ensure that eligibility checking is part of the interface. (Warning: in some cases, a fee is charged by clearing houses in order to extract this information. To avoid this issue, make sure that your EHR system obtains this information from a free data source.)
- Some vendors charge an additional fee for this set of functionality. If you cannot find formulary checking functionality, check with your EHR vendor to confirm whether you actually have the feature and the right version of the product.
Remember that formulary checking is one of the optional Meaningful Use measures.
As with formulary checking, medication reconciliation is an advanced E-Prescribing feature that qualifies as an optional Meaningful Use metric. To understand this feature I think it is best to divide the functionality into two components.
- Importing a Medication List:Unlike other features, the medication list can be drawn from different sources. For instance, it may come from a local hospital (with which you have an interface) or a Health Information Exchange (HIE) or Surescripts. When using this feature it is important to consider the source of the data and how much trust you have in the information. In most cases you will want to use it as a supplemental source of data and not the master list. Once you import a medication list, you will want to reconcile it with your existing list of medications. If you want to use this feature, make sure to receive adequate training as the consequences of errors when doing reconciliation are significant. In the AmericanEHR Partners report, The Correlation of Training Duration with EHR Satisfaction: Implications for Meaningful Use, we found that additional training was essential in order to be able to use this functionality.
- Reconcile an Imported Medication List: Rather than automatically overwriting an existing medication list, you will want to compare the imported list with your existing list. EHR vendors all handle this task differently and I recommend that you obtain training on your system.
Medication Fill / Compliance Data
The newest advanced E-Prescribing feature is “fill” data (i.e. if the patient is actually filling their prescription and the frequency with which they are doing so). This has obvious benefits in terms of assisting patients with compliance coaching but there are still concerns about patient privacy and the reliability of the data. When using this feature, do not assume the data is error-free.
For those of you interested, here are some interesting articles on the use of E-Prescribing.
Joy M. Grossman Even When Physicians Adopt E-Prescribing, Use of Advanced Features Lags Health System Change Issue Brief No. 133 July 2010
Thomas Isaac; Joel S. Weissman, et al Overrides of Medication Alerts in Ambulatory Care Arch Intern Med. 2009;169(3):305–311.
Michael A. Fischer; Christine Vogeli et al “Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost Arch Intern Med. 2008;168(22):2433–2439
Joy M. Grossman, Anneliese Gerland, et al Physicians’ Experiences Using Commercial E-Prescribing Systems Health Aff May 2007 26:3w393–w404
Jesse C. Crosson, Rebecca S. Etz, et al Meaningful Use of Electronic Prescribing in 5 Exemplar Primary Care Practices Ann Fam Med September/October 2011 vol. 9 no. 5 392–397
Grossman JM, Cross DA, Boukus ER, et al. Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies J Am Med Inform Assoc (2011). doi:10.1136/amiajnl-2011-000515
This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.