Meaningful Use and E-Prescribing Workflow (Text Version)

On September 15, 2009, Douglas S. Bell, MD, PhD made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (1.5 MB).

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Slide 1

Meaningful Use and E-Prescribing Workflow

Douglas S. Bell, MD, PhD

Associate Professor, Dept. of Medicine, UCLA

Research Scientist, RAND Corporation

 

Slide 2

E-Prescribing: A Model System?

 

Slide 3

Benefits for Everyone

• Valid, complete Rx
  
• Safety alerts
• Generics identified
• Insurance coverage
• Work delegation

 

• Physicians
  • Decrease pharmacy calls
  • Automate renewal handling
• Pharmacies
  • Decrease calls
  • Automation
• Payors
  • Drug, other spending
• Patients
  • Safety
  • OOP costs

 

Slide 4

E-Prescribing Policy

• Medicare Modernization Act of 2003 (MMA)
  • Authority to mandate transaction standards
  • • NCPDP SCRIPT:
    • • New Rx
      • Refill request
      • Medication history
    • 270/271 Eligibility
    • Formulary and Benefit

 

Slide 5

If You Install It, Will They Use?

• New Jersey E-Prescribe Program, Jan - June 2006
  • 293 prescribers who installed in CY 2005
  • Incentive for use up to $500/qtr

 

Slide 6

Does Use Change Over Time?

• Users with at least 1 quarter at >50% use (41%)

 

Slide 7

Does Use Change Over Time?

Users without any quarter of >50% use (59%)
 

 

Slide 8

Medicare Improvements for Patients and Providers Act (MIPPA)

• Payment incentive for "meaningful use"

	bonus...	then penalty if not
2009	2%
2010	2%
2011	1%
2012	1%	-1.0%
2013	0.5%	-1.5%
2014+		-2.0%

• Qualified systems must be able to:
  • Communicate with the patient's pharmacy
  • Help the physician identify appropriate drugs and provide information on lower cost alternatives for the patient
  • Provide information on formulary and tiered formulary medications
  • Generate alerts about possible adverse events, such as improper dosing, drug-to-drug interactions, or allergy concerns

 

Slide 9

Mechanism of E-Prescribing Effects

• Information available in the system
• Information display / capture at prescriber
• Changes in work processes
  • Changes in drug use
    • Appropriateness
    • Costs
    • Patient adherence
  • Other effects
    • Labor and other costs
      
    • Health service use
      
    • Patient satisfaction

Slide 10

Macro Process Model

Diagram describing the Macro Process Model.

JAMIA, 2004; 11:60-70
 

 

Slide 11

Rework Pathways

Diagram describing Rework Pathways.

 

Slide 12

E-Prescribing: Attenuate the Rework

Diagram describing E-Prescribing.

 

Slide 13

Sample Modeling Results: New Rx

Two diagrams describing

1. Prescriber Time, 1000 New Rx
2. Staff Time, 1000 New Rx

 

Slide 14

Lessons from Successful Practices

• Messages for buy-in, expectations:
  • ERx empowers you as a professional
  • Benefits may be intangible (e.g. more accurate info)
• Setup
  • Keep lists of favorites and default Sigs short to minimize search
  • Reach out to pharmacies RE: common problems
• Workflow
  • Protocols for renewal authorization vs. tasking to prescriber
  • Centralize renewals for medical group
  • Confirm pt's pharmacy at check-in
  • Handout "Rx pad" patient reminder & pharmacy instructions

 

Slide 15

E-Prescribing Implementation Toolset

• Toolset chapters
  1. Understanding the building blocks
  2. Setting goals and achieving buy-in
  3. Assessing readiness & preparing for change
  4. Selecting a system
  5. Scheduling & monitoring the implementation process
  6. Setting up the technology
  7. Planning work process changes
  8. Training staff
  9. Launch
  10. Monitoring and remediating shortfalls
• Pilot testing toolset set to begin Sept., 2009

 

Slide 16

Conclusions

• Achieving meaningful use of eRx may be challenging
  • MIPPA incentives may be low
• Workflow, implementation innovations hold promise
• Future work
  • Improving technical standards
  • Validating workflow models
  • EHR integration
  • Implementation processes carried out by RECs

 

Slide 17

Thank You

Questions?

dbell@ucla.edu or dbell@rand.org

Slide 18

Reasons for Continuing to Use Paper

	Strongly disagree	Disagree	Neutral	Agree	Strongly Agree
Patients were not in the PDA	5	8	5	47	36
I can't use the PDA because of technical problems	3	3	6	37	51
I get too busy	10	17	7	35	31
Pharmacies don't reliably receive and process the electronic prescriptions	8	13	33	36	10
system interfered with established office workflow	16	34	22	22	7
System takes too much of my time	15	24	19	30	13
System takes too much of my staff's time	24	32	30	9	6

 

Slide 19

E-Prescribing is Growing.
but underused

	2006	2007	2008
Prescriptions	13M	29M	68M
4.5% of 1.5B prescriptions/yr in U.S.
Prescribers	15K	36K	74K
12% of 610K physicians, NPs & PAs
Pharmacies	35K	41K	46k
76% of 61k community pharmacies 46% of independents 6 of the largest mail-order pharmacies