eRx Resources
e-Prescribing Services
e-Prescribing systems provide many services based on creating and transmitting a variety of prescription-related information:
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Prescriber/dispenser/consumer identity: Manage and verify the identity of all parties to the e-prescribing transaction.
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E-prescriptions: Capture the digital information required to describe a prescription (provider, the patient, pharmacy, drug, form, dosage, and patient instructions), and transmit it from the physician to the pharmacy.
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E-refills: Capture the digital information required to describe a prescription refill (consistent with the original prescription), transmit it from the pharmacy to the prescriber, and capture and transmit an authorization or denial from the prescriber to the pharmacy.
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Notification: When the consumer picks up an initial prescription or refill, the pharmacy may notify the prescriber to provide some information about patient compliance.
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Rx history: Retrieve and display list of prescriptions that the patient received in the past.
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Eligibility: Confirm that the patient has insurance coverage - at the time of prescribing.
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Formulary: Confirm that the patient's insurance covers the product prescribed or suggest a covered alternative. Prescriber advice: Display information to help prescribers ensure that they are prescribing the right medication in the right dose while properly considering contra-indications and drug-drug interactions.
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Patient advice: Inform the patient and prescriber to ensure that patient takes medication as recommended.
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Monitoring information: Capture information from the patient to help patient and prescriber ensure that patient is receiving desired effects of medication while minimizing undesirable side-effects.
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Reporting: Retrieve historical medication data about one or more patients to implement drug recalls, identify substance abuse, etc.
Benefits
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To the prescriber: fewer pharmacy call-backs, fewer adverse drug effects (ADEs), reduced handwriting interpretation errors, formulary access, automated documentation of prescriptions, facilitated prior authorization, broad drug history access, one-click refills, remote/ mobile access, real-time decision support (drug-drug, drug-allergy, diagnoses, weight, age, drug appropriateness/evidence-based medicine, correct dosing, contraindications, adverse reactions, duplicate therapy alert, abuse monitoring), facilitated care coordination, canned and custom reports.
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To office staff: fewer pharmacy call-backs, fewer workflow interruptions, fewer chart pulls/refiles, less faxing in/out, reduced billing labor.
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To the patient: lower co-pays (formulary/generics), quicker pharmacy visits, fewer ADEs, facilitated compliance (lower cost, greater convenience, facilitated monitoring), easy access to patient education, increased safety.
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To the pharmacist: fewer calls to prescribers (handwriting, coverage, prior authorization, drug interactions), better service to customers, less data entry, fewer errors.
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To the payer/employer/consumer/society: better health, lower costs (formulary/ generics), lower costs (fewer ADEs, less hospitalization), lower long-term costs (better compliance, less hospitalization), lower costs (better use of provider time).
How e-Prescribing works
There are two basic types of systems that implement e-Prescribing capability:
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Dedicated, or "standalone", eRx Systems
Examples: DrFirst, eRx Now, and RxNT -
Integrated EMR/eRx Systems
Examples: Allscripts TouchWorks, NextGen EMR, and eClinicalWorks.
Dedicated eRx Systems
Dedicated eRx systems are exclusively devoted to e-prescribing. They typically include some demographic information about the patient to facilitate patient identification and systems integration, but do not incorporate the broad variety of clinical patient information typical of an EMR.
Lacking full EMR capabilities, dedicated eRx systems are less expensive than EMR systems and simpler to implement in a clinical practice. The software for one notable example, eRx NowTM, is actually free, and other major solutions are available for less than $1,000 per prescriber per year.
Dedicated eRx systems typically provide a more comprehensive set of eRx capabilities than eRx embedded in EMR systems. For example, most dedicated systems are SureScripts Gold Certified for offering a wide range of e-prescribing capabilities, while few EMRs have such certification.
Integrated EMR/eRx systems
Most modern EMR systems include the capability to write prescriptions and efficiently process refills- integrated with a host of other capabilities. A few EMRs have the full suite of e-prescribing capabilities as defined by Surescripts Gold certification, but most offer the fundamental capabilities of creating and transmitting new prescriptions and efficiently handling refills.
Although some may currently lack capabilities such as formulary access, eligibility, and prescription history from external sources, EMR systems offer the additional benefits of complete clinical information at the point of care, even if the prescriber is working away from the office. For more information on EMR systems, check out the EMR page.
Legal Issues
Many of the legal issues surrounding e-prescribing have been resolved in recent years. According to SureScripts, all 50 states and Washington, DC now permit prescriptions to be created and transmitted electronically (compared to only 25 states in 2004).
The one major unresolved issue is prescriptions for controlled substances. The federal Drug Enforcement Administration continues to prohibit the use of e-prescribing for controlled substances. In December 2007, however, the DEA told the Senate Judiciary Committee that, "With proper controls, DEA believes the risk of diversion can actually be reduced through the use of electronic prescriptions. Among the essential elements of an envisioned system are the assurances that only DEA registrants electronically sign and authorize controlled substance prescriptions and that the prescription record cannot be altered without the alteration being detectable." The DEA plans to issue regulations that will detail the requirements for systems that will be permitted to handle e-prescriptions.
Organizations and Web Sites
SureScripts and RxHub: The leading e-prescription intermediaries, providing networks enabling e-prescription transactions and decision support.
The Center for Improving Medication Management: An organization dedicated to advancing the user of technology throughout the medication management process. They also sponsor the separate Web site GetRxConnected.com, providing an online ePrescribing readiness assessment tool.
Florida e-Prescribe Clearinghouse: A state-supported Web site supplying oceans of information to promote adoption of electronic prescribing.
ePrescribeFlorida.com: A leading statewide e-prescribing collaborative. The educational materials from their first summit are available free online.
eRxCollaborative.org: A Massachusetts e-prescribing initiative.
eHealth Initiative: A national organization promoting and supporting the adoption of health IT and health information exchange.
HIMSS: The Health Information Management and Systems Society, a national membership organization focused on optimizing the use of information and management systems in healthcare.
NEPSI: The National ePrescribing Patient Safety Initiative (NEPSI) is collaborating with technology vendor Allscripts and a variety of regional partners to distribute free e-Prescribing software, eRx NowTM.
eRx Books and Journals
In addition to the websites listed above and the documents included to the right, there are also a few key books and journals that are especially helpful when considering implementing e-prescribing in your practice.
Electronic Prescribing for the Medical Practice: Everything You Wanted to Know But Were Afraid to Ask
By Patricia L. Hale
This is a 2007 book about e-prescribing, covering legal issues, data standards, system selection, implementation, and the future of e-prescribing. Available from HIMSS Publications.
Scholarly articles on e-prescribing can be found in the Journal of the American Medical Association (emphasis on the underlying technology) or Health Affairs (emphasis on relevant policy).
