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Meaningful Use and E-Prescribing Workflow (Text Version)

Slide presentation from the AHRQ 2009 conference.

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).


Slide 1

Slide 1. Meaningful

Meaningful Use and E-Prescribing Workflow

Douglas S. Bell, MD, PhD

Associate Professor, Dept. of Medicine, UCLA

Research Scientist, RAND Corporation

 

Slide 2

Slide 2. E-Prescribing: A Model System?

E-Prescribing: A Model System?

 

Slide 3

Slide 3. Benefits for Everyone

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

Slide 4. E-Prescribing Policy

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

Slide 5. If You Install It, Will They Use?

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

Slide 6. Does Use Change Over Time?

Does Use Change Over Time?

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

 

Slide 7

Slide 7. Does Use Change Over Time?

Does Use Change Over Time?

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

 

Slide 8

Slide 8. Medicare Improvements for Patients and Providers Act (MIPPA)

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

Slide 9. Mechanism of E-Prescribing Effects

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

Slide 10. Macro Process Model

Macro Process Model

Diagram describing the Macro Process Model.

JAMIA, 2004; 11:60-70
 

 

Slide 11

Slide 11. Rework Pathways

Rework Pathways

Diagram describing Rework Pathways.

 

Slide 12

Slide 12. E-Prescribing: Attenuate the Rework

E-Prescribing: Attenuate the Rework

Diagram describing E-Prescribing.

 

Slide 13

Slide 13. Sample Modeling Results: New Rx

Sample Modeling Results: New Rx

Two diagrams describing

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

 

Slide 14

Slide 14. Lessons from Successful Practices

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

Slide 15. E-Prescribing Implementation Toolset

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

Slide 16. Conclusions

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

Slide 17. Thank

Thank You

Questions?

dbell@ucla.edu or dbell@rand.org

Slide 18

Slide 18. Reasons for Continuing to Use Paper

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

Slide 19. E-Prescribing

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
Current as of December 2009
Internet Citation: Meaningful Use and E-Prescribing Workflow (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/news/events/conference/2009/bell/index.html

 

The information on this page is archived and provided for reference purposes only.

 

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