As a kid, when I received some type of toy, the most exciting aspect was figuring out how it worked. I couldn’t just play with it, I needed to tear it apart, analyze it and rebuild it. I guess this has followed me into my career, as I disassembled eRx to its pieces. The term eRx is generally understood as just sending a prescription electronically to the pharmacy. While this is a great feature, there are many other benefits which your practice can capitalize on.
During a typical eRx transaction there are many players involved, which include providers, payers, pharmacists and the main “character behind the curtain”- Surescripts. While there are other smaller eRx networks in the country, Surescripts is by far the primary network that handles connections between all stakeholders. Communication between Surescripts and the other involved parties is achieved with a standard called National Council for Prescription Drug Programs script (NCPCP script). NCPCP allows everyone to talk the same language.
Participation with Surescripts is free to physicians, but pharmacies are charged on a per-electronic-prescription basis. This is because an eRx provides tremendous time savings to a pharmacy compared to paper based prescriptions. Pharmacies were quick to adopt this technology, and now close to 95% of pharmacies are connected to the network.
Surescripts offers services other than routing of prescriptions between the provider to the pharmacy. These lesser known services include refills, Rx history, and Rx eligibility.
e-Refills is a process that typically has the pharmacists requesting an authorization for a renewal of a medication. With e-Refills requests returning digitally to the provider, they are viewed in an application such as an EHR. While receiving a new eRx is a time saver for pharmacists, it is not a huge time saver for a provider. In many studies it can take longer to “write” an e-prescription. However the real time saver on the practice is e-Refills that are received. You will notice that I said practice and not provider. This is because often the clinical support staffs are the ones handling the incoming refill requests.
Reconciling medications with the patient is a common step during the clinical work flow process. The Surescripts network also allows providers to automatically aggregate a patient medication history with the click of a button. Surescripts gathers this information by accessing data from community pharmacies as well as payers. While this is not one hundred percent accurate for gathering all medications every time, it does give clinical staff a substantial head start. This prescription history service results in improved patient safety and quality.Rx Benefit checking is another core service Surescripts offers that can access the patient’s prescription eligibility information in real time during an office visit. During the prescription process physicians can determine if drugs are covered with the patients insurance. Personally, I wish this service was offered more often. When my daughter was a newborn she was prescribed some skin cream. As a new dad I was shocked at the cost when I went to pick up the medication from the pharmacy. When I asked if a generic medication was available, I had to wait while the pharmacist called the pediatrician for approval. This cumbersome process wasted the time of all involved parties: the patient, the pharmacy, and the provider. An easy way to reduce healthcare costs is simply by using prescription benefit checking.
The one common denominator these additional Surescripts features share is that they rely on the connectivity that your EHR vendor offers. There are some third party websites and applications that offer these services without an EHR, but a vast majority of practices are making use of these with their EHR software. If you are currently examining your choices for EHR these features should take precedence on your needs analysis. Surescripts ranks the EHR interoperability at the following site: http://www.surescripts.com/certification-status.html
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Since most of the office-based providers are not using EHR’s at this time, I would not overlook the speed at which a provider can be up and running with a Stand-Alone eRx solution. EHR’s take time to evaluate, train and implement. An EHR involves the entire patient encounter. It has a medium to long learning curve to adjust from the paper world to electronic. Stand-Alone e-Rx applications have a short learning curve and involves a small piece of the patient encounter. e-RX applications mimic the paper script. Incentives are in place now to e-prescribe (MIPPA). And a good Stand-Alone e-RX application will allow a provider to migrate their patient data to an EHR when and if they choose one.
I would agree with the comment above. There are good stand-alone eRx applications out there and even some free stand-alone apps to capitalize on if you don’t mind getting calls from sales vendors. Going to a stand-alone is a must smaller project than going to an EHR.
Payers at one point where also giving incentives but we are now starting to see these fade as ARRA HITECH steps into the limelight. The ARRA HITECH does not allow double dipping of eRx incentives and EHR incentives which I think is interesting.
From my experience the stand-alone applications have one negative and that is integration. When a new patient is entered into the Practice Management it is nice to have the patient show in the eRx application. Providers do not want to key in patients twice nor lookup the patient twice. Most stand-alone vendors offer this advanced feature but it is not free and will depend a lot on your practice management.
If EHR is not for you I would say you still need the stand-alone eRx application. If you are actively looking at an EHR I would advise using the services that the EHR vendor offers.