Health plan collaboration helps advance e-Rx initiatives

THE HITECH Act of 2009 provides the requirements for meaningful use of an electronic health record, including transmitting 40% of prescriptions electronically. However, the slow uptake in electronic systems overall is stalling the potential of electronic prescribing.

On a positive note in the e-prescribing arena, an 18-month collaborative effort among the California Public Employees' Retirement System (CalPERS), Blue Shield of California, Anthem Blue Cross and Medco Health Solutions has achieved results. The program doubled the use of e-prescribing among its 13,000 physicians in the pilot, representing five California-based physician groups.

"The goal was to improve safe use of medications through more accurate prescribing and dispensing methods and technologies" says Nancy Stalker, vice president, pharmacy services for Blue Shield of California.

The number of prescribers routing prescriptions electronically grew from 74,000 at the end of 2008 to 234,000 by the end of 2010, according to Surescripts in "The National Progress Report on E-prescribing and Interoperable Care." The number of electronic prescriptions in 2010 increased to 326 million, up from 190 million e-prescriptions in 2009. By the end of 2010, approximately 25% of eligible prescriptions were prescribed electronically.

FEDERAL INCENTIVES FOR ADOPTION

Doug Johnson, vice president, PBM/payer customer relations for Surescripts, attributes the upswing in e-prescribing to new federal incentives and to recognition by stakeholders of the value of health information technology and e-prescribing.

"We have produced some terrific results from encouraging the use of electronic prescribing," says Tony Oliveira, interim chair, CalPERS Health Benefits Committee.

The CalPERS pilot generated these findings:

"We also expected the pilot to improve overall cost of healthcare by increasing safety and accuracy with e-prescribing, such as reducing drug-drug interactions and medication dispensing errors; however, those measures are not available," Stalker says.

As a health plan partner, Blue Shield provided pharmacists and project managers to plan and launch the program, along with resources to identify and resolve issues in workflow and technical barriers, Stalker says.

After the pilot, plan partners agreed to continue to pursue and implement e-prescribing adoption strategies with physician groups and pharmacies.

CMS FOSTERS E-RX GROWTH

To pave the way for physicians, six healthcare organizations have revised their 2008 edition of "A Clinician's Guide to E-Prescribing." The guide studies the implications of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the incentive program authorized under the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, healthcare reform and the approval of e-prescribing of controlled substances.

"The how-to guide is a practical and well-written publication and serves as a starting point for practices who are interested in adopting e-prescribing and as a resource for those already experienced with the technology," says Robert Tennant, senior policy advisor, Medical Group Management Assn., one of six organizations collaborating on the guide.

While not an easy road for physicians-primarily the financial investment and interruption of practice work flow-Tennant sees the potential of e-prescribing to mitigate errors, drive out unnecessary costs, capture front-end medication information, verify eligibility and benefits in real-time, streamline administrative processes and check on formulary status electronically.