Webinar: Leadership is crucial in e-prescribing initiatives
Leadership and vision are crucial for an e-prescribing initiative because effective leadership is necessary to build commitment across a team, according to Diane R. Jones, JD, vice president of policy and programs at e-Health Initiative during an informational webinar on the current and future states of e-prescribing.

“The staff needs to be open to change and appreciate the benefits of [e-prescribing], but the leadership is going to be crucial [as well as] what the team hopes to accomplish through e-prescribing and that vision should encompass an understanding of the functionality and the benefits offered by e-prescribing,” stated Jones.

The webinar, sponsored by health organization Open Health IT Exchange, sought to teach attendees about the Medicare Improvements for Patients and Providers Act (MIPPA), the HITECH Act and related facts surrounding incentives, penalties, timelines and qualified system definitions.

Jones, quoting a 2009 report from e-prescribing company Surescripts, stated that approximately 85 percent of community pharmacies in the U.S. are connected for prescription routing and the number of prescribers routing prescriptions electronically has grown from 74,000 to 156,000.

To give context and clarity, Jones defined e-prescribing as the transmission of electronic media of prescription or prescription related information between a prescriber, dispenser, pharmacy benefit manager or health plan, either directly or through an intermediary including an e-prescribing network.

One challenge of deploying e-prescribing for Sidney Clinic in Sidney, Mont., is that the facilitiy's e-prescribing application currently doesn't have "cancelation" or "change in medication directions" options, said Pam McGlothilin, clinical information systems coordinator at Sidney Clinic. To provide a peer prespective, McGlothilin noted that their faciltiy, which serves a region of 5,000 people, currently has five providers using e-prescribing to order 50-75 prescriptions a day.

McGlothilin noted that most pharmacies in her region support e-prescribing and that within a 50 mile radius, 15 pharmacies will accept e-prescriptions. Anecdotally, McGlothilin said that e-prescribing has been helpful in that it is faster than faxing orders so providers are more prone to use the system, especially with electronic refill requests.

"Our practice has benefited by doing this earilier; once meaningful use comes out...we'll be ahead of the curve," said McGlothilin, who added that within the coming weeks, a cancelation button option will be added to the e-prescribing system.

In addition to assessing organizational readiness and defining practice needs, Jones stated that when following through with an e-prescribing initiative, the provider should also evaluate the costs and financing of a system and undergo a peer review or test a system before deploying it.

E-prescribing will be a key component of meaningful use requirements, according Michelle Allender-Smith, RN, nurse consultant/government task lead for the Centers for Medicare & Medicaid Services (CMS). Any medical professional defined as “eligible” by CMS may participate to receive MIPPA incentives, Allender-Smith noted.

In July of 2008, Congress passed MIPPA in an effort to prevent mandated cuts in Medicare payment to physicians for approved services, stated Allender-Smith. In October of 2008, the five-year e-prescribing incentive program was implemented to provide eligible professionals with incentive payments each year, if they meet requirements for being a successful e-prescriber.

Allender-Smith stated that a qualified system should be able to:
  • Generate a complete active medication list (with information from pharmacy benefit management organizations or pharmacies if available);
  • Select medications, print prescriptions, transmit prescriptions electronically using the applicable standards, and warn the prescriber of possible undesirable or unsafe situations;
  • Provide information on lower-cost, therapeutically-appropriate alternatives; and
  • Provide information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient’s drug plan.

Each incentive payment is based on the covered professional services furnished by an eligible professional during the reporting period (one year) which began in January 2009. The last reporting period will be in 2013, added Allender-Smith.

However, because eligible professionals cannot both receive Medicare and Medicaid HITECH Act incentive payments, beginning in 2011 providers must decide between MIPAA and HITECH Act incentives, according to Allender-Smith.

Those that choose not to adopt an e-prescribing system by the year 2012 will be subject to a payment differential, in which their fee schedule payments will be reduced for each year after, stated Allender-Smith.

Allender-Smith also noted that there is a current Interim Final Rule (IFR) published in the March 31 Federal Registar on providing a mechanism that supports e-prescribing on controlled substances. The IFR is currently in a 60-day public comment period but because it is a "major rule," Allender-Smith it is subject to congressional review. Therefore, its effective date could be delayed.

Once the Drug Enforcement Agency issues the final rule, controlled substances would first have to be accepted into the CMS e-presricing program. "It is not yet known what the actual timing will be or if the current reporting requirements for individual and group practices will be the smae for regular versus controlled substances should they be approved by CMS," the presentation noted.

The webinar concluded that there is a wealth of resources online at CMS' website for e-prescribing. To access this information, click here.