Featuring posts written by the DoseSpot e-Prescribing Integration Team!

A CCHIT Based Guide to Qualified E-prescribing System – The First decision

Posted: May 30th, 2009 | Author: | Filed under: Basics | 3 Comments »

Now that we’ve taken a look at the whole of what is deemed a qualified e-prescribing system in the eyes of CCHIT, I think its time to get into the weeds a bit and see what those high level requirements really mean.  Just as we have to crawl before we walk, I’m going to address the primary goal of getting a prescription order from your EHR to the pharmacy for fulfillment.  It’s a straightforward requirement, but there are a lot of things you must think about before being ready to e-prescribe.

The reality is that any transactions between your system and the pharmacy system will be handled by a third party delivery service.  This service company is Surescripts RxHub.  Some may be familiar with the history of the company, but for those not, in a nutshell they used to be two companies serving two very different user bases.  Surescripts worked with the retail pharmacies, while Rx Hub worked with the Pharmacy Benefit Managers (in other words, the insurers).   I’m sure Surescripts RxNorm are working towards a unified system, but until then you can still think of Surescripts RxHub as two different systems.

Implementing ePrescribing for the first time will be a lot of development work, so if you wanted to stage the development over time and get more bang for your buck it may be a good idea to start with one group rather than the whole kit and caboodle.

Fortunately, taking a look at the following CCHIT requirements makes this first decision pretty easy:

IO-AM 09.13 The system shall provide the ability to send a query to verify prescription drug insurance eligibility and apply response to formulary and benefit files to determine coverage
IO-AM 09.14 The system shall provide the ability to capture and display formulary information from pharmacy or PBM (Pharmacy Benefits Manager) by applying eligibility response
IO-AM 09.15 The system shall provide the ability to send a query for medication history to PBM or pharmacy to capture and display medication list from the EHR

As you can see, CCHIT tries not to be partial for either group in the last two requirements but the simple truth is that the first requirement really points towards implementing a solution through the PBMs. Determining, the eligibility of drug insurance is definitely not a function of a pharmacy; and even if it was wouldn’t it be more efficient to go straight to the source – the insurer?

Stay Tuned

I started this post stating we’re really trying to just get a prescription from your existing EHR into the hands of the fulfiller.  Now, we’re talking about first getting not only the patient’s eligibility information but also changing your EHR to provide formulary information.  If that wasn’t enough, you’ll also be adding a view into the patient’s medication history.  In my next post, I plan on going into more detail just what all of this means and the things you should think about when you’re ready to implement this functionality.

3 Comments on “A CCHIT Based Guide to Qualified E-prescribing System – The First decision”

  1. 1 Rodney Hornbake said at 3:32 am on June 6th, 2009:

    I would be very interested to hearing more on the biggest frustrations in using e-prescribing. (I am an early adopter and use DrFirst freestanding from an EMR)

    1. Renewal authorizations are clearly the big payback for physicians. This is the task where time and money are saved. Yet mail-order pharmacies persist in sending renewal requests via fax (to which I respond online). When will they join the 21st century.

    2. Controlled substance prescribing. When can we expect reasonable federal policy on this???

    3. Diabetes supplies billed to Medicare B. Some pharmacies insist that an electronic signature is not permitted. It is easy to add the ICD9 code and a notation about insulin use to the Rx. Some pharmacies have figured this out but most have not. Back to print, sign and fax OR fill out the pharmacy’s blasted form. A clear statement from CMS on this topic would be very helpful. Any insights?

  2. 2 George Getty III said at 12:01 pm on June 10th, 2009:

    I think all of those concerns are very valid and I’ll work on posts on all topics you offered. In the meantime, the DEA has proposed a rule for eprescribing controlled substances that was open for comment until Sept 25th, 2008. Where it is now, I’m not sure but worthy of more digging on my part to find out for you.


  3. 3 Chase said at 10:54 am on March 29th, 2010:

    What other third party service vendors provide e-prescribing? Can you contract with those vendors individually or is that functionality included in your EMR purchase?


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