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:

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.

I started by going to CCHIT and downloaded the final CCHIT Certified 08 Ambulatory EHR criteria and test scripts.  I then used the excel spreadsheet(CCHITCriteriaAMBULATORY08FINAL.xls)  and filtered by category “9. Medications / ePrescribing”.  For the sake of providing a foundational view of ePrescribing, I then further filtered my results to only include the 2008 provisions.  The list contained requirements that The table below illustrates my results:

I was initially confused by the first two entries.  It makes sense that EHRs be able to handle incoming and generate codified Allergy and Conditions to help in safely ordering medications, but I want to focus strictly on ordering the medication in my EHR and getting that prescription to the pharmacy electronically.  The Continuity of Care Document (CCD) is a subject worthy of its own series of posts.

Once I remove the CCD requirements, there are really only five requirements to satisfy in order to claim victory for the 2008 requirement set.  It may seem simple enough, but to satisfy these requirements you will find that the ordering system your granddaddy used (from paper to even existing electronic ordering) will need to be changed considerably.

Stay Tuned

Now that we’ve looked at all that is required to be a qualified e-prescribing system in 2008 according to CCHIT, I plan on detailing what exactly this entails per requirement.  Eventually, I plan on catching us up to the present year by doing the same with the 2009 requirements.  After that, get your flux capacitors fluxing and we’ll even check out what the future holds for us (2010 and beyond).

• E-prescribing makes sure that the prescriber is providing enough specific information for the pharmacist to fill the prescription, including the name of the drug, the dosage, its physical form, the route, and the physician’s instructions.
• Electronic prescribing software eliminates the time and effort of trying to understand the prescriber’s handwriting, as well as the chance of an error in that translation.
• E-prescribing significantly reduces the chance that the prescriber’s intentions are misinterpreted.
• E-prescribing is often used in conjuction with clinical decision support to ensure that any drug to drug interactions or drug to diagnosis issues are found and reported to the physician before the prescription order is completed.

Electronic prescribing is considered one of the most important areas of Healthcare IT, which is why Medicare created payment incentives for physicians who use a qualified e-prescribing system. In 2009, the incentives are an increase of 2% in revenue for each patient when e-prescribing is used. Due to the 2009 HITECH Act, electronic prescribing is required as part of any EMR (EHR) which qualifies for Medicare reimbursement in 2011.