Dental ePrescribing Map

Step #1: Add patient’s demographic information to DoseSpot (ie: Name, DOB, Address).

Step #2: DoseSpot automatically retrieves the patient’s medication history from all prescribers directly from the insurance companies and pharmacies.

Step #3: Dentist or office staff member can create the prescription electronically with dental specific information at your fingertips.

Step #4: DoseSpot automatically runs drug to drug and drug to allergy interactions.

Step #5: Select the patient’s preferred pharmacy and send the prescription on its way!

Step #6: Patient picks up the prescription at the pharmacy.

For more information, please visit www.dentaleprescribing.com

ePrescribing Integration Made Easy!

About Bear River Mental Health: Bear River Mental Health (BRMH) began providing mental health services in January 1977 and became the first free-standing, private not-for-profit comprehensive entity in the state of Utah. BRMH has been providing quality mental health treatment for over three decades and currently serves over 2,000 residents annually.

Bear River Mental Health’s ePrescribing Timeline:

Customer Testimonial: “DoseSpot was a perfect fit for our electronic prescription requirements. The DoseSpot team has been great to work with, very helpful and responsive. The integration of their solution into our system was quick and simple, and I have been very pleased with the process overall.”

- Thad Hunsaker, BRMH Software Development

Medication Allergies: Easily send medication allergies back and forth between your EHR & DoseSpot.  Below is some sample code from our API Guide for all the techies out there.

Wolters Kluwer Health Announces Lexicomp and DoseSpot Partnership to Offer an Integrated ePrescribing Solution for Dental Professionals..http://bit.ly/z254xe

Empower Systems Achieves Full Surescripts Certification Through DoseSpot..http://bit.ly/w1SbKB

]]> http://www.eprescribing.org/dosespot-january-newsletter/feed/ 0 http://www.eprescribing.org/dental-eprescribing-is-officially-open/ http://www.eprescribing.org/dental-eprescribing-is-officially-open/#comments Fri, 20 Jan 2012 14:53:52 +0000 Greg http://www.eprescribing.org/?p=141 Today, Wolters Kluwer Health officially announced the Lexicomp and DoseSpot Partnership to Offer the Industry’s First Integrated ePrescribing Solution for Dental Professionals.

Please visit dentaleprescribing.com for more information!

Wolters Kluwer Health

Lexicomp and DoseSpot Partner to

Offer Industry’s First Integrated ePrescribing Solution for Dental Professionals

HUDSON, OH–January 20, 2012 – Wolters Kluwer Health, a leading global provider of information for healthcare professionals and students, announced today that Lexicomp has partnered with DoseSpot to deliver an integrated eprescribing tool for the dental office. In response to the growing trend of electronic prescribing in dental offices, this product offering combines eprescribing capabilities with direct access to Lexicomp Online for Dentistry™, Lexicomp’s dental-specific drug and clinical information solution, to deliver the information that dental professionals need to safely and efficiently prescribe medication and check for dangerous drug interactions.  “We are very pleased to offer this first-of-its kind combined dental eprescribing and medication management tool to dental professionals”, commented Steven Kerscher, Vice President and General Manager, Lexicomp. “Dental professionals are now able to review their patient’s saved medication history and receive patient safety alerts regarding drug interactions, drug allergies and procedure safety checks for dental treatment.  Having these capabilities, in addition to electronic prescriptions, will save dentists valuable time and help avoid adverse medication events.”

About Lexicomp

Lexicomp is the leader in delivering dental-specific drug information, drug interaction and clinical content for use at the point-of-care. Dental professionals can access their dental drug information and clinical references online, on the latest Smartphone/mobile devices and in printed reference books. Content can also be integrated with practice management systems to improve medication safety and save time within a busy dental practice.

Lexicomp is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.6 billion ($4.7 billion).

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The only way for your customers to qualify for the Meaningful Use Incentive Program is if your application is Meaningful Use Certified through an organization such as CCHIT or Drummond.  It is also a great marketing tool for your company!

WHAT DO YOU HAVE TO RECEIVE MEANINGFUL USE CERTIFICATION?

Same criteria as listed below for Surescripts certification.

DO YOU NEED SURESCRIPTS CERTIFICATION TO RECEIVE MEANINGFUL USE CERTIFICATION?

Your company can choose to go through Meaningful Use certification before Surescripts certification and you will still achieve the Meaningful Use certification for marketing purposes.  However, you will need SureScripts Certification to “go live” with a Meaningful Use certified version.

In order to electronically route prescriptions and search patient specific eligibility, formulary, and medication history, your application must achieve Surescripts certification.  Even when integrating with a Surescripts certified vendor such as DoseSpot, Surescripts still requires a quick certification meeting to “go live”.

WHAT DO YOU HAVE TO DO IN ORDER TO ACHIEVE SURESCRIPTS CERTIFICATION?

When using DoseSpot, your application will have to pass a quick screen demo test that includes different validation scenarios and the ability to send Surescripts messages appropriately in the backend.

WHAT’S THE MINIMUM FUNCTIONALITY THAT YOU NEED TO PASS?

If you are using DoseSpot’s e-prescribing application, the minimum functionality to pass Surescripts certification is the following:

- Method to pop the DoseSpot application in a browser from your application (using credentials & passing your patient information) and receive the DoseSpotPatientID back from DoseSpot.

- Prescribe within DoseSpot (nothing you need to do here)

- Use the DoseSpot API to check for refill requests and transmission errors in DoseSpot and provide a link within your software to DoseSpot for fulfillment.

- Appropriately validate a patient’s demographic information before sending it to DoseSpot

The advantages for adopting ePrescribing are vast:

Patient Safety

The electronic prescription reduces prescriptions errors caused by illegible hand writing, drug-to-drug interactions, incorrect dosing, drug allergy reactions, duplication of drugs, etc.

Fraud and Crime

The medication history his saved electronically and can be monitored easier than paper.

Medication Adherence

Patients are more likely to fill prescriptions as they’ll be waiting at the pharmacy for pickup.  The refill process is also expedited without multiple phone calls between patient, provider, and pharmacy.

Real-time communication

Providers can write notes that follow the prescription to the pharmacist. Pharmacists can submit refill request on behalf of the patient for approval by the physician (no phone call needed).

Decision Support

Health care professionals will have critical drug alerts and patient specific information at the time of prescribing.

Government Regulations

In January 2011, the state of Minnesota released a mandate for all Prescribing Providers to electronically prescribe medications.  This mandate includes dentists.  The rule wasn’t put in place to punish dentists.  It was actually designed to bring dentist into the fold of sharing health information.

Most dental Practice Management Systems don’t have electronic prescribing capabilities.  In the next few years a number of these companies will begin adding ePrescribing capabilities.  A company called DoseSpot has developed a dental e-prescribing application accessible from the web.  The dental industry is about change the way it prescribes medications.  Stay tuned…

On June 27, 2008, DEA published a Notice of Proposed Rulemaking (NPRM) to revise the regulation to allow creation, signature, transmission and processing of controlled substances electronically. The DEA gave consideration to over 200 comments while drafting the IFR.

The DEA’s obligation as noted in the rule, is to ensure that the regulations minimize, to the greatest extent possible, the potential for diversion of a controlled substance resulting from non-registrants gaining access to electronic prescribing applications and systems.  The concern of insufficient Security has been the main barrier to allowing the ePrescription of controlled substances.  The authentication methods used in online or desktop applications is generally username and password.  Passwords are easily guessed or broken by using various password guessing programs.

In response to these concerns, the DEA is adopting an approach to identity proofing (verifying that the authenticated user is who he/she claims to be) and logical access control (verifying that the authenticated user has the authority to perform the requested operation).  The DEA will require registrants to apply to certain federally approved credential service providers (CSP) or certification authorities to obtain security certificates.

The strongest requirement of the IFR will be authentication.  The DEA is proposing a two-factor authentication which is defined as two of the following:  something you know, something you have, something you are.  Authentication based only on knowledge factors, such as user names and passwords,  are easily compromised because they can be observed, guessed, or hacked and used without the practitioners knowledge.

The US Government has been using this similar approach for all electronic initiatives.  A draft of the federal electronic authentication guideline can be found here:  http://csrc.nist.gov/publications/drafts/800-63-rev1/SP800-63-Rev1_Dec2008.pdf

The Federal Register is expected to publish the Interim Final rule on March 31, 2010, which will kick off a 60-day comment period.

A draft of the interim final rule (IFR) was posted on March 24, 2010.  The draft can be found here:  http://www.federalregister.gov/OFRUpload/OFRData/2010-06687_PI.pdf

Hopes were high because e-prescribing was seen to provide immediate benefits that could greatly improve the delivery of quality health care and speed up the migration to electronic health records.

Although major progress has been made in improving the functionality and interoperability of e-prescribing, recent studies have pointed out that fewer than one in ten doctors have adopted the electronic system.

Several hurdles need to be tore down to make e-prescribing “truly interoperable” and produce the national-scale effects on prescription drug use that were originally envisioned,” health policy analysts reported in the recent issue of Health Affairs journal.

“If current trends continue, e-prescribing still represents a step toward reaping the benefits of IT and automated decision support in health care on a national scale,” they said.

The report was written by Maria Friedman and Anthony Schueth, executives of two separate e-health strategy and management firm in Maryland and Florida, and Douglas Bell, a RAND research scientist and associate professor in the David Geffen School of Medicine at the University of California, Los Angeles.

The trio recommended five policy points that will likely affect increased adoption and interoperability of e-prescribing: moving beyond incentive scheme, making a stronger business case, increasing stakeholders’ involvements, addressing issues of privacy and security, and pilot-testing and industry collaboration.

The current incentive scheme to adopt and use e-prescribing will “help get user adoption beyond its current nascent point,” researchers said, but pointed out that payments alone are not enough.

They cited the Southeastern Michigan e-Prescribing Initiative (SEMI), which suggested that for every $5 spent on incentives, $1 should be invested on user training and education.

Return on investment (ROI) should be clearly quantified for adopters, they said, but added that the value, as distinct from ROI, should also be made at it can be more convincing than ROI numbers alone.

For example, e-prescribing could improve nurses’ work life by eliminating after-hour prescription follow-up, while pharmacists can have more time to deal with patients instead of handling prescription callbacks.

“Value also can be created by adding clinical content or links to e-prescribing for data to improve the quality of patient care, such as laboratory tests or results,” the researchers said.

They also called for the increased involvement of stakeholders. For instance, independent pharmacies in rural areas tend to lack the ability to receive and process e-prescriptions, or if they do, they might not use all features because of concern over transaction fees.

Payers likewise need to make their formularies readily available for use in e-prescribing so doctors can choose less costly alternatives for their patients.

Meanwhile, privacy and security issues have slowed down efforts to expand the use and interoperability of health IT.

Policymakers have been debating whether to expand the 1996 Health Information Portability and Accountability Act to include other entities in the e-prescribing chain beyond prescribers, payers, and pharmacies

“Considerable attention continues to be paid to ensuring the authentication of users, the integrity of prescriptions, and the privacy and security of personal health information that passes through the e-prescribing networks,” the researchers said.

They also said that one of the most valuable lessons learned from HIPAA implementation is the need for pilot-testing before standards are made, saying that even small pilot studies yield valuable results in creating metrics or demonstrating value and ROI.

“The e-prescribing industry has been collaborative in pilot-testing e-prescribing implementations and tweaking standards. The expectation is that this will continue, along with federal funding for larger-scale endeavors,” they said.

For more information:
Friedman MA, Schueth A, Bell DS. Interoperable electronic prescribing in the United States: a progress report. Health Aff (Millwood). 2009 Mar-Apr;28(2):393-403.

The law mandated the use of “electronic prescription program” should any Part D plan providers and pharmacies voluntarily choose to prescribe using computer systems. It also called for the establishment of standards for the electronic transmission of prescriptions and certain other information for covered Part D drugs.

Health and Human Services Michael O. Leavitt reported in 2007 that Prescription Drug Plan (PDP) sponsors, Medicare Advantage (MA) Organizations offering Medicare Advantage-Prescription Drug (MA-PD) plans and other Part D sponsors “must support and comply with electronic prescribing standards when communicating with prescribers who want to use e-prescribing technology.”

Indeed, the importance of technical standards was underscored by a recent study, “Interoperable Electronic Prescribing In The United States: A Progress Report,” published by the Health Affairs journal last month.

“These standards are important because they are the key to systems’ interoperability and to achieving policy goals. They also create a level playing field among vendors’ offerings, so that purchasers can buy with confidence,” researchers wrote.

When the MMA was passed six years ago, the U.S. Department of Health and Human Services determined that “adequate experience existed for three basic e-prescribing standards,” the report said. These include the SCRIPT standard for transmitting electronic prescription requests between prescribers and pharmacies (please see Table below).

In 2006, the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) conducted pilot studies to include more standards, paving the way for the adoption of three additional standards for Part D e-prescribing, which took effect on
April 1, 2009.

The Health Affairs report summarized the three add-ons as follows:

• Formulary and benefit transaction standard. Use of this standard gives prescribers information about which drugs are covered by a beneficiary’s drug benefit plan.
• Medication history transaction standard. Use of this standard provides prescribers with information about the medications a beneficiary is already taking, including those prescribed by other providers, to help reduce the number of adverse drug events.
• Fill status notification. This allows prescribers to receive an electronic notice from the pharmacy telling them that a patient’s prescription has been picked up, has not been picked up, or has been partially filled. Its use is expected to improve the monitoring of medication adherence in patients with chronic conditions.

The report said the final rule also adopted the National Provider Identifier (NPI) for e-prescribing under Medicare Part D, and it retired National Council for Prescription Drug Programs (NCPDP) SCRIPT 5.0 in favor of the upgraded NCPDP SCRIPT 8.1.12.

Meanwhile, the pilot tests in 2006 also concluded that the following three standards were not yet ready for use. These are:

• RxNorm drug nomenclature. This standard—developed and maintained by the National Library of Medicine (NLM)—provides standard names for clinical drugs (active ingredient + strength + dose form).
• Structured and Codified Sig. This standard provides uniform and codified patient instructions for taking medicines (e.g., take one tablet twice a day)
• Transactions for electronic prior authorization (ePA) of medications. This set of standard-based transactions enable more efficient preapproval from health plans for certain medications and justification of those that are viewed as expensive.

Overview of Current E-Prescribing Functions and Standards

Source: Friedman M, Schueth A, & Bell D. (2009). “Interoperable Electronic Prescribing In The United States: A Progress Report.” Health Affairs, Mar-Apr;28(2):393–403.

A study based on e-prescribing in Massachusetts found that doctors who used e-prescribing systems could save $0.70 per patient per month, which translates to $845,000 annually per 100,000 insured patients filling prescriptions.

The savings were linked to one of the features of e-prescribing systems called formulary decision support, which prompts prescribers to prescribe lower-cost medications. Such feature increased the prescribing of generics and other lower-cost options, researchers reported in the Archives of Internal Medicine, one of the JAMA/Archives journals.

“The potential savings increase with more availability and use of e-prescribing; for complete e-prescribing use, the projected savings are $3.91 million per 100,000 patients per year,” said lead author Michael A. Fischer of Brigham and Women’s Hospital and Harvard Medical School in Boston.

Noting that prescription drug costs account for a significant proportion of medical spending, authors suggested that a tiered copayment system could lower the cost of medication.

In the study, insurers identified preferred medications, such as generic drugs, and classified them as first-tier with the lowest copayment. Moderately priced brand-name medications were categorized as second-tier while expensive brand-name medications were designated as third-tier.

More than 1.5 million patients filled 17.4 million prescriptions during the 18-month study period. After implementation of e-prescribing, tier 1 prescriptions increased by 3.3 percent and second- and third-tier prescriptions decreased accordingly, researchers reported.

“Our results suggest that there are important economic gains achievable through the broader use of e-prescribing with formulary decision support but that merely providing e-prescribing systems to clinicians will not necessarily achieve those savings,” they said.

Several health plans have been partnering with providers of e-prescribing programs, and they expect that the increased use of generic drugs will give them initial return on investment. The Health Alliance Plan of Michigan, for instance, estimated a five-year ROI of more than $14 million by improving its generic use rate.

The study “Interoperable Electronic Prescribing In The United States” published by the Health Affairs journal said the savings are significant for Medicare, which spent $42.2 billion in 2007 for beneficiaries’ prescription drugs.

“Such savings also could become increasingly important for private insurers that are facing decreasing investment earnings and enrollment because of the recent economic crisis,” the study noted.

For more information:

Fischer MA, Vogeli C, Stedman M, Ferris T, Brookhart MA, Weissman JS. (2008). Effect of Electronic Prescribing with Formulary Decision Support on Medication Use and Cost. Archives of Internal Medicine, Dec 8;168(22):2433-9.

Friedman M, Schueth A, & Bell D. (2009). Interoperable Electronic Prescribing In The United States: A Progress Report. Health Affairs, Mar-Apr;28(2):393–403.