Incremental cost if additional module (not always applicable) □ Costs of interfaces, customization, other services, and increase in bandwidth are usually an inherent part of the EHR □ No fee to connect to SureScripts for providers (pharmacies pay per-eRx) Barriers to e- Rx in general □ Until DEA issues final regulation on eRx for controlled substances (estimated at 11% of all prescriptions written), requires print out and signature □ About 3% of chain drug stores and 73% of independent pharmacies are not yet connected, although this is changing rapidly □ Most Medicaid systems do not participate in supplying formulary information □ Formulary information for commercial payers is “hit-or-miss” at best; with eligibility specific to a patient’s drug benefit plan often requiring a separate drug benefit plan identifier not generally collected by clinics, and not often available on the standard insurance card. Formulary information is recognized as the “weak link” by the federal government in its incentive programs and users are not penalized for not using the functionality □ All states allow eRx, although a few have regulatory restrictions needing resolution □ Requires broadband Internet access Barriers to specific forms of e-Rx □ Information collected and stored in most standalone systems are not easily transferable to EHRs □ Fully integrated functionality enables seamless population of prescription information from practice management system and to medication lists, etc. in EHR People challenges □ Change management requires adequate planning, training, support, and continuous quality improvement □ Workflow changes may result in new roles and responsibilities, lost productivity during transition, and communication with local drug stores or pharmacies about upgrading their systems to accommodate eRx □ Incentives require application of G codes to all claims, whether there is a prescription written through e- prescribing or not. This workflow change is confusing to some providers □ Some patients do not want to commit to a specific pharmacy □ Change management issues greater for EHR, although eRx component often viewed as the “simpler” part □ Workflow and patient issues same as for standalone eRx Section 2.2 Utilize – Effective Use – Optimization Strategies for e-Prescribing - 2
Attribute Standalone eRx eRx with EHR System challenges □ Drug benefit plan may be different than health insurance plan. If not captured, formulary information not available □ Demographic information dependent upon manual entry or interface to practice management system □ Medication history and medication reconciliation from payer/pharmacy benefits managers (PBM) may be incomplete or inaccurate. Requires manual entry to build medication list initially □ Clinic must decide whether e-prescribing system or paper chart is the “source of truth” for the medication list □ Medical history information is not included. Desired information such as allergies must be entered manually.
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- Fall '19
- Pharmacology, Electronic health record, erx