Here is the latest evidence and information available on electronic prescribing:
The Centers for Medicare & Medicaid Services (CMS) released a report to Congress entitled Pilot Testing of Initial Electronic Prescribing Standards. This report was mandated by the Medicare Modernization Act of 2003 (MMA), and it details the rigorous pilot testing of information standards by five leading electronic prescribing (e-prescribing) organizations. The MMA requires use of these standards when adopted by CMS regulation. In addition, the pilot projects studied many key issues in e-prescribing, such as reduction of adverse drug events, provider uptake, and potential gains in efficiency and effectiveness. Use of the proposed standards advances interoperability in the American health care system and greatly enhances the ability of health IT to improve safety and quality. Such efforts are integral to AHRQ's mission to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.
AHRQ's National Resource Center released an evaluation report on the AHRQ and CMS-funded e-prescribing pilot projects. Also available from the National Resource Center are individual reports that chronicle the experiences and findings of each pilot project.
The Center for Studying Health System Change (HSC) published an article on the barriers and facilitators of greater adoption of e-prescribing in the United States.
Background
Electronic prescription (e-prescribing) writing is defined by the eHealth Initiative as "the use of computing devices to enter, modify, review, and output or communicate drug prescriptions." Although the term e-prescribing implies the use of a computer for any type of prescribing action, there is a wide range of e-prescribing activities with varying levels of sophistication:
Level 1 - electronic reference handbook Level 2 - stand alone prescription writer Level 3 - patient-specific prescription creation or refilling Level 4 - medication management (access to medication history, warnings, and alerts) Level 5 - connectivity to dispensing site Level 6 - integration with an electronic medical record
All levels of electronic prescription writing confer varying degrees of improvements in patient safety. Level 6, which is the most sophisticated, has been shown to confer the highest degree of patient safety and the largest return on the investment. Over the last 5 years, national interest in e-prescribing has increased as the Federal Government has enacted legislation, including the Medicare Modernization Act, aimed at increasing the adoption of e-prescribing.
Current Activities
Existing e-prescribing tools have begun to take into account a variety of new uses for a medication history. Those uses include knowing what medications a patient has actually received from a pharmacist using data from Pharmacy Benefit Managers (PBMs). Services such as RxHub provide this information to electronic prescription writing systems, allowing providers to see a complete view of the patient's medication history. Another current trend is transmission of electronic prescriptions using a standard known as NCPDP-SCRIPT. This standard supports interfaces to pharmacy information systems, and is a foundation standard adopted by DHHS in 2005. A frequently used practice is to communicate via fax, which is often plagued by inaccurate fax numbers, poor management of faxes that are received by pharmacies, and poor systems to provide feedback about the status of fax delivery.
The Medicare Modernization Act of 2003 (MMA) requires that Part D plans support an electronic prescription program, should any of their providers and pharmacies voluntarily choose to e-prescribe. This program is required to provide for the electronic transmittal of prescription orders themselves; plan eligibility queries and responses; plan benefit information; drug interactions, warnings or cautions, and any dosage adjustments related to the drug being prescribed or dispensed; appropriate lower-cost alternatives, if any, for a drug being prescribed; and the patient's medical history related to a covered Part D drug being prescribed or dispensed. For each requirement, HHS must promulgate uniform standards that are compatible with existing standards, especially the transactions specified in the administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. MMA also required pilot projects during 2006 to test any standards for which there is not adequate industry experience. AHRQ and the Centers for Medicare & Medicaid Services (CMS) collaborated to issue grants and contracts for pilot testing e-prescribing standards. Results of these pilot projects were released in April 2007 in the form of an evaluation report from the AHRQ National Resource Center for Health Information Technology. Final e-prescribing standards are due by April 2008, with implementation up to a year later.
In addition to the MMA, the Joint Commission for the Accreditation of Hospital Organizations (JCAHO) has recently endorsed medication reconciliation in 2006. Hospitals that are accredited by the JCAHO need to demonstrate methods to verify that medication histories are reconciled and up-to-date with medication lists after each care transition (from outpatient status to inpatient status; from inpatient ward to inpatient ICU; from outpatient hospital to nursing home facility). Medication reconciliation has been shown to be an extremely time-intensive activity on the part of those people involved. E-prescribing tools may improve the process by providing more accurate and complete histories.
Projects Funded by AHRQ
The Agency for Healthcare Research and Quality (AHRQ) has funded organizations across the country that are implementing and evaluating e-prescribing technologies. Some of these include:
A computer-generated message generated when specific criteria are met; e.g., entry of a critically abnormal laboratory test value generates a warning message to the care provider who ordered the test.
The American Medical Association (AMA) is an organization of physicians which works on the most important professional and public health issues including health information technology (HIT).
The American Medical Informatics Association (AMIA) is an organization dedicated to the development and application of biomedical and health informatics in support of patient care, teaching, research, and health care administration.
Ambulatory medical record system (AMRS), which is a clinical information system that supports the functions of an outpatient clinic, generally including registration, appointment scheduling, order entry, reporting of results, clinical documentation, and billing.
The American Nurses Association (ANA) is a professional organization representing registered nurses with the goal of advancing the nursing profession by fostering high standards of nursing practice and lobbying Congress and regulatory agencies on health care issues affecting nurses and the public, including the use of information technology (IT) in nursing practice.
The American National Standards Institute (ANSI) oversees the creation, promulgation, and use and thousands of standards and guidelines, in nearly every sector of the economy, in order to strengthen the U.S. market in the world economy and to improve the health and safety of consumers.
A computer program designed to help physicians in the proper ordering of antibiotics.
The Arden Syntax standard, which is maintained by HL7, is a coding scheme which provides a standard means for writing rules designed to relate specific patient situations to appropriate actions.
Application Service Provider (ASP) is a type of client-server installation where a business hosts computer-based services for customers to access across a network, such as electronic health record (EHR) solutions accessed over the Internet.
A mode of communication in which exchange of data does not require both parties to be actively involved at the same time.
Asynchronous transfer mode (ATM) is a network protocol for sending small, fixed-length packets of data over network connections.
A record of all accesses and updates to medical data, which is generally maintained in chronological order, which is used to promoted accountability of access to the data.
A process for the positive identification of system users; this process is used to control access to the system.
A process for limiting user access and activities to only the actions deemed appropriate for that user.
The American Academy of Family Physicians (AAFP) is the national association of family doctors; its mission is to improve the health of patients, families, and communities which includes the introduction and use of health information technology (HIT).
A level of encoding of medical data which involves reviewing the data and labeling the data based on an item from a terminology.
A security function in which users are responsible for their access to and use of medical information. The users must have a right to know and a need to know the information they access.
Time between learning sessions when teams work on improvements within their organization. The teams are supported by collaborative faculty/staff.
An adverse drug event (ADE) is an unexpected or dangerous reaction to a drug.
Admission-discharge-transfer (ADT), which is a component of a health information system (HIS) designed to maintain and update the hospital census.
Computer software designed to operate with a degree of autonomy from its programmer (e.g., an agent may be used to search the Internet for specified information).
The American Hospital Association (AHA) is the national organization representing all types of hospitals, health care networks, and their patients plus communities. It strives to ensure that its members’ perspectives and needs are addressed in national health policy development, legislative and regulatory debates, and judicial matters; this includes issues related to health information technology (HIT).
The American Health Information Community (AHIC) is a federal government advisory body chartered to provide recommendations to the Secretary of the U.S. Department of Health and Human Services (HHS) on how to accelerate the development and adoption of health information technology (HIT).
The American Health Information Management Association (AHIMA) is a professional organization devoted to improving healthcare by advancing best practices and standards for health information management (HIM).
Agency for Healthcare Research and Quality (AHRQ) is the lead federal government agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. As one of 12 agencies within the Department of Health and Human Services (HHS), AHRQ supports health services research that will improve the quality of health care and promote evidence-based decision making.
This refers to the amount of data that can be transmitted over a communication channel in a given period of time.
A measurement obtained prior to an intervention and used for comparison to post-intervention measurements.
The College of American Pathologists (CAP) is a professional organization of pathologists which fosters and advocates excellence in the practice of pathology and laboratory medicine. It was responsible for developing the Systematized Nomenclature of Medicine (SNOMED).
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