E-Prescribing Pilot Projects

HHS awarded nearly $6 million to five grantee teams as part of a pilot project to test initial standards for electronic prescribing (e-prescribing). The project, which ran during calendar year 2006, involved testing several systems of electronic data transmission standards and determining how efficiently and effectively prescriptions and prescription-related information could be sent to and received by the providers and pharmacies participating in e-prescribing for Medicare Part D beneficiaries. The project was administered jointly by the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ).

In April 2007, the grantee teams completed reports about their experiences with the e-prescribing standards. Also completed was an evaluation across the five pilots by AHRQ's National Resource Center for Health Information Technology and a summary report, mandated by the Medicare Modernization Act of 2003, by CMS. All of these reports are available online: access the reports.

The awardees are as follows:

• Achieve Healthcare Information Technology, MN, in conjunction with nursing facilities in Minnesota associated with the Benedictine Health System and Preferred Choice Pharmacy, will be the first program to evaluate how the e-prescribing standards work in certain long-term care settings. The project also will assess the impact of e-prescribing on the workflow among prescribers, nurses, the pharmacies, and payers.
• Brigham and Women's Hospital, Boston, MA, in conjunction with physician practices in Massachusetts associated with a hospital network, will use an existing community utility for e-prescribing called the eRx Gateway. The pilot will test the e-prescribing standards and will conduct needed research into ambulatory drug safety and the impact of e-prescribing on physician workflows.
• Ohio KePRO/UHMP, Cleveland, OH, a consortium of Ohio KePRO, Ohio’s Medicare Quality Improvement Organization; University Hospitals Medical Practices (UHMP), University Hospitals of Cleveland; Medical Group Management Association Center for Research; University of Minnesota, Division of Health Policy and Management; Partners HealthCare; RAND Corporation; InstandDx/OnCallData; SureScripts; RxHub; Anthem; Aetna; Medical Mutual of Ohio; QualChoice; and Wolters Kluwer Health. The pilot will evaluate 47 primary care clinics in Cleveland and Northeast Ohio to establish differences in practice culture, workflow, and efficiency and determine issues in the adoption of e-prescribing. Production tests of medication history, fill status notification, and prior authorization will also be conducted to determine the functionality of the standards and assess prescriber opinion. In addition, laboratory tests will be conducted of Structured Sig and RxNorm to assess the functionality of these initial standards.
• RAND Corporation, Santa Monica, CA, in conjunction with the New Jersey E-Prescribing Action Coalition, an industry-academic partnership involving RAND Health; Horizon Blue Cross Blue Shield of New Jersey; the e-prescribing vendors AllScripts, Caremark iScribe, and InstantDx; Caremark's prescription benefit management plans; the electronic prescription routing companies RxHub and SureScripts; Caremark's mail-order pharmacy and Walgreen's retail pharmacies will conduct the pilot in New Jersey. In addition to testing the standards, the project will determine changes in drug use, clinical outcomes, and patient satisfaction as a result of e-prescribing.
• SureScripts, Alexandria, VA, partnering with Brown University and five vendors (Allscripts, DrFirst, Gold Standard, Medplus/Quest Diagnostics, and ZixCorp.) will recruit physicians and pharmacies for participation in Florida, Massachusetts, Nevada, New Jersey, Tennessee, and, potentially, Rhode Island. The pilot will evaluate how the e-prescribing standards work in a variety of practice settings, geographic areas, and e-prescribing technologies. In addition, the project will assess how prescriber and vendor characteristics influence e-prescribing adoption and what "best features" of vendor software improve medication-related safety outcomes.