The inability for multiple systems to share information with a standard format and vocabulary has been a hurdle to effective implementation of e-prescribing. To address this problem, the Medicare Modernization Act of 2003 (MMA) directed the Secretary of Health and Human Services (HHS) to establish Federal standards that all e-prescribers must follow for patients enrolled in Part D.
When HHS promulgated rules proposing standards for electronic prescribing, the rules identified three well-accepted standards ready ("foundation" standards) for immediate implementation, and several other areas in which standards are needed. In these areas, HHS proposed six "initial" standards for pilot testing.
In 2005, 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).
Individual Pilot Project Sites and Findings
The five pilot sites are listed below along with links to their final reports. Each report describes the results of standards testing and of the study of key issues in e-prescribing.
- 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.
- Achieve Healthcare Technologies Report (PDF, 508 KB)
- 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.
- Brigham and Women's Hospital Report (PDF, 149 KB)
- 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.
- Ohio KePRO/UHMP Report (PDF, 1.01 MB)
- 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.
- RAND Corporation Report (PDF, 176 KB)
- 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.
- SureScripts Report (PDF, 169 KB)
CMS Report to Congress
As required by the Medicare Modernization Act of 2003 (MMA), the Centers for Medicare & Medicaid Services (CMS) produced a summary report for the United States Congress that highlights the key outcomes of the pilot testing collaboration project with AHRQ.
- Pilot Testing of Initial Electronic Prescribing Standards Report (PDF, 236 KB) .
AHRQ Evaluation Report
AHRQ was charged with compiling an evaluation report to summarize and synthesize findings across the pilot projects with the goals of advising the Federal Government on standards adoption and disseminating key data on e-prescribing outcomes among the policy community.
- Findings from the Evaluation of E-Prescribing Pilot Sites Report (PDF, 2.12 MB).