Maximizing Effectiveness of E-Prescribing Between Physicians and Community Pharmacies

This project, part of five grants awarded by the Agency for Healthcare Research and Quality to conduct electronic prescribing (e-Prescribing) pilots, involved six e-Prescribing physician software vendors who coded, implemented, and deployed e-Prescribing software standards in Florida, Massachusetts, New Jersey, Nevada, Rhode Island, and Tennessee. The project was evaluated by conducting a mixed method study which included focus groups, semi-structured interviews, direct observation and surveys. The main objectives of this project were to:

• Test the interoperability of the standards, certification processes, and pilot testing;
• Evaluate the implementation of the standards from multiple perspectives using a mixed-method approach;
• Evaluate the extent to which the proposed Medicare Modernization Act (MMA) e-Prescribing standards work effectively and efficiently within a variety of practice, technology, and geographic settings around the country; and
• Determine what changes need to be made to the MMA e-Prescribing standards to improve their effectiveness.

The e-Prescribing standards were fully evaluated. The study found that some standards were ready for implementation and others were deemed to be ineffective and not recommended for adoption. Those standards which the group determined were ready for implementation included: Formulary and Benefit, Medication History, and RXFILL. Those standards that were determined to require more testing before implementation included: Structured and Codified SIG, RxNorm, and Prior Authorization. Two standards, Change and Cancel, were already deemed as foundational, but regardless, were tested in the pilot and confirmed to be technically viable. The standards classified as not ready for implementation were felt to have no impact from their lack of use, as their functions are being addressed in alternative ways.

The project team concluded that improvements in the implementation of standards in physician and pharmacy software applications are needed to order to achieve the optimal realization of efficiency and patient safety gains associated with e-Prescribing.