According to Surescripts, a company that electronically connects physician practices to pharmacies, 58% of office-based prescribers wrote electronic prescriptions at the end of last year. The Centers for Medicare and Medicaid Services (CMS) is already trimming Medicare reimbursements to penalize those who don't e-prescribe and don't quality for hardship waivers.
Meanwhile, 91% of community pharmacies--including 98% of chain pharmacies and 79% of independent drugstores--were connected to the Surescripts network as of late 2011.
Asked why it took AHRQ so long to complete its toolkits, which could have helped many practices and pharmacies earlier in the process, Teresa Zayas-Caban, AHRQ's senior health IT manager, said in an interview with InformationWeek Healthcare that there were delays in getting some of the providers and drugstores involved in the project to provide input for the toolsets. "Some preliminary testing by our contractor, Rand, was delayed, as well."
At this point, she said, the toolsets "can help both the practices and the remaining pharmacies that haven't yet implemented e-prescribing and are thinking about how they can go about doing that. For the ones that have started e-prescribing, and are encountering challenges in getting the process completely worked out, we have some tools and suggestions for how to understand what may be working well and what may be not and how to better achieve the goals they want to achieve by using e-prescribing."
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The physician toolkit, Zayas-Caban said, is aimed at independent practices of various sizes. Yet, though only 46% of solo practitioners e-prescribe, according to Surescripts, much of AHRQ's materials seem to be written for larger organizations. For example, the "core team" required to implement e-prescribing is said to include a team leader, a physician champion, a project manager, and a nursing leader. After the e-prescribing application has been selected, the toolkit says, a practice should include IT staff on the team--i.e., if a practice has anyone answering to that description.
The toolkit also includes a chapter on standalone e-prescribing applications--although only 18% of e-prescribers still use such programs rather than the e-prescribing modules in their electronic health records. Nevertheless, Zayas-Caban said the tools are just as applicable to physicians who want to e-prescribe through their electronic health record systems.
Other areas covered by the physician toolkit include:
-- A worksheet for setting implementation goals.
-- A health IT readiness assessment form.
-- Sample workflow diagrams and task tables.
-- A tool for assessing e-prescribing vendors and their products.
-- An EHR implementation and planning tool.
-- An outreach letter for announcing e-prescribing plans to pharmacies.
-- A computer skills assessment form for staff.
-- Flyers for patients, in English and Spanish, about the transition to e-prescribing.
-- Bilingual "e-prescription pads" that tell patients their prescription has been written and sent electronically. These printable forms also advise patients to tell their pharmacist to look for an e-prescription in the pharmacy system.
The pharmacy toolkit is a comprehensive booklet that includes information about the benefits of e-prescribing; what it is and how it works; government e-prescribing regulations; how to train staff on e-prescribing; how to communicate with patients and physicians about it; using e-prescribing for refills; dealing with common issues; optimizing workflow; doing a cost-benefit analysis; and troubleshooting.
Some of this could be very useful to pharmacies that are already involved in e-prescribing, especially for troubleshooting. A recent study in the Journal of the American Medical Informatics Association found that e-prescribing was plagued by communications gaps, transmission barriers, and software problems. For example, the study, conducted by AHRQ and the Center for Studying Health System Change, found that electronic renewals were often problematic because many practices were not set up to receive renewal requests online. Also, the study noted, some pharmacies sent multiple renewal requests for the same prescription, both online and via fax.
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