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Thursday, October 16, 2008

E-Prescribing and E-Referral Moving Forward in the USA

The e-Health Initiative recently released this news item.

Health Care Stakeholders Release “How-To” Guide to Help Clinicians Switch from Paper to E-Prescribing Systems

Challenges, Opportunities Await Providers Investing in New Technology

BOSTON, MA – OCTOBER 7, 2008 – The eHealth Initiative (eHI), in collaboration with the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the Medical Group Management Association, and the Center for Improving Medication Management (Center), issued the first comprehensive, multi-stakeholder-informed “how-to” guide to help clinicians make informed decisions about how and when to transition from paper to electronic prescribing systems. A Clinician’s Guide to Electronic Prescribing was released at the Centers for Medicare and Medicaid Services (CMS) National e-Prescribing Conference in Boston today and follows the agency’s decision earlier this year to offer financial incentives--beginning in 2009--to providers who adopt e-prescribing.

“We know e-prescribing is an efficient way to improve health care delivery, decrease medication errors, and prevent potentially dangerous drug interactions,” said eHI Chief Executive Officer Janet Marchibroda. “However, the transition from a paper to electronic system is quite challenging. This guide is meant to remove some of the mystery around e-prescribing and help physicians begin to realize some of the many benefits e-prescribing can bring to their patients and their practices.”

Developed with the strategic guidance of a multi-stakeholder Steering Group comprised of clinicians, consumers, employers, health plans, and pharmacies, and in partnership with four major medical associations, the guide is designed to meet the needs of two target audiences: The first section of the guide targets office-based clinicians who are new to the concept of e-prescribing, and who seek a basic understanding of what e-prescribing is, how it works, what its benefits and challenges are, and the current environment impacting its widespread adoption. The second section of the guide targets office-based clinicians who are ready to move forward and bring e-prescribing into their practices. It presents fundamental questions and steps to follow in planning for, selecting and implementing an e-prescribing system. The guide also provides a list of key references and resources readers may consult to help make the transition to e-prescribing as smooth as possible.

“E-prescribing holds great promise for improvements in patient safety and advances in care coordination, and the AMA is committed to helping physicians adopt this technology,” said American Medical Association Board Member, Steven J. Stack, M.D. “This guide is an important resource for physicians and can aid in the adoption and implementation of e-prescribing.”

“With all the momentum toward e-prescribing and its accelerated growth, it is important to assist physicians and other prescribers to ensure that e-prescribing is implemented well in order for the full range of benefits can be achieved,” said Steven E. Waldren, MD, MS, Director, Center for Health-IT at the American Academy of Family Physicians and Center for Improving Medication Management Board member. “This Guide provides substantial detail not only on how to get started but what challenges to expect and how to overcome them.”

In June, eHI and the Center for Improving Medication Management released a report detailing the latest figures on e-prescribing, including the progress made, the obstacles that remain, and recommendations for how different stakeholders in the system can support the migration from paper-based prescriptions to an electronic system. Among the findings from the report were the following:

  • More than 35 million prescription transactions were sent electronically in 2007, a 170 percent increase over the previous year.
  • At the end of 2007, at least 35,000 prescribers were actively e-prescribing. Estimates indicate there will be at least 85,000 active users of e-prescribing by the end of 2008.
  • While e-prescribing is growing rapidly, the adoption level at the end of 2007 represents only about six percent of physicians.
  • Only two percent of eligible prescriptions were transmitted electronically in 2007.
  • The biggest challenges to widespread adoption of e-prescribing by providers are financial burdens, workflow changes, continued needs for improved connectivity and technology, and the need for reconciled medication histories.

Accompanying the June report were corresponding guides that offer practical information for health care payers to support effective adoption, and for consumers to better understand e-prescribing’s benefits and use.

The full prescriber guide and the earlier e-prescribing reports are available at www.ehealthinitiative.org.

The full release is found here:

http://www.ehealthinitiative.org/news/2008-10-07.mspx

This release announces the latest piece of work in the area:

There is more and relevant links to reports found here:

Practical Guidance on Accelerating the Use of Electronic Prescribing to Improve the Quality, Safety and Efficiency of Health Care

The eHealth Initiative in collaboration with the Center for Improving Medication Management, with the strategic guidance and input from a diverse Steering Group made up of the many stakeholders in health care, including clinicians, consumers, employers, health plans, health IT vendors and pharmacists and pharmacies, has developed a series of reports designed to help the U.S. health care system transition from a largely paper-based system of prescribing to electronic prescribing, to support more effective medication management.

A series of guides and reports have been issued over the last four months to support the effective adoption of e-prescribing to drive improvements in the quality, safety and effectiveness of health care:

Click here for the June 11, 2008 release on "Electronic Prescribing: Becoming Mainstream Practice," and the corresponding guides supporting both consumers and payers.

Click here for the October 7, 2008 release on "A Clinician's Guide to Electronic Prescribing".

The report is useful in that it describes how things work in the US as well as providing the reasons why it is a useful step forward in improving patient safety. There is also valuable discussion on the various barriers to use and so on.

With the US putting a significant incentive framework for actual electronic prescription transmission it is time we stated to move beyond prescription printing and developed a national, secure and open system to have this also happen in Australia. The time has definitely come!

On a slightly different but related track the California Health Care Foundation has released another great document.

Bridging the Care Gap: Using Web Technology for Patient Referrals

Jane Metzger and Walt Zywiak, CSC

September 2008

Arranging referrals for specialty or follow-up care typically involves a disjointed sequence of phone calls, faxes, and slips of paper. Besides being inefficient, this system frequently results in unsuccessful, duplicate, and inappropriate referrals, which can have serious health consequences for patients.

Some providers, particularly public health systems and others working in the safety net, are now turning to advanced electronic solutions to modernize and improve the referral process. These applications — some of them homegrown — help standardize the screening and decision-making steps of a patient referral, improve tracking and communication, and strengthen data collection.

More here:

http://www.chcf.org/topics/view.cfm?itemID=133761

Document Downloads

Bridging the Care Gap: Using Web Technology for Patient Referrals (728K)

There is also a good summary article here:

E-Referrals: Health 2.0’s Next Big Thing?

Kathryn Mackenzie, for HealthLeaders Media, October 7, 2008

A new process that could streamline referrals, effectively lighten the load on the ER, and save millions of dollars? While it may sound too good to be true, a new report from the California HealthCare Foundation outlines the benefits of modernizing the referral process by making use of Web-based systems.

Making referrals for specialty or follow-up care is typically a fairly manual process—the originating physician may make a phone call or fax a request to a specialist, but in most cases that's as technologically advanced as it gets. More likely, the patient will receive a slip of paper and instructions to make an appointment for follow-up care. Recently some providers have updated their referral process by making use of Web-based systems designed to help automate and standardize the referral process.

To date, the primary users of so-called e-referring are public health systems and safety net hospitals seeking to reduce overcrowding in the emergency room by referring patients to a primary care provider in the community, according to the report.

http://www.healthleadersmedia.com/content/221032/topic/WS_HLM2_TEC/EReferrals-Health-20s-Next-Big-Thing.html

These two reports provide more than enough reading for the weekend!

David.

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