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Electronic Prescribing: The First Step Towards an Integrated Health Delivery System?

Staff  |  Issue: February 2009  |  February 1, 2009

With the introduction of the 2009 Centers for Medicare and Medicaid Services’ (CMS’s) electronic prescribing incentive program, the door is opening for widespread adoption of health information technology (HIT) within the physician’s practice.

HIT is the use of computer applications to record, store, protect, retrieve, and transfer clinical, administrative, and financial information electronically within healthcare settings. Innovations in information technology have improved the efficiency and quality of many industries, and are now beginning to form a common network that brings all healthcare stakeholders together and is beginning to break down barriers between care providers, insurers, medical researchers, and public health professionals. HIT includes both hardware and software applications designed to meet the needs of healthcare providers, payers, patients, and administrators. The ultimate goal of HIT is to improve both the quality and efficiency of clinical and administrative processes in the delivery of healthcare.

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2% Incentive for E-Prescribing

In order to promote the adoption and use of e-prescribing systems, the “Medicare Improvements for Patients and Providers Act of 2008” (MIPPA) authorized an e-prescribing incentive program beginning January 1, 2009.

This program will provide eligible professionals who successfully e-prescribe an incentive of 2% of the total estimated allowed charges for professional services covered by Medicare Part B and furnished by an eligible professional during the reporting period of one calendar year.

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There are three steps to ensure that a physician can qualify for the e-prescribing incentive:

  1. The electronic prescribing system must meet the standards approved by MIPPA;
  2. The incentive will not apply if the Medicare-allowed charges pertaining to the e-prescribing measure codes are at least 10% of the total allowed charges under Medicare Part B, or if the secretary determines that the eligible provider did not submit an adequate number of prescriptions under Part D; and
  3. The provider must report the applicable measure in at least 50% of the cases in which the measure could have been reported during the calendar year, or the secretary must determine that the physician electronically submitted a sufficient number of prescriptions under Part D during the reporting period.

For more information on this incentive program, contact Itara Barnes at [email protected]

Electronic (e-)prescribing is leading the movement toward more coordinated care built on HIT applications. From a high-level view, e-prescribing may appear to be simply an electronic link between the physician and the pharmacy to deliver a prescription to the patient. Upon taking a closer look into this process, we see that e-prescribing actually links all stakeholders—including the patient, prescriber, pharmacist, and payer—through an intricate web of code that instantly communicates patient data between various systems and applications, delivering relevant, user-specific, consistent, and meaningful information to all parties.

Numerous studies have shown that adoption of e-prescribing improves both efficiency and quality of patient care. It is important to understand that the e-prescribing software, or the program that you see in your office, is not the key to these results. The technology and communication behind the process as a whole is the very important and necessary tool that will improve patient safety, reduce medical errors, decrease adverse drug events, reduce hospitalizations, improve patient adherence, and increase patient satisfaction.

E-prescribing also demonstrates that collaborative work between these stakeholders can produce a structure that takes into account the needs and interests of the providers, patients, payers, accreditors, government agencies, researchers, and health information systems manufacturers and vendors through an effective melding of communication and outreach, organizational, legal and policy developments, business planning, and technical infrastructure development. The work is difficult, but the end result enables high-quality, timely, and accessible healthcare across all sites of care.

HIT is rapidly establishing a firm and growing presence in the delivery of healthcare and is breaking down barriers between the many participants involved in patient care. HIT has the potential to significantly improve healthcare quality and safety, simplify its delivery, empower patients, and significantly reduce the cost of care. Although some do resist, it is important to realize that the design and implementation of mainstream information systems are not driven by technology features, but by user needs. The key to realizing the greatest return on investment for your practice—and the health system in general—is to understand your individual needs, speak up for those needs, and shop around for a system that gives you the benefit of available technology in a way that suits your needs.

The 2009 State-of-the-Art Symposium promises to be an exciting departure from recent years with the addition of our hands-on ultrasound workshops and new small-group sessions, which will each offer participants practical experience in an intimate setting.

—Christopher Ritchlin, MD

The healthcare system is now undergoing a technological redesign. E-prescribing demonstrates our ability to make significant improvements in patient care through the development of networks to support communication among the various arms of the healthcare industry. The increase in incentive programs supported by public and private payers show the increasing momentum of HIT on the national stage. However, with any major transition comes challenges, and, in the case of HIT, many of these challenges are operational and policy based. Support for HIT efforts will increase as we move forward, as will use of standards-based and interoperable technology, streamlining of the licensure process for HIT applications, and consumer use of HIT to manage their health and healthcare. Movement toward a digital health system is inevitable; the hard part of this process is navigating this winding path and effectively and efficiently leading all stakeholders through the forest.

For more information on e-prescribing, contact Itara Barnes at [email protected] or visit the ACR’s Web site at www.rheumatology.org/practice.

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