Pharmacy Technology by nzy55037


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									Electronic Prescribing
       Holly Prievo, RPh, MS
   Pharmacy Supervisor, Las Vegas East District
                Walgreen Co.
             October 28, 2008

                                                  Pharmacy Technology Services
              Current State of Prescribing
               • Prescribing process is error prone
                       – Adverse drug events (ADE)
                              • 4th leading cause of death
                              • Costs as much as $136 billion each year
                       – Of ADEs, 7,000 deaths a year attributed to
                         prescription error
                              • Illegible handwriting
                              • Wrong dosage
                              • Missed drug-drug or drug-allergy interactions
                       – Medication errors account for 1 out of 131
                         ambulatory care deaths                                 Pharmacy Technology Services
Source: Institute of Medicine, Center for Information Technology Leadership
               Current State of Prescribing
                • Poor compliance
                  – Approximately 20% of
                    prescriptions are
                    never filled
                  – Cost of poor
                                                                         NOT filled = 20%
                    compliance estimated                                 Filled = 80%
                    between $100 billion
                    and $150 billion
                                                                                  Pharmacy Technology Services
Source: Institute of Medicine, Institute for Safe Medication Practices
   Current State of Prescribing
• Increasingly complex benefits & plan designs
   – Average doctor manages at least 11 managed care formularies
• Growing number of available prescription drugs
   –   500% increase in the past decade
       •   1-2 each week
   –   17,000 trade and generic names marketed in North America
• Electronic Prescribing is only used for true prescriptions.
   – Questions/queries from the Pharmacy to the Prescriber still have
     to be called or faxed in. (Example: Prior Authorization Request
     from the Pharmacy to Prescriber. Clarification on a sig, etc)

                                                           Pharmacy Technology Services
              Benefits for Physicians
              (from our perspective)
• Improved efficiency
   • Reduced number of callbacks from pharmacies
       - Quickly access vital patient info
   • Refill Renewal Authorizations completed in seconds, not
     hours (This is key to true adoption and workflow
   • More time on patient care and other key activities
• Enables physicians to
   •   Prevent medication errors
   •   More efficiently select drugs
   •   Manage multiple and competing formularies
   •   Promote increased use of generic drugs

                                                               Pharmacy Technology Services
     Benefits for Pharmacists
• All necessary prescription information is
  transmitted and received
  – Less Quality Assurance concerns
• Saves Time
  – An internal Walgreens study in 2007 showed that
    eRx’s took 1.07 minutes less to enter vs. paper Rx’s
  – There is an additional savings per Rx based on fewer
    MD calls for clarifications/DUR’s,etc

                                                Pharmacy Technology Services
     Benefits for Pharmacists
• Reduces Transcription Errors
• Improves Patient Services
  – Provides more time to be spent with customers
  – Ensures fast prescription pick-up
• Improves Record Keeping
• Reduces Turnaround Time on Renewal
  Requests and Authorizations
• Improves Efficiency – Allows more Pharmacist –
  Patient Interaction
                                               Pharmacy Technology Services
                                Benefits for Patients
      • Complete prescription history available
      • Improved efficiencies
         – Pharmacy of choice
         – Secure
         – Prescription available for pickup 60 minutes after
           it is received
      • Adjudication to the Patient’s Prescription Insurance
        continues as it does today providing an accurate co-
        pay amount at the Point-of-Sale
      • Higher levels of patient confidence & satisfaction
         – Potential to reduce medication errors by as much
           as 55%
                                                                                                                         Pharmacy Technology Services
Institute for Safe Medicine Practices. A Call to Action: Eliminate Handwritten Prescriptions Within Three Years, 2000.
     eFaxing vs. ePrescribing
• eFaxing:
  – When a prescriber uses a computer application to
    send a pharmacy a prescription, however, the
    Pharmacy receives it as a faxed piece of paper. It
    can take upwards of 20+ minutes for the Pharmacy to
    receive this fax.
• ePrescribing:
  – When a prescriber uses a computer application to
    send a pharmacy a prescription and it arrives directly
    into the Pharmacy computer system. There is no
    paper, no fax, no delay.                      Pharmacy Technology Services
               Handwritten vs. Fax vs. eRx
       Handwritten                                              Fax                                             eRx
          May be difficult to read             Easier to read, but still grainy from being            No difficulty in reading at all
                                                             sent as a fax

      May not have all the necessary              Should have most of the necessary             All necessary information is transmitted
    information needed to process the             information needed to process the             and received at the Pharmacy based on
               prescription                     prescription, but nothing regulating that            the CMS / NCPDP Standards

Patient needs to bring the prescription into   The prescription is faxed ahead of when         An eRx typically arrives in the pharmacies
   the pharmacy and wait for us to fill it       the patient arrives and we begin the           system within a couple minutes after the
                                               process to fill it. There can be delays of      Prescriber hits the “Send” button. They all
                                               20+ minutes in receiving a fax however             are given a 60 minute promised time
                                                                                                which will hopefully mean it will be ready
                                                                                                  when the patient arrives to pick it up.

  Prescriber does not know if the drug is        The prescriber may know what tier the         The Prescriber will most likely know what
   covered on the patient’s prescription       drug is (if using a certified system) for the    tier on the patient’s formulary a specific
                insurance                       patient prior to faxing it to the Pharmacy     drug is and potentially change it if it is not
                                                                                                                    Pharmacy Technology the
                                                                                                 covered PRIOR to it being sent to Services

  The prescriber can receive a fax or a          The prescriber can receive a fax or a         The prescriber will most likely only receive
phone call from the pharmacy if there are      phone call from the pharmacy if there are        phone calls (no faxes) for a question or
  any questions or concerns about the            any questions or concerns about the            concern on a prescription. There is an
               prescription                                   prescription                       ongoing industry effort to change this
         New Rx Workflow
• eRx is received and given a 60 minute
  promised time
• Script Entry
• Adjudication
• Data Review
• Filling
• Product Review
• Consultation                       Pharmacy Technology Services
                        The Pharmacy Technician processes a NEW eRx

This is the data that
is sent over
electronically. It
can not be altered                                                          This is the data
in any way, and will                                                        that will be printed
always be attached                                                          on the patient’s
to the patient’s                                                            prescription label
prescription record

                                                                      Pharmacy Technology Services
                   Additional Information is viewable on Page 2 of the created image

Prescribers may send over
information regarding their
Supervising Physician, any
comments they want us to relay
to the patient, and any
appropriate diagnosis codes for
the particular script.
This will be displayed on “Page
2” of our image created

                                                                                 Pharmacy Technology Services
          Refill Rx Workflow
• Patient Requests Refill with zero remaining fills
• System checks to see if the Prescriber is set up
  to receive eRx or Fax Refill Requests from us
  – A Prescriber can have eRx OR Fax – not both.
• The Refill Request is sent the appropriate
  method automatically for the store
• The Script gets placed into our Exception Queue
• Once we get the Refill Authorization/Denial, we
  make the necessary change to the Prescription
  and notify the patient.
                                               Pharmacy Technology Services
                                The Exception Queue - Refills

When our staff looks at this
                                                                   Our staff is trained to
Queue, they know that this
                                                                   know what each of
Refill Request was sent
                                                                   these “Pre-scribe
electronically, therefore
                                                                   Replies” mean, and
they do not need to call or
                                                                   how to process them in
fax for a 2nd Refill Request.
                                                                   a timely matter.

                                                                Pharmacy Technology Services
           eRx Percent Filled
• eRx has grown drastically over the recent years
• eRx Percentage of Total Rx’s Filled = 2.5%
  – 2007: 1.14%
  – 2006: 0.77%
• eRx Percentage of “eRx Eligible Rx’s” = 7.75%
  – This includes All Rx’s minus controlled substances
    and normal Refills (refills that do not need prescriber
  – 2007: 3.8%                                     Pharmacy Technology Services
Percent Sold Study - 2007
               Difference Before & After
                       using eRx
 Total Rx’s             + 5.74%
  Patients             + 7.54%
 New Rx’s              + 8.05%
 Refill Rx’s           + 3.38%
Unsold Rx’s           - 39.45%
                                 Pharmacy Technology Services
               eRx Standards
• Electronic Prescribing messaging is established by a
  standards organization – NCPDP.
• All parties that use Electronic Prescribing must comply
  with these standards
• These standards are also what CMS uses as their
  Electronic Prescribing standards
• Changing the standards is a very lengthy, time
  consuming process, but can be done
• We are currently trying to add a message that would
  allow for a query to be sent from a Pharmacy to a
  Prescriber (example, clarification on a sig code)
                                                   Pharmacy Technology Services
            Future Growth
• The growth of e-prescribing largely depends on
  additional value of connectivity in healthcare
  – Early adopters on board, electronic medical records
    becoming mainstream in larger practices
  – Need to create a stronger value proposition for
    physicians to adopt e-prescribing
     • Encourage physician vendors to increase client
       utilization of e-prescribing
     • Encourage health plans, manufacturers, and
       government policymakers to support e-prescribing
                                                 Pharmacy Technology Services
          Future Growth
• DEA Proposed Regulations
• CMS Mandates
• High prescribers still need to adopt eRx
  – 15% of all physicians produce 50% of all
    written prescriptions
  – 30% of all physicians produce 83% of all
    written prescriptions

                                        Pharmacy Technology Services
Let’s “Get Connected!”
   Thank you for your time!

                              Pharmacy Technology Services

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