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Accenture

Because e-prescribing takes a process laden with numerous work-around steps and streamlinesit to offer significant clinical improvements, industry leaders are taking actionable steps tobreak down the barriers of its adoption.

What Is E-Prescribing?

In defining e-prescribing, it is sometimes better to start with what it is not. Even within the health care community, there are several myths pertaining to e-prescribing. One of the myths is that e-prescribing is an online pharmacy. Others believe that e-prescribing is in violation of HIPAA regulations. But these myths are far from the truth. The truth is that e-prescribing is one of the first steps on the road to a truly connected digital health care community.

E-Prescribing is the ability for the physician to submit an electronic “clean” prescription to the pharmacy from the point of care. E-Prescribing applications have evolved to be deviceindependent and configurable to different physician office workflows. E-Prescribing applications can reside on a handheld, tablet, or desktop computer. Some of the functionality that these applications provide is listed in Figure 1.

Figure 1. Some of the functionality that e-prescribing applications provide.

What Is the Value That E-Prescribing Brings?

With all the functionality that e-prescribing offers, many people ask the question: What is the value? At a high level, the value is the opportunity to take a manual process laden with numerous work-around steps and streamline it to the benefit of patient care and operational efficiencies. It offers a win-win scenario for all of the stakeholders involved. As an example, consider a patient with cardiovascular disease who is at risk for a heart attack. The patient’s physician is managing his disease with a prescription medication. Without e-prescribing, the physician knows only what has been prescribed and does not have access to information that could tell him if the patient has not filled the prescription. That information exists, but with today’s manual processes the physician is isolated from it. Thus, the patient’s care may be inadequate, not because of physician error but due to lack of complete information that could inform the physician of an issue regarding compliance with therapy. E-Prescribing helps to augment the information flow and the physician’s access to it; it is a critical piece of the overall health care puzzle.

To best explain the full benefit that can be achieved by using an e-prescribing application, we must look at the stakeholders involved. The four key stakeholders in this transaction flow are: physician, patient, pharmacist, and payer. Figure 2 shows the continuum of benefits that can be realized by each group.

Figure 2. Continuum of Benefits for Each Key Stakeholder

With the amazing functionality available, proven benefits, and ROI for the key stakeholders, why has e-prescribing not achieved greater market penetration? One of the major reasons is that health care, as an industry, spends far less on information technology than other information- and transaction-intensive industries. According to some estimates, the health care industry spends approximately 2 to 3 percent of its revenues on IT. In contrast, banking, airlines, and retail industries spend about 10 to 15 percent of their revenues on IT.

As a result of this underinvestment, most health care organizations have separate and numerous legacy systems that act as information silos. This drives the rather staggering figures that are all too commonplace within the United States. These range from medication errors that are responsible for an estimated 7,000 deaths per year to the $77 billion spent to cover the 2 million adverse drug events annually

Pharmacists and physicians also have to deal with numerous operational inefficiencies. These inefficiencies add up to roughly 150 million phone calls into physician offices regarding medications and up to 30 percent of a pharmacist’s time getting the proper medications for the patient. All of the errors in the process lead to rework for approximately 40 percent of prescriptions before they are dispensed to the patient.

What Is the State of the Market?

Over the last few years, e-prescribing has evolved from a fragmented niche offering to an integrated standards-based solution that can stand alone or be leveraged as part of a broader physician office solution.

There have been a number of catalysts to the e-prescribing market. Some of them include:

• RxHub exchange function for eligibility verification, formulary access, and medication history;
• SureScripts to complete the electronic highway by connecting the retail pharmacies with physician offices via the e-prescribing vendors;
• Medicare Rx benefit that encourages and may eventually require e-prescribing;
• The NCPDP SCRIPT standard for e-prescribing;
• Evolution of e-prescribing vendor business models and platforms;
• Consortiums such as the eHealth Initiative to drive standards and interoperability;
• Emergence of large payers involved in moving health care technology and e-prescribing forward, including:
  • Tufts Health Plan and BCBSMA (Blue Cross Blue Shield of Massachusetts);
  • Massachusetts Consortium;
  • WellPoint Physician Technology Initiative;
  • Highmark – UPMC (University of Pittsburgh Medical Center); and ° Horizon BCBS of New Jersey.
• Maturation and availability of mobile computing technology;
• Recognition by medical societies and physician associations of the value and need of e-prescribing; and
• Heightened involvement of politicians in the health care technology debate as evidenced at the World Health Congress, and increased funding for health care technology.

The e-prescribing function is not just a stand-alone application. The health care market is evolving to build out e-prescribing applications as part of existing practice management systems, electronic health/medical records, laboratory systems, and physician portals. In addition to the broader dispersion of the e-prescribing functionality, the depth of full e-prescribing is progressing. An electronic prescription can be one that is:

1. Printed out in the physician office from the e-prescribing application;
2. Faxed from the e-prescribing application vendor to the retail pharmacy; or
3. Electronically transmitted from the e-prescribing application vendor to the pharmacy.

The third option is a fully electronic process, and over the last year the industry has made significant strides in setting up the infrastructure to accomplish this. This has been driven in large part by organizations such as SureScripts that are connecting retail pharmacies to physician offices via e-prescribing vendors.

Large payers recently have become engaged in the e-prescribing environment. Most notable is the $40 million investment that WellPoint is making to improve technology in the physician’s office. This initiative attempts to bridge the gap for physicians with limited basic IT infrastructure by offering a desktop administrative paperwork reduction package. It also moves other physicians along the digital physician office continuum by offering a mobile prescription writing improvement (e-prescribing) package. This is the single largest payer initiative to date, and its indirect impact should not be underestimated. It may be the event that causes a chain reaction of other payers to enter the eprescribing fold with similar or unique programs.

WellPoint is very excited to be moving the market, according to Charles Kennedy, M.D., vice president of clinical informatics at WellPoint. “I believe e-prescribing is an excellent opportunity to introduce information technology into the physicians’ work environment. Prescribing drugs is an activity that practicing physicians perform regularly. It is a function that can be made electronic without significant disruption to the physicians’ workflow, and offers significant clinical improvements and administrative ease. I expect WellPoint to continue to lead the way in helping physicians take advantage of this new technology.”

Physicians and physician organizations seem to be moving actively to the e-prescribing table. It is no longer a question of if e-prescribing will become the standard of care, but when. Their hesitancy has been one of economics. How can they pay for incorporation of an e-prescribing application into their current office and workflow? The direct subsidy of this system by some payers, as well as other models that indirectly subsidize the use of an e-prescribing system through incentive payments or preferred contracts, is helping to reduce this barrier to physician adoption.

Addressing the Market Need

Capgemini has brought together a group of health care and technology industry leaders to take actionable steps to break down the barriers of e-prescribing adoption. This group is Café Rx, the Collaborative Alliance Facilitating e-Prescribing (see Figure 3). This alliance of industry-leading companies and organizations is working together with a common mission: Remove barriers to adoption and utilization of e-prescribing solutions through collaboration, with the goal of improving the quality of patient care.

While there are other collaborative initiatives, Café Rx will build upon their accomplishments by taking them into actionable steps and projects. These organizations have significantly increased awareness of value, driven creation of new standards and formats, and have moved the e-prescribing agenda forward. Café Rx is an extension of the work that has been done and strives to actively engage the payer and provider/physician communities in moving eprescribing to the next level.

Figure 3 Who is Café Rx?

The goals of Café Rx are to:

• Provide key stakeholders (including, but not limited to, payers, health care systems, and medical malpractice insurance companies) with successful strategies and specific plans to remove the barriers to adoption by their provider communities;
• Provide information and assist in lobbying efforts urging federal and state governments to adopt smart mandates that facilitate adoption of e-prescribing; and
• Educate physicians and physician office staff to eliminate many of the myths that have become barriers to adoption of electronic prescribing.