Accelerating e-Prescribing

Blumenthal Says Medicine of the Future Will Include Widespread HIT Adoption

According to e-Health Smartbrief, it may seem unlikely today, but within the next 10 years there will be widespread use of electronic health records across the country, the nation's health IT chief predicted Thursday.  David Blumenthal, MD, the national coordinator for health information technology spoke at the 18th National HIPAA Summit  in Washington DC, where other federal officials and stakeholders said the adoption of healthcare IT is urgent.

"History has shown that things that improve healthcare become part of what is used," Blumenthal said. "I propose to you that in a few years doctors will all support EHRs," he said. "Using EHRs will become a core competency for physicians. And once we've established that, it will be considered an absolute requisite."

Blumenthal compared the kick-off of federal incentives for meaningful use of electronic health records in 2011 to boarding an escalator. "I think we're going to see the upward slope of the adoption curve within a year or two; but it will be difficult to predict the slope," he said.

Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality, said the usefulness of health data will naturally drive healthcare IT adoption.  "Information is the lifeblood of medicine," she said. "Clinicians are trained to look at patients one at a time. But, what's missing is aggregated information."

Andy Slavitt, CEO of Ingenix said, "One of the saddest parts of our jobs is that no one is asking the questions they once wondered about, but thought there were no answers to. Answers are available, they just aren't getting to doctors. "

"There's a lot going on in the trenches that is the only thing that keeps this flawed healthcare system going day in and day out," he said.

Georgia Secures HIT Grant

U.S. Health and Human Services, Centers for Medicare and Medicaid Services (CMS) awarded the Georgia Department of Community Health (DCH) $3,171,328 to create a State Medicaid Health Information Technology Plan (SMHP) and complete initial planning activities related to promoting the adoption and utilization of electronic health records (EHR) among Medicaid providers.  The funding is made available through the American Recovery and Reinvestment Act (ARRA) Medicaid incentive program.

 

The SMHP will outline Georgia’s strategy for providing payment incentives to Medicaid providers for purchasing an EHR system and re-engineering their practices to maximize the use of health information technology.  The plan will also define the reimbursement methodology for Medicaid providers who adopt EHRs in accordance with the meaningful use criteria.  The plan will enable Georgia to achieve its overarching goal of ensuring every Medicaid provider has access to an electronic medical record system and the capacity to participate in an electronic health information exchange (HIE). 

 

Georgia is the first state in the region and the fourth in the nation to receive such an award from CMS. 

 

“DCH is ready to hit the ground running with the resources provided by CMS for the development of our state’s Medicaid Health Information Technology plan,” said Dr. Rhonda Medows, Commissioner, DCH.  “This plan will align with each of the state’s health information technology goals, including the development of a state health information exchange, the launch of Georgia Healthe Connect – a HIE that provides access to an EHR to Medicaid providers who desire software as a service, and the work of the Regional Extension Center.”

 

Georgia requested funds to:

• Plan the Medicaid incentive payment program as outlined in section 4201 of the 2009 ARRA and further described in the Letter to State Medicaid Directors dated September 1, 2009, including tracking meaningful use of certified EHR technology by Medicaid providers;
• Plan for the Department’s capability of providing management and oversight of the incentive program, including routine tracking of meaningful use attestations and reporting mechanisms;
• Plan initiatives that encourage the adoption of EHR technology certifiable in accordance with CMS criterion (to be determined) to promote health care quality and the exchange of health information among Medicaid providers and members;
• Plan that Georgia implements a program that is in support of the applicable laws and regulations governing HIE, while ensuring the privacy and security of the data provided by the data exchange partners; and
• Plan a comprehensive program that aligns the Medicaid incentive program with the existing state HIT initiatives and new activities funded by ARRA.

DCH will leverage existing relationships across the health care and HIT community to ensure that stakeholders are engaged in the development of HIT in Georgia. 

 

For more information about this and other Georgia HITT Initiatives, visit www.dch.georgia.gov/gahitt.   

 

Delaware Medicaid Boosts e-Prescribing

According to Government IT, the state of Delaware credits a decision a year ago to fund e-prescribing start-up costs for the top Medicaid providers in the state for a 150 percent jump in the number of Medicaid providers now using the e-health service.  The top-down approach, which included offering e-prescribing technology and training services to the top 50 Medicaid providers in the state, has sparked adoption of prescribing by one in five Delaware Medicaid providers, according to state healthcare officials. 

“It surprised us even that the level of participation actually more than doubled in such a short period of time,” said Rita Landgraf, secretary of the Delaware Department of Health and Social Services.

The Delaware Medicaid E-Prescribing Network, which went live a year ago, was launched by the Delaware Department of Health and Social Services Division of Medicaid and Medical Assistance (DMMA) with a $1 million Medicaid Transformation Grant from the Centers for Medicare and Medicaid Services (CMS).

The network is integrated with the state’s Medicaid Management Information System and enables physicians to securely verify Medicaid benefit eligibility, access medication history from Medicaid and other third-party payers, view the Medicaid formulary and transmit electronic prescriptions to pharmacies.

Landgraf credits the pilot project as a big driver for getting physicians to start using e-prescribing. It involved providing e-prescribing hardware, software and training to the 50 highest-volume Medicaid providers in the state.  Although the physicians in this group represented only 2 percent of the state’s Medicaid providers, they were responsible for 20 percent of the total annual paid pharmacy claims volume, she said.

The Medicaid network also expanded e-prescribing features available to the estimated 200 providers that had already adopted an e-prescribing system offered through the State Employees Health Plan and Blue Cross Blue Shield of Delaware. 

As the Medicaid-e-prescribing network expands, DMMA officials are hoping to conduct studies that validate the advantages of e-prescribing. These include fewer errors, increased patient safety, time and cost savings and a reduction in fraud.

e-Prescribing Becoming Increasingly Popular

According to Modern Medicine, more than 140,000 (23 percent) of all office-based physicians, nurse practitioners, and physician assistants in the U.S. are now using electronic prescribing.  At the current pace, Surescripts projects that the total number of health care professionals prescribing medication electronically via its network this year will more than double from the 74,000 active electronic prescribers who used it at the end of last year.

“E-prescribing is worthwhile for me because I can create a prescription in one-quarter of the time it took me previously, as it is automatically recorded into our system,” says Greg Fuller, MD, a family physician in Keller, Texas, according to a news release from Surescripts. “This is also very beneficial for tracking and managing potential drug interactions with other medications. Plus, it solves the age-old problem of illegible handwriting.”

Narinder Batra, MD, an internist and pediatrician at Lenawee Adult & Pediatric Medicine located in Adrian, Michigan, says, “The e-prescribing process adds efficiencies to our practice in many ways, as time-consuming faxes have been eliminated, making our patient service more efficient.  We also no longer need to regenerate prescriptions, due to the automatic electronic record keeping. Formulary review also significantly reduces costs, and drug interactions and allergies are also checked, which avoids complications.”

Expect Continued Growth in e-Prescribing

Twenty-three percent of office-based physicians, nurse practitioners and physician assistants now use electronic prescribing software, according to Surescripts. That equates to 140,000 of a total of 610,000 office-based prescribing clinicians. At the current pace, Surescripts estimates its total number of active prescribers in 2009 will more than double the 74,000 it had at the end of last year.

The company also notes that prescribers now can choose from more than 200 types of e-prescribing and electronic health records software certified and connected to the Surescripts network. The network links to 84% of retail pharmacies and six large mail order pharmacies.

New Study Reveals Patient Safety and Cost Effectiveness of e-Prescribing

According to a new study published in the Archives of Internal Medicine, computer-based systems that allow clinicians to prescribe drugs electronically are designed to automatically warn of potential medication errors. The new study reveals electronic prescribing not only prevents mistakes, but is also helping to reduce health care costs.

The study suggests that Massachusetts physicians using a commercial electronic prescribing system for a six month period in 2006 may have prevented three deaths and more than 400 injuries as well as saved more than $400,000 by heeding medication error alerts.

"Our previous research showed that most doctors ignore or reject most drug interaction alerts, calling into question the value of this technology," says the study's lead author, Saul N. Weingart, MD, PhD, vice president for quality improvement and patient safety at Dana-Farber. "However, these new findings show that these systems create significant value despite the high number of ignored alerts."

The researchers reviewed 279,476 alerted prescriptions written by 2,321 ambulatory care clinicians in Massachusetts using a single commercial e-prescribing system from January 1 through June 30, 2006. An expert panel reviewed a sample of common drug interaction alerts and then estimated the likelihood and severity of adverse drug events associated with each alert, the likely injury to the patient, and the health care utilization required to address each adverse drug event. Researchers established the cost savings due to e-prescribing by using third-party-payer and publicly available information.

"The findings add support to current, national efforts to expand the use of electronic health records in ambulatory care," says Weingart. "However, the work also shows that these systems are often inefficient. We need to develop more powerful and refined systems to better support the work of frontline clinicians."
The study was supported by a grant from Blue Cross Blue Shield of Massachusetts.

e-Prescribing Alerts Improve Patient Safety

According to HealthDay News, drug interaction alerts from electronic prescribing programs improve patient safety and reduce costs in outpatient care, despite the fact that over 90 percent of the alerts are overridden by physicians, according to a study in the Sept. 14 issue of Archives of Internal Medicine.

Saul N. Weingart, M.D., from the Dana-Farber Cancer Institute in Boston, and colleagues examined the benefit of electronic prescribing and drug interaction alerts in ambulatory care using data from 279,476 alerted prescriptions in Massachusetts in the first six months of 2006. The impact of the alerts on patient safety and health care utilization was determined by an expert panel. They note that drug interaction alerts occurred in 7.3 percent of prescribing attempts and 91.1 percent of alerts were overridden by clinicians.

The panel estimated that the electronic alerts likely prevented 402 adverse events. Accepted alerts may have prevented three deaths, 14 cases of permanent disability, and 31 cases of temporary disability. The researchers estimated that alerts may have led to 39 fewer hospitalizations, 34 fewer visits to the emergency department and 267 fewer office visits, resulting in a savings of $402,619. The panel estimated that 331 alerts were required to prevent one adverse drug event, and only 10 percent of alerts may have accounted for 78 percent of the reduced costs.

"Electronic prescribing alerts in ambulatory care may prevent a substantial number of injuries and reduce health care costs in Massachusetts," Weingart and colleagues conclude. "Because a few alerts account for most of the benefit, e-prescribing systems should suppress low-value alerts."

The study was supported by a grant from Blue Cross Blue Shield of Massachusetts.

Five Decisions Determine the Fate of e-Health Records

FederalComputerWeek indicates that there are 5 critical decisions that will determine the fate of e-health records. Under the economic stimulus law passed earlier this year, as much as $45 billion will be distributed to health care providers who buy and use approved electronic health record systems.

The road ahead is still bumpy for EHRs, but experts say success hinges on the outcomes of five major decisions.  FederalComputerWeek's five decisions are listed here:

1. Follow the rules or be innovative?

Officials at the Health and Human Services Department have the daunting task of creating a framework for certifying EHR systems that are capable of collecting and sharing patient data in ways that satisfy the broader goals of the stimulus law. A critical question is whether HHS can strike the right balance of rigidity and flexibility.

“There is always a trade-off between innovation and any kind of a certification process,” said Wes Rishel, a vice president and distinguished analyst at Gartner’s health care provider research practice.

2. Broaden the meaning of “meaningful use?"

In the stimulus law, Congress said only doctors and hospitals that show meaningful use of EHRs can receive incentive payments. That language was meant to prevent the buying of systems that sit idle or are not used as intended. Key decisions for HHS are how broadly and stringently to apply the meaningful-use framework to meet major goals, such as cost savings, improved care and better public health.

3. Take baby steps or giant leaps forward?

To help HHS meet its fast-approaching deadlines, an advisory committee urged the agency to immediately set up a temporary program that would allow an existing organization to certify vendors’ EHR systems until more permanent arrangements could be made.

Dr. Carol Diamond, managing director of the Markle Foundation’s Health Program, said HHS should allow the same sort of flexibility for providers to meet EHR-use goals. Some are already using EHRs, but others lag far behind, she added. “We still live in the real world,” she said. “You cannot get up to speed all at once.”

4. Let the states lead the way on data exchange?

The ultimate goal of health information technology is the automatic sharing of patient data. The reasoning goes that if providers exchange patient data with government agencies and one another, analysts can identify trends and send the results back to doctors and hospitals to help them provide better care and reduce costs.

For now, a little sugar is making the medicine go down easier — such as the $564 million in state grants for health information exchanges that HHS announced in August. But the agency still has a key decision to make on the federal government’s role in creating that data network.

“You have to either grow the state exchanges that will be connected or try to seed from the top,” said Deven McGraw, director of the Center for Democracy and Technology’s Health Privacy Project.

5. Wait for broader health reforms or forge ahead?

Dr. David Blumenthal, HHS’s national coordinator for health IT, said he hopes to strike a balance between incentives and penalties for EHR use. The rules must foster competitiveness, innovation, privacy and security, among other often-conflicting goals. But decisions are also looming about how hard HHS should push for health IT in advance of more comprehensive reforms that will affect health care access and payments.

“If we do not do the work on payment reforms, we will not really reap all the value of health IT,” McGraw said.

CCHIT to Offer Limited Certificate

According to Government Health IT, the Certification Commission for Health IT (CCHIT) recently indicated that it would move ahead with its plans to offer “more limited, modular” certification of electronic health records so providers could get a jump start on health IT purchases under the economic stimulus plan. CCHIT said it would hold a “Town Call” Web conference Sept. 3 to go over its “new paths to certification,” which involve offering preliminary certification for individual EHR components, such as electronic prescribing or computerized physician order entry software that meet the “meaningful use” conditions of the stimulus law.

“We are concerned that providers could not achieve meaningful EHR use in 2011 if they wait until spring 2010 – the expected date of HHS final approval of requirements – to begin adopting this technology,” said Mark Leavitt, CCHIT’s chairman. The American Recovery and Reinvestment Act (ARRA) required that providers be meaningful users of EHRs to be eligible for Medicare and Medicaid incentives beginning in 2011.

In addition to limited certification, CCHIT said it would continue to offer comprehensive certification of EHRs for different clinical settings that meet the terms of meaningful use.  The Department of Health and Human Service’s Health IT Policy Committee, chaired by national health IT coordinator Dr. David Blumenthal, has recommended that providers be required to purchase EHRs, or components of those systems, that are certified for a minimum set of measures of meaningful use.

The committee would not require CCHIT’s more comprehensive certification, but CCHIT said it would continue to offer it. The Health IT Committee also recommended that more organizations be able to certify systems in the future once a method was developed to approve them. 

The stimulus package required that providers be meaningful users of their electronic health records systems to be eligible for Medicare and Medicaid incentives beginning in 2011. HHS, which expects to publish an interim final rule in December, will not finalize details for meaningful use until early 2010.

CCHIT’s Sept. 3 Webcast will provide developers and vendors a chance to discuss details of the commission’s certification programs and the differences between the certification paths. CCHIT will also hold sessions Sept. 29 and Oct. 1 in Chicago to educate vendors and developers on new application processes, certification and system test scripts. 

Grants Available for HIT Infrastructure

According to Reuters, the U.S. government announced grants of almost $1.2 billion to help hospitals and healthcare providers implement and use electronic health records. The Obama administration has made the overhaul of the $2.5 trillion U.S. healthcare system the centerpiece of its domestic agenda, including the use of technology to improve efficiency and cut costs.

The grants include $598 million to set up some 70 health information technology centers to help healthcare institutions acquire electronic health record systems and $564 million to develop a nationwide system of health information networks. "Expanding the use of electronic health records is fundamental to reforming our healthcare system," said Health and Human Services Secretary Kathleen Sebelius, unveiling the grants with VP Joe Biden in Chicago.

The grants will be funded by the American Recovery and Reinvestment Act of 2009 and be made available in 2010, the statement said.