e-Prescribing Overview
The current process today begins with a physician generating a handwritten
prescription that the patient delivers to a pharmacy. The pharmacy interprets the
hand written information and enters the data into a computer system that
connects with the pharmacy benefit management (PBM) program that is used by
the patient’s insurer. The PBM checks the prescription (electronically) for its
compliance to a pharmacy program, possible drug interactions based on the
patient’s medication history, and any other utilization criteria. If there is an issue
on any element, a message is sent back to the pharmacist, who then may need
to intervene. Many times this requires a call back to the physician to change the
prescription to another medication. The pharmacist who is not the prescriber is
connected to key pieces of information but the physician is not. E-Prescribing
attempts to bridge this information gap by providing physicians with information
at the point of decision making and there by eliminating administrative and
operational costs as well as reducing the potential for medication errors.
The case for e-Prescribing :
 Prescription writing process today is a disconnected and manual process
that presents several opportunity for errors.
 Medication errors cause an estimated 770,000 injuries or deaths each
year in hospitals. (Source: 1999 IOM Report, To Err is Human)
o Cost approximately $5.6 million each year per hospital, depending
on size. (Source: Reducing and Preventing Adverse Drug Events
To Decrease Hospital Costs. Research in Action, Issue 1. AHRQ
Publication Number 01-0020, March 2001. Agency for Healthcare
Research and Quality, Rockville, MD.)
o Contribute to approximately 7,000 deaths a year, with an estimated
cost for drug-related morbidity and mortality exceeding $77 billion a
year. (Source: Reducing and Preventing Adverse Drug Events To
Decrease Hospital Costs. Research in Action, Issue 1. AHRQ
Publication Number 01-0020, March 2001. Agency for Healthcare
Research and Quality, Rockville, MD.)
Specifically, what is the value of e-Prescribing to the physician?
It has the ability to issue prompts that warn against the possibility of drug
interaction, allergy or overdose. It provides accurate, current information that helps
physicians keep up with new drugs as they are introduced into the market,
provides drug-specific information that eliminates confusion among drug names
that sound alike, improves communication between physicians and pharmacists
and reduces health care costs due to improved efficiencies.
It can also make the physician’s office more efficient by decreasing prescription
related calls and provides a legible and clean prescription to the pharmacy.
What specifically will the e-Prescribing application do?
e-Prescribing enables a physician at the point of writing a prescription to have
access to a relevant list of medications and formulary based on that patient’s
drug benefit. The application also performs eligibility verification and a drug
utilization assessment to check for drug interactions or contra-indications based
on the patient’s medication history. The physician may also be able to receive
that patient’s full medication history.
Application can be integrated with the physician’s office management system.
The application can reside on a desktop, laptop, tablet or PDA.
e-Prescribing Process Flow & Conceptual Data Flow
Pharmacy Claims to PBM for
Payment
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E-RX
Vendor
Pharmacy (retail or mail)
requests submitted
by vendor
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Eligibility, Formulary
Medication
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based on
Electronically Submitted
Scripts (EDI or Fax)
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PBM
Printed
Prescription
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1
Eligibility Requests based on
patient lists from Physicians
Data being transferred:
• First Name
• Last Name
• Date of Birth
• Member ID
• Member Plan Information
e-Prescribing Process
Flow & Conceptual Data
Flow Diagram
Process Description:
1. The physician’s patient list or patient schedule (for next day) is provided to the
selected e-Prescribing vendor to be used for verification of eligibility, formulary
and drug history. This patient data is stored at the ISV’s secure data center for
use during the execution of an electronic prescription.
2. The vendor uses the data provided by the physician to request the eligibility,
formulary and drug history for a patient from the patient’s payer or Pharmacy
Benefit Manager.
3. The PBM checks for a matching member in their system and provides the
appropriate data back to the e-Prescribing vendor for use during the patients visit.
4. The physician now has all of the information needed to confidently write a
prescription at the point of care utilizing the e-Prescribing package that connects
real time to the vendors secure data centre.
5. The prescription is sent via Fax or EDI to the appropriate pharmacy where it is
filled and ready to be picked up by the patient. The physician also has the option
to print the prescription in the office for the patient to take to the pharmacy of
their choice.
6. Once the prescription is filled, the pharmacy submits a claim to the PBM for
payment. This claim will then be part of the drug history provided to the
physician the next time the patient is seen.