Electronic prescribing, or commonly known as e-prescribing, holds a promise to reduce medication errors and help achieve cost savings. In this article, I will provide a brief background of e-prescribing and then discuss its advantages and disadvantages. Finally, the end of the article will describe how providers can get money for e-prescribing and detail some steps you can follow to get started. I use Medicare Part D medications as an example, but please remember that e-prescribing can be used for any medication. The incentive payment structure, requirements of use and regulations governing, however, may be different for non-Medicare Part D medications.
What is e-prescribing?
There are many definitions of e-prescribing. Take, for instance, the CMS definition: “a prescriber’s ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point of care”.
Is e-prescribing a new idea?
E-prescribing is not a new concept. In 2003, it was mentioned in the Medicare Prescription Drug Improvement and Modernization Act. This established a prescription drug benefit for seniors (Part D) and mandated organizations to establish a program by which the prescription could be transmitted electronically from provider to the pharmacy.
Potential benefits of e-prescribing:
Electronic prescribing does provide certain benefits. Most of these relate to canceling out any errors that would be made through humans in the process of getting a prescription from the provider to the pharmacy. Additionally, added benefit is derived from useful information (drug- drug interactions, insurance info, etc.) that computers can provide at the point-of-care. Finally, patient satisfaction may be manifested in reduced time it takes to get the prescription from the provider to the pharmacy and the reduction of errors in prescribing. The benefits of e-prescribing are:
• Decreased incidence of medication errors
• Not dependent on deciphering provider handwriting
• Immediate checking of drug-drug interactions
• Analytics that enable patient-specific drug use considerations
• Immediate checking of insurance plans that will pay for the drug
• More timely transfer of Rx to pharmacy
• Enhances quality of care through reductions in medication errors
• Analytics that enable evidence-based prescribing
Areas of care e-prescribing may not help with:
Most of these points have to do with behaviors that are out of the physician’s control.
• Patient non-compliance with medications
• Patient misuse of over-the-counter medications
• Physician prescribing errors due to bad judgment
• Pharmacy dispensing errors due to bad pharmacist judgment
• Patient benefit of medication explanation from face-to-face interaction with pharmacists
How it works
The e-prescribing model is analogous to the traditional model of when a prescription goes from the provider to a pharmacy directly, pharmacy benefit management company (i.e. Medco) or the patient’s insurance company. The difference is, however, before it reaches those entities the prescription is cycled through a software program. This is where the drug-drug interactions, patient specific use information and evidence based recommendations are provided. Notice e-prescribing allows direct interfacing with the software program through a variety of inputs –computer, PDA or other handhelds. After passing through the e-prescribing software program, the prescription can be sent back and forth between pharmacies, PBMs and insurers, as done currently. Examples of some e-prescribing software applications include Touchworks v 10.1.1 by Allscripts and EpicCare EMR Spring 2007 by Epic.
Standards used
Whenever transfer of data occurs or exchange of information is occurring there is a need for data standards. There are initial standards that are part of any e-prescribing program. Regulations dictate what standards need to be used. Medicare Part D is a good example to use since there is lots of published information about their regulations. Below are standards and specifications required for e-prescribing medications covered by Medicare Part D.
For the exchange of eligibility information between prescribers and Medicare Part D sponsors: Accredited Standards Committee X112N 270/271, Version 4010, May 2000
For the exchange of eligibility inquiries and responses between dispensers and Part D sponsors: The National Council for Prescription Drug Programs Telecommunication Standard Specification (NCPDP), Version 5.0, September 1999
For the exchange of new prescriptions, changes, renewals and cancellations: NCPDP SCRIPT Standard, Implementation Guide, Version 5.0, May 12, 2004
There are other standards available but not yet adopted.
RxFill for Fill Standard notification- this enables a pharmacy to communicate to a prescriber when a prescription is picked up, partially filled or not picked up and returned to stock
Rx Norm standard for clinical drug terminology- this provides a database for drug names, active ingredients, dosage and form
NCPDP Structured and Codified standard 1.0- standardized format and vocabulary used in patient instructions
Standard for prior authorization- certification from drug benefit plan to provider that patient meets criteria for a certain drug to be covered
Important Dates regarding prescriptions
Health plans covering Part D medications must offer it by May 2009
As Jan 1, 2012 Part D prescriptions can longer be offered by computer fax. Must be handed to patient or manually faxed.
How to get incentive money for e-prescribing
90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014,
96150, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214,
99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326,
99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348,
99349, 99350, G0101, G0108, G0109
Some important rules regarding e-prescribing for Medicare Part D prescriptions
Electronic prescribing is certainly an important development in modern healthcare information technology. The adoption rates are currently quite variable and often depend on whether providers can derive financial benefits from their insurers for using such technology. The “meaningful use” criteria as established by the government will dictate largely how e-prescribing, among other health IT initiatives, are used. There continue to changes in the regulations of governing e-prescribing Part D prescriptions.
Individual providers and organizations should do a risk/ benefit and return of investment analysis before venturing into a particular e-prescribing program. With many vendors available, it is important to assess how the program will integrate into the existing system (ie. current EMR, etc.)
By Jitesh Chawla, MD
What is e-prescribing?
There are many definitions of e-prescribing. Take, for instance, the CMS definition: “a prescriber’s ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point of care”.
Is e-prescribing a new idea?
E-prescribing is not a new concept. In 2003, it was mentioned in the Medicare Prescription Drug Improvement and Modernization Act. This established a prescription drug benefit for seniors (Part D) and mandated organizations to establish a program by which the prescription could be transmitted electronically from provider to the pharmacy.
Potential benefits of e-prescribing:
Electronic prescribing does provide certain benefits. Most of these relate to canceling out any errors that would be made through humans in the process of getting a prescription from the provider to the pharmacy. Additionally, added benefit is derived from useful information (drug- drug interactions, insurance info, etc.) that computers can provide at the point-of-care. Finally, patient satisfaction may be manifested in reduced time it takes to get the prescription from the provider to the pharmacy and the reduction of errors in prescribing. The benefits of e-prescribing are:
• Decreased incidence of medication errors
• Not dependent on deciphering provider handwriting
• Immediate checking of drug-drug interactions
• Analytics that enable patient-specific drug use considerations
• Immediate checking of insurance plans that will pay for the drug
• More timely transfer of Rx to pharmacy
• Enhances quality of care through reductions in medication errors
• Analytics that enable evidence-based prescribing
Areas of care e-prescribing may not help with:
Most of these points have to do with behaviors that are out of the physician’s control.
• Patient non-compliance with medications
• Patient misuse of over-the-counter medications
• Physician prescribing errors due to bad judgment
• Pharmacy dispensing errors due to bad pharmacist judgment
• Patient benefit of medication explanation from face-to-face interaction with pharmacists
How it works
The e-prescribing model is analogous to the traditional model of when a prescription goes from the provider to a pharmacy directly, pharmacy benefit management company (i.e. Medco) or the patient’s insurance company. The difference is, however, before it reaches those entities the prescription is cycled through a software program. This is where the drug-drug interactions, patient specific use information and evidence based recommendations are provided. Notice e-prescribing allows direct interfacing with the software program through a variety of inputs –computer, PDA or other handhelds. After passing through the e-prescribing software program, the prescription can be sent back and forth between pharmacies, PBMs and insurers, as done currently. Examples of some e-prescribing software applications include Touchworks v 10.1.1 by Allscripts and EpicCare EMR Spring 2007 by Epic.
Standards used
Whenever transfer of data occurs or exchange of information is occurring there is a need for data standards. There are initial standards that are part of any e-prescribing program. Regulations dictate what standards need to be used. Medicare Part D is a good example to use since there is lots of published information about their regulations. Below are standards and specifications required for e-prescribing medications covered by Medicare Part D.
For the exchange of eligibility information between prescribers and Medicare Part D sponsors: Accredited Standards Committee X112N 270/271, Version 4010, May 2000
For the exchange of eligibility inquiries and responses between dispensers and Part D sponsors: The National Council for Prescription Drug Programs Telecommunication Standard Specification (NCPDP), Version 5.0, September 1999
For the exchange of new prescriptions, changes, renewals and cancellations: NCPDP SCRIPT Standard, Implementation Guide, Version 5.0, May 12, 2004
There are other standards available but not yet adopted.
RxFill for Fill Standard notification- this enables a pharmacy to communicate to a prescriber when a prescription is picked up, partially filled or not picked up and returned to stock
Rx Norm standard for clinical drug terminology- this provides a database for drug names, active ingredients, dosage and form
NCPDP Structured and Codified standard 1.0- standardized format and vocabulary used in patient instructions
Standard for prior authorization- certification from drug benefit plan to provider that patient meets criteria for a certain drug to be covered
Important Dates regarding prescriptions
Health plans covering Part D medications must offer it by May 2009
As Jan 1, 2012 Part D prescriptions can longer be offered by computer fax. Must be handed to patient or manually faxed.
How to get incentive money for e-prescribing
- Only 25 e-prescribing events required over course of the year
- Must be must be done by an eligible provider using a qualified EMR system
- Use the G code 8553 for the numerator and # of codes for denominator
90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014,
96150, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214,
99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326,
99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348,
99349, 99350, G0101, G0108, G0109
- Requirement is that at least 10% of a provider’s Medicare allowable charges must be coded using one of the above denominator codes to qualify
- Produce a complete list of medications for that particular patient (PBMs or pharmacies can get this for you)
- Ability to select medications, print them, send electronically using the required standards (please see standards section above) and giving clinician warning that unwanted or unsafe prescribing is being done
- List any lower cost and therapeutically indicated alternative medications
- Provide drug plan information such as authorization, patient eligibility and formulary meds
| Year | Incentive Money | Penalty for not e-prescribing |
| 2009 | 2% | None |
| 2010 | 2% | None |
| 2011 | 1% | None |
| 2012 | 1% | 1% |
| 2013 | .5% | 1.5% |
| Beyond 2013 | None | 2.0% |
Some important rules regarding e-prescribing for Medicare Part D prescriptions
- MIPPA (The Medicare Improvements for Patients and Providers Act) stipulates that submitting prescription information electronically is acceptable for
part D medications in lieu of claims based reporting - If get MIPPA e-prescribing incentives then can’t also get money under HITECH program.
- Consider using e-prescribing in your practice to reap the benefits and satisfy meaningful use criteria
- Confirm whether your EMR can support e-prescribing. Some EMRs that can are:
- Buy and utilize a handheld device (ie. PDA, palm, iPad) to write prescriptions and make
- If you get stuck or have additional questions please contact your EMR vendor. If you are a Patagonia customer we can help you through the entire process.
Electronic prescribing is certainly an important development in modern healthcare information technology. The adoption rates are currently quite variable and often depend on whether providers can derive financial benefits from their insurers for using such technology. The “meaningful use” criteria as established by the government will dictate largely how e-prescribing, among other health IT initiatives, are used. There continue to changes in the regulations of governing e-prescribing Part D prescriptions.
Individual providers and organizations should do a risk/ benefit and return of investment analysis before venturing into a particular e-prescribing program. With many vendors available, it is important to assess how the program will integrate into the existing system (ie. current EMR, etc.)
By Jitesh Chawla, MD
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