Meaningful Use and E-Prescribing Workflow (Text Version)

Slide presentation from the AHRQ 2009 conference.

On September 15, 2009, Douglas S. Bell, MD, PhD made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (1.5 MB) (Plugin Software Help).

Slide 1

Slide 1. Meaningful

Meaningful Use and E-Prescribing Workflow

Douglas S. Bell, MD, PhD

Associate Professor, Dept. of Medicine, UCLA

Research Scientist, RAND Corporation


Slide 2

Slide 2. E-Prescribing: A Model System?

E-Prescribing: A Model System?


Slide 3

Slide 3. Benefits for Everyone

Benefits for Everyone

  • Valid, complete Rx
  • Safety alerts
  • Generics identified
  • Insurance coverage
  • Work delegation


  • Physicians
    • Decrease pharmacy calls
    • Automate renewal handling
  • Pharmacies
    • Decrease calls
    • Automation
  • Payors
    • Drug, other spending
  • Patients
    • Safety
    • OOP costs


Slide 4

Slide 4. E-Prescribing Policy

E-Prescribing Policy

  • Medicare Modernization Act of 2003 (MMA)
    • Authority to mandate transaction standards
        • New Rx
        • Refill request
        • Medication history
      • 270/271 Eligibility
      • Formulary and Benefit


Slide 5

Slide 5. If You Install It, Will They Use?

If You Install It, Will They Use?

  • New Jersey E-Prescribe Program, Jan - June 2006
    • 293 prescribers who installed in CY 2005
    • Incentive for use up to $500/qtr


Slide 6

Slide 6. Does Use Change Over Time?

Does Use Change Over Time?

  • Users with at least 1 quarter at >50% use (41%)


Slide 7

Slide 7. Does Use Change Over Time?

Does Use Change Over Time?

Users without any quarter of >50% use (59%)


Slide 8

Slide 8. Medicare Improvements for Patients and Providers Act (MIPPA)

Medicare Improvements for Patients and Providers Act (MIPPA)

  • Payment incentive for "meaningful use"
 bonus...then penalty if not
2014+ -2.0%
  • Qualified systems must be able to:
    • Communicate with the patient's pharmacy
    • Help the physician identify appropriate drugs and provide information on lower cost alternatives for the patient
    • Provide information on formulary and tiered formulary medications
    • Generate alerts about possible adverse events, such as improper dosing, drug-to-drug interactions, or allergy concerns


Slide 9

Slide 9. Mechanism of E-Prescribing Effects

Mechanism of E-Prescribing Effects

  • Information available in the system
  • Information display / capture at prescriber
  • Changes in work processes
    • Changes in drug use
      • Appropriateness
      • Costs
      • Patient adherence
    • Other effects
      • Labor and other costs
      • Health service use
      • Patient satisfaction

Slide 10

Slide 10. Macro Process Model

Macro Process Model

Diagram describing the Macro Process Model.

JAMIA, 2004; 11:60-70


Slide 11

Slide 11. Rework Pathways

Rework Pathways

Diagram describing Rework Pathways.


Slide 12

Slide 12. E-Prescribing: Attenuate the Rework

E-Prescribing: Attenuate the Rework

Diagram describing E-Prescribing.


Slide 13

Slide 13. Sample Modeling Results: New Rx

Sample Modeling Results: New Rx

Two diagrams describing

  1. Prescriber Time, 1000 New Rx
  2. Staff Time, 1000 New Rx


Slide 14

Slide 14. Lessons from Successful Practices

Lessons from Successful Practices

  • Messages for buy-in, expectations:
    • ERx empowers you as a professional
    • Benefits may be intangible (e.g. more accurate info)
  • Setup
    • Keep lists of favorites and default Sigs short to minimize search
    • Reach out to pharmacies RE: common problems
  • Workflow
    • Protocols for renewal authorization vs. tasking to prescriber
    • Centralize renewals for medical group
    • Confirm pt's pharmacy at check-in
    • Handout "Rx pad" patient reminder & pharmacy instructions


Slide 15

Slide 15. E-Prescribing Implementation Toolset

E-Prescribing Implementation Toolset

  • Toolset chapters
    1. Understanding the building blocks
    2. Setting goals and achieving buy-in
    3. Assessing readiness & preparing for change
    4. Selecting a system
    5. Scheduling & monitoring the implementation process
    6. Setting up the technology
    7. Planning work process changes
    8. Training staff
    9. Launch
    10. Monitoring and remediating shortfalls
  • Pilot testing toolset set to begin Sept., 2009


Slide 16

Slide 16. Conclusions


  • Achieving meaningful use of eRx may be challenging
    • MIPPA incentives may be low
  • Workflow, implementation innovations hold promise
  • Future work
    • Improving technical standards
    • Validating workflow models
    • EHR integration
    • Implementation processes carried out by RECs


Slide 17

Slide 17. Thank

Thank You

Questions? or

Slide 18

Slide 18. Reasons for Continuing to Use Paper

Reasons for Continuing to Use Paper

 Strongly disagreeDisagreeNeutralAgreeStrongly Agree
Patients were not in the PDA5854736
I can't use the PDA because of technical problems3363751
I get too busy101773531
Pharmacies don't reliably receive and process the electronic prescriptions813333610
system interfered with established office workflow163422227
System takes too much of my time1524193013
System takes too much of my staff's time24323096


Slide 19

Slide 19. E-Prescribing

E-Prescribing is Growing.
but underused

  • 4.5% of 1.5B prescriptions/yr in U.S.
  • 12% of 610K physicians, NPs & PAs
  • 76% of 61k community pharmacies
  • 46% of independents
  • 6 of the largest mail-order pharmacies
Current as of December 2009
Internet Citation: Meaningful Use and E-Prescribing Workflow (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD.