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    CMS e-prescribing pilot project falling into place

    Part D sponsors must support, comply with e-prescribing standards


    Bob Gatty
    Washington—The federal government is pressing forward with an initiative launched by the Medicare Modernization Act of 2003 (MMA) to implement a national system of electronic prescriptions intended to increase both efficiency and patient safety.

    In a report to Congress released in April, Health and Human Services Secretary Michael Leavitt said three electronic prescribing standards tested in an e-prescribing pilot project sponsored by the Centers for Medicare & Medicaid Services are capable of supporting transactions in Medicare Part D.

    HHS said the standards involve transactions that will provide physicians with patients' formulary and benefit information, medication history, and the fill status of their medications. The report also found that, with some adjustments, e-prescribing could work successfully in long-term care settings.

    Some initial e-prescribing standards tested by the pilot project were found to have potential, but HHS said they need further development if they are to be adopted. These include a method for conveying structured patient instructions, terminology to describe clinical drugs, and messages that convey prior authorization information.

    The pilot project, conducted in cooperation with the Agency for Healthcare Research and Quality (AHRQ), selected five pilot sites operating in eight states to test initial standards to determine if they were ready for widespread adoption. The sites were Achieve Healthcare Information Technologies, LLP, Eden Prairie, MN; Brigham and Women's Hospital, Boston; RAND Corp., Santa Monica, CA; SureScripts, LLC, Alexandria, VA; and University Hospitals Health System, Cleveland.

    Fast Facts
    The report to Congress said that a shift to electronic prescribing systems could avert more than two million adverse drug events annually, of which 130,000 are life threatening. It said e-prescribing also has "enormous potential to create savings in health care costs through reduction of adverse drug events and improved work flows." The study estimated potential savings of $27 billion a year in the United States.

    Congress mandated the establishment of standards for the electronic transmission of prescriptions and other information for covered Part D drugs prescribed in the new Medicare drug program. Although physicians are not required to write prescriptions electronically, if they do, they must use the adopted e-prescribing standards.

    Under the MMA, prescription drug plan sponsors, Medicare Advantage organizations offering Medicare Advantage-Prescription Drug plans, and other Part D sponsors must support and comply with electronic prescribing standards when communicating with prescribers who want to use e-prescribing technology.

    Beneficial effects

    According to HHS, the use of interoperable health information technology will benefit individuals and the healthcare system in "profound" ways, such as:

    • higher quality care
    • reduction in medical errors
    • fewer duplicate treatments and tests
    • decrease in paperwork
    • lower healthcare costs
    • constant access to health information
    • expansion of access to affordable care
    • early detection of infectious disease outbreaks
    • improved tracking of chronic disease management
    • ability to gather de-identified data for research purposes
    • evaluation of healthcare based on value, enabled by collection of price and quality information that can be compared.

    In 2006, the Certification Commission for Healthcare Information Technology certified the first 37 ambulatory—or clinician office-based—electronic health record products. The commission's seal of approval is awarded to products that meet the established criteria for functionality, security, and interoperability.

    Last year, HHS also issued new regulations to allow certain arrangements in which a hospital or other healthcare entity may donate health IT and training services to healthcare providers. HHS says these regulations "will accelerate adoption by healthcare providers by giving them access to increased financial assistance in implementing health IT."


    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.