abstract #550 irb approval received category c2 pharmacy outreach using the rand e-prescribing...
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Abstract #550
IRB Approval Received
Category C2
Pharmacy Outreach Using the RAND e-Prescribing Toolset (PORT) StudySokkim Lim, PharmDPGY1 Pharmacy Specialty ResidentUniversity of California, San FranciscoDepartment of Health Care Services
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Investigators have no conflict of interest to disclose. This study was not funded. Proprietary
information or results of ongoing research may be subject to different interpretations.
Disclosure Statement
Speaker’s Non-Commercialism AgreementSpeaker’s presentation of this slide indicates
agreement to abide by the non-commercialism guidelines provided on the CE Requirements page.
Sokkim Lim, PharmD
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Department of Health Care Services: Medi-Cal
• Nation’s largest Medicaid program in terms of the number of people it serves: 7.3 million
• Second largest in terms of dollars spent: $36 billion
• Drug expenditures in Medi-Cal FFS program : $4.2 billion
Medi-Cal FACTS AND FIGURES, September 2009 (http://www.chcf.org/publications/)
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Leader Pharmacies
• National network of more than 3,200 independently owned community pharmacies
• Contracts negotiated on a group basis in order to acquire a more competitive purchasing level
– Independent pharmacies in Sacramento Valley and surrounding areas
• Incorporated in 1986
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Pre-Test Assessment Questions:e-Prescribing (eRx)
1. Prescriptions are received mostly in which of the following forms?
a. e-Prescription
b. Fax
c. Phone
d. Hard copy
2. Most eRx issues are related to the pharmacy management system (True/False).
3. Which problem type would include e-refill approvals that do not automatically link to the original prescription?
a. Interoperability
b. EMR System
c. Pharmacy Management System
d. eRx Network
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Background
• Prescribers and eRx
– American Recovery and Reinvestment Act: $19 billion allocated toward adoption of health information technology
– Center for Medicare and Medicaid Services released proposed regulations defining meaningful use of EMRs: e-prescribing key component
– Adoption of eRx expected to increase from approx. 34% to 75% over the next five to six years
• Pharmacies and eRx
– National: 98% chains vs. 73% independents connected
– California: Independent Pharmacies (California)
• 50% of Medi-Cal prescription claims
• Largely not connected for eRx
E-prescription market headed to $204.6M. April 15, 2011. http://www.healthcareitnews.com/news/e-prescription-market-headed-2046m.
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Background
Northern Sierra
SacramentoSacramento
San FranciscoFrancisco
Silicon ValleyValley
CentralCentral Valley
Los AngelesAngeles
Inland Empire
Orange CountyCounty
San Diego San Diego
Re
gio
n
# of Pharmacies
Chain Pharmacies(Connected)
Independent Pharmacies(Connected)
Chain Pharmacies (Not connected)
Independent Pharmacies(Not connected)
• California eRx
2009 Medi-Cal Data: Top 25 Medi-Cal Serving Pharmacies by Volume
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Study Objectives
• Primary
– Test usability and usefulness:
• RAND eRx Toolset
• eRx support person
• Secondary
– Identify and address eRx issues
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Methods – Participation
• Inclusion Criteria:
– Current staff member in a Leader Pharmacy in Sacramento Valley or surrounding area
• Exclusion Criteria:
– Not a current staff member in a Leader Pharmacy in Sacramento Valley or surrounding area
• Consent form for voluntary participation
• 9 Leader Pharmacies
– 7 eRx
– 2 non-eRx
• 8 week study
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Methods – Pharmacy Staff
• Orientation: pilot study, the toolset, and the eRx eRx support person
– Resources: Existing contacts, RAND eRx Toolset, eRx support person, problems tracking sheet
– Staff: documented and attempted to solve eRx related issues
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Methods – RAND eRx Toolset
• RAND Corp. – research in health, education, national security, environment, and other areas
• Toolset Chapters
– 1. How to use the Toolset
– 2. Background: What you need to know
– 3. Getting ready for e-prescribing
– 4. Optimizing workflow to take advantage of e-prescribing
– 5. Costs and benefits: Measuring the economic impact
– 6. Troubleshooting and preventing common problems with e-Prescribing
– 7. Future directions
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Methods – eRx Support Person• Weekly Pharmacy Visits
– Reported and triaged issues to eRx support person
– eRx support person contacted prescribers, health IT team of medical groups, EMR vendors, pharmacy system vendors, and eRx networks as necessary
• Weekly Updates
– Prioritized issues
– Documented all troubleshooting activities
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Methods – eRx Support Person
• Additional Resources
– Created eRx contact list
– Compiled and distributed eRx costs comparison list
• Surveys
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Results – Demographics
• Non-eRx Pharmacy Participants, N=2
• eRx Pharmacy Participants, N=17
– Pharmacy Role
• Pharmacy Manager/Owner: 29%
• Pharmacy Technician: 59%
• Pharmacy Clerk: 12%
– Length of time at pharmacy
• <1 yr: 6%
• 1 to 2 yrs: 12%
• 3 to 6 yrs: 29%
• >6 yrs: 53%
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Results – Demographics
• eRx Pharmacy Participants, N=17
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Results – Demographics
• eRx Pharmacy Participants, N=17
Routes of Incoming Prescriptions
Mainly eRx 0%
Mainly Fax 23.5%
Mainly Phone 0%
Mainly Hard Copy 76.5%
Preference of Route for Incoming
e-Prescriptions 62.5%
Faxed prescriptions 25.0%
Phoned prescriptions 0%
Hard-copy prescriptions 12.5%
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Results – Surveys
• eRx Pharmacy Participants, N=17
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Results – Surveys
• eRx Pharmacy Participants, N=17
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Results – Surveys
• eRx Pharmacy Participants, N=17
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Results – Identified eRx Issues
• eRx Pharmacy Participants, N=17
• Total number of issues identified, N=74
Types of eRx Issues
Interoperability (multi-system,
formatting, matching
standardization)
eRx Network
EMR System
Pharmacy Management
System
Prescriber Workflow
Pharmacy Workflow
Cost/Benefit
12% 20% 27% 38% 41% 11% 8%
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Results – Identified eRx Issues
• Interoperability
– Non-matching physician names
• Robert T. Smith vs. Robert T. SmithMD vs Bob SmithMD
• eRx Network
– Duplicate eRxs
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Results – Identified eRx Issues• EMR System
– eRx with multiple sigs
• Pharmacy Management System
– e-refill response does not automatically link to original
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Results – Identified eRx Issues
• Prescriber Workflow
– Wrong quantity, responded to e-refill requests by sending new eRx
• Pharmacy Workflow
– Inconsistency in interpreting number of refills
• Cost/Benefit
– $600-800/month transaction fees
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Study Limitations
• Short timeframe
• Lack of control group
• Small sample size
• Categorization of some problems may be objective
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Conclusions
• Most participants reported benefit in eRx in their pharmacy
• Most participants valued the eRx support person in addressing eRx issues
• Most participants did not use the RAND Toolset
• Many different types of eRx issues were identified
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Pre-Test Assessment Questions:e-Prescribing (eRx)
1. Prescriptions are received mostly in which of the following forms?
a. e-Prescription
b. Fax
c. Phone
d. Hard copy
2. Most eRx issues are related to the pharmacy management system (True/False)
3. Which problem type would include e-refill approvals that do not automatically link to the original prescription?
a. Interoperability
b. EMR System
c. Pharmacy Management System
d. eRx Network
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Questions?
Sokkim Lim, Pharm.D.PGY1 Pharmacy Resident, eHealth Policy and Research
UCSF, School of Pharmacy
Medi-Cal, Office of Health Information TechnologyCalifornia Department of Health Care Services
1501 Capitol Avenue, MS 0004P.O. Box 997413
Sacramento, CA [email protected]