Friday, March 21, 2008

The Impact of e-Prescribing

In 2007, we went live with integrated e-Prescribing within our enterprise electronic health record via the MA-Share rxGateway, our statewide health information exchange collaboration of payers and providers. We had to redefine workflows, cleanup old prescription data and refine the our existing applications to adapt to the new features of e-Prescribing (eligibility checking, formulary enforcement, medication history display and prescription routing). The following is a summary of the impact of e-prescribing on our General Internal Medicine practice in the first year:

Time and Resource Impact:
1. Prior to full implementation of e-prescribing, Medical Assistant call-in of prescriptions averaged 350 prescriptions per day. We've reduced this to 80/day and we'll further reduce this to 30/day by next month when all residents go live with e-Prescribing.

2. Each call-in averages 4 minutes per prescription and this equals 23 hours or 3 FTE worth of work per day, approximately $96,000.00 of salary. This has been reduced to 0.66 FTE of Medical Assistant work per day or $21,000.00 salary.

3. The Medical Assistant staff are now available to more consistently perform the core work required to support the patients, providers, and practice. In the past, the lack of control over the daily volume of prescriptions resulted in unpredictable exam room support.

4. We experienced significant improvement in efficiency and patient satisfaction in the time for prescriptions to reach the pharmacy. With e-prescribing, prescriptions travel quickly to pharmacies versus up to 2 days for the rx to be called to the pharmacy.

5. We have also seen a decrease in medication errors, in terms of wrong patient, wrong medication, wrong dose since e-prescribing has decreased the potential for "communication errors"

6. We are able to track prescriptions more efficiently. With the paper call-in system, rxs were being called in by many people. Now we can look in our EMR and quickly determine where a prescription is in the process (i.e. in queue, transmitted successfully, transmission failed, etc)

By redirecting our Medical Assistance staff from prescription refills to other tasks we have:

* Piloted a standardized patient visit check out process that is going well
* Provided consistent documentation of vital signs for all patients.
* Helped with fee ticket entry improving the timeliness of charge capture
* Improved examination room turn around time, resulting in decreased waiting room stays

All of these workflow and efficiency improvements have reduced nurse stress level substantially. In addition, nurses are very happy about the decreased opportunity for error and the rework this caused with errors in prescription call ins.

e-Prescribing has been a win/win/win for providers, payers and patients. Massachusetts is now the number #1 e-Prescriber in the country and the MA-Share rxGateway enables payers and providers to collaboratively implement e-Prescribing quickly. It's now live at BIDMC and Partners. It will soon be live at Children's and we've offered it to all other hospitals in the state.


Unknown said...

I operate a reseller firm in Oregon with rights to sell eClinicalWorks, the product you are implementing soon or now. We too are interested in ePrescribing. However, we have only one clinic that has attempted to use it and they gave it up after three months of hassle.

The problem is with scheduled medications which by FDA guidelines must be written prescriptions. The clinics that wanted (and still want to use it) are either internal medicine or family practice. They found that well over 50% of their scripts were for scheduled medications that could not be done through ePrescribing through eCW interface. This was very disturbing and therefore we are on hold until the scheduled medication issue is resolved.

Unknown said...

I would tag onto the earlier comment that we already do "ePrescribing" if you include faxed scripts. But the issues that had were with SureScripts, the totally electronic solution.

John Halamka said...

Massachusetts has a DEA exemption 2008-2009, run by the Massachusetts Department of Public Health, to pilot the e-prescribing of scheduled medications in one community. I agree that e-Prescribing will only be widely adopted if scheduled medications can be e-prescribed.

Bart Jaspers said...

90% of all 140 million annually produced RXS in The Netherlands are digitally sent from the GP's IS (that produce 80% of all recurring prescriptions) to the Pharmacy's IS. The issues you are currently experiencing in the US are just startup problems, that will eventually be overcome (notwithstanding the need for an adjusted law on digital prescription).

With more and more patient centered health information becoming digitized, the (economic) added value of pharmacies will also perish.

Ross Martin said...

John -

Are you using the SureScripts network for this or is this a standalone part of the MA-Share network? For the inpatient-to-ambulatory eRx transactions, did you make use of the HL7-NCPDP ePrescribing Mapping Guidance Document to do this? If so, what was your experience with using that document and do you think it needs another update (substantive or minor)?

Anonymous said...

Please consider taking the entire series and putting it together into a single document. I think it might be useful to have it in that format. It might also be something that could be published in that form.

John Halamka said...

The MA-Share gateway connects to RxHub, Surescripts, and local payers which do not participate in RxHub. Everything is NCPDP Script based.

Lily said...

Why would someone not take the medications his doctor has prescribed? Because he can’t afford them! I found a prescription discount card that helps lower the cost of prescription medications for people who don’t have health insurance. It’s at The membership fee is only $4.50 a month. Drug prices are shown on that website to check before you enroll. You can save up to 80%. Generics and brand-name drugs are both covered.

Johnnie said...

E-Prescribing will only become more commonplace with time, and I believe that there are already mandating it for Medicare Part D participants. Great way to help reduce medication eras as well. There may be problems in some states, but most will allow E-prescribing of control med(except CII); similar to previuos comment; Its liked faxing legally. May follow up on topic on my blog

Unknown said...

Have you tried RxNT ePrescribing? It's a really cost effective, terrific product. I recommend visiting their website ( before signing-up for any other solution.

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