Governors Announce State Rankings for E-Prescribing

Massachusetts Prescribers Now Route More Than 20 Percent of Prescriptions Electronically, Followed by Rhode Island at 17 Percent

Tennessee Gov. Phil Bredesen and Vermont Gov. Jim Douglas Accept Safe-Rx™ Award, Highlighting States’ Improved Use of E-Prescribing

WASHINGTON, – At an event at the National Press Club, Surescripts announced today that Massachusetts ranks first in the nation when it comes to routing prescriptions electronically. According to the results of an annual nationwide audit of electronic prescriptions routed in 2008, it was determined that prescribers in the Bay State sent more than 6.7 million prescriptions electronically, representing 20.5 percent of all eligible prescriptions in the state – as compared to 2.3 percent in 2005. For this accomplishment, Massachusetts was recognized, along with 14 other states, at the fourth annual Safe-Rx Awards.

Surescripts created the Safe-Rx Awards to raise awareness of e-prescribing as a means of enhancing patient safety by providing a more secure, accurate and informed prescribing process.

“Congratulations to all the Safe-Rx Award winners for increasing the use of e-prescribing and for the benefit it has brought to the economy, safety and quality of patient care in communities throughout their states,” said Harry Totonis, president and CEO of Surescripts. “And as much as this program is about measuring and recognizing real success, its greater purpose is to highlight the leaders who are driving that success and the stories of how they are doing it. As the numbers and rankings suggest, each year there are more and more examples of how a state and the various stakeholders within the state can work together to drive e-prescribing adoption and use. We congratulate those leaders and hope that their examples will inspire and inform many more successful efforts in many more states in the year ahead.”

“The Massachusetts model should serve as a roadmap for the rest of the nation,” said U.S. Sen. John Kerry (D-Mass.). “Electronic prescribing saves money, improves efficiency and, most importantly, reduces life or death medical errors. While we debate how to reform our healthcare system, improve quality and lower costs, one of our top priorities should include modernizing the way physicians write prescriptions.”

In its first three years, the Safe-Rx Award was given annually by Surescripts to the top 10 e-prescribing states in the nation. In an effort to measure and recognize critical progress occurring outside states that finished in the top 10, Surescripts has introduced a new category of state rankings: the Top 5 Most Improved (see both lists for 2008 below).

Top 10 E-Prescribing States Top 5 Most Improved States

1. Massachusetts 1. Vermont 2. Rhode Island 2. Tennessee 3. Michigan 3. Kansas 4. Nevada 4. Illinois 5. Delaware 5. Missouri 6. North Carolina 7. Pennsylvania* 8. Connecticut 9. Maine* 10. Arizona *New to the top 10

Today’s event featured Tennessee Gov. Phil Bredesen and Vermont Gov. Jim Douglas, co-chairs of the State Alliance for e-Health and co-hosts of the Fourth Annual Safe-Rx Awards. The State Alliance was created by the National Governors Association Center for Best Practices in January 2007 to improve the nation’s healthcare system by forming a collaborative body that enables states to increase the efficiency and effectiveness of the health information technology initiatives they develop. The State Alliance has recognized the potential for e-prescribing to improve both patient safety and the health of all Americans and has encouraged states to be proactive in creating and implementing policies that advance this and other e-health initiatives. Govs. Bredesen and Douglas were also on hand to receive Safe-Rx Awards recognizing their states’ sizable jumps in e-prescribing use.

“The State Alliance recognized early on that encouraging states to make e-prescribing a top priority would have an immense value in our electronic health efforts,” said Bredesen. “Paperless prescribing is making its way into the health care mainstream in Tennessee and across the nation. It’s our hope to see e-prescribing become a natural part of every health care provider’s workflow because of its practical benefits to patients in providing better care.”

“To the State Alliance, e-prescribing is important to building momentum toward the goals of an effective health care system and improved public health,” said Vermont Governor Jim Douglas. “And I’m proud that e-prescribing has been an integral part of Vermont’s Health Information Technology strategy from the start. That’s because e-prescribing is a fundamental system improvement for ensuring accurate, timely health care communication. Much of Vermont health care reform is about utilizing the right tools to enhance our systemic approach to health care reform and the evidence regarding the value of e-prescribing is clear.”

Surescripts Announces A Meaningful Change to Future State Rankings Historically, the Safe-Rx Awards have been based on an analysis of data from new prescriptions and refill responses electronically routed over the Surescripts network. States were ranked and recognized according to the number of prescriptions routed electronically in 2008 as a percentage of the total number of prescriptions eligible for electronic routing.

In January 2010, Surescripts will release a new state ranking. Using data from 2009, the rankings will measure use of not one, but three critical steps in electronic prescribing:

1. Prescription Benefit: Electronically accessing a patient’s prescription benefit information. 2. Prescription History: With a patient’s consent, electronically accessing that patient’s prescription history from pharmacies and payers. 3. Prescription Routing: Electronically routing the patient’s prescription to their choice of pharmacy and electronically reviewing and responding to a prescription renewal request that pharmacies send to the physicians’ practices for approval.

This approach recognizes the combined role that prescription benefit, history and routing play in improving the overall safety, efficiency, cost and quality of the prescribing process. It is Surescripts’ position that measuring and reporting the actual use of all three of these services helps define ”meaningful use of electronic prescribing” under the American Recovery and Reinvestment Act of 2009.

For a full description of the change in ranking methodology, go to www.surescripts.com/Safe-Rx.

What About My State? Individuals who are interested in finding out how their state is progressing in its efforts to move to e-prescribing can go to the Safe-Rx Awards Web site at www.surescripts.com/Safe-Rx. The site shows a complete ranking of all 50 states and the District of Columbia based on prescription routing. For an in-depth statistical review of each state’s progress across a number of e-prescribing use and adoption metrics, go to the U.S. maps on either www.surescripts.com/Safe-Rx orwww.surescripts.com/stats and click on your state.

Blue Cross Blue Shield of Massachusetts Honored With Safe-Rx Evangelist Award The Safe-Rx Evangelist Award goes to a single person or organization whose leadership has made an extraordinarily positive impact on raising awareness and reducing medication errors by promoting the adoption and use of electronic prescribing. In 2008, the Safe-Rx Evangelist Award went to Health and Human Services Secretary Michael Leavitt. In 2007, the Safe-Rx Evangelist Award went to the Institute of Medicine for its breakthrough report Preventing Medication Errors.

Blue Cross Blue Shield of Massachusetts (BCBS MA) is widely known as a leader in electronic prescribing and health information technology initiatives. It was one of the very first organizations to embark on an initiative to encourage electronic prescribing with physicians because of the many patient safety, practice efficiency and cost saving benefits. BCBSMA took a very collaborative approach, bringing in multiple health plans to create the eRx Collaborative – itself a prominent advocate for e-prescribing – and ensuring that prescribers would have access to more comprehensive prescription benefit and prescription history information on their patients.

“Working together sends a message that e-prescribing is important for everyone in the community,” said Steve Fox, vice president of provider network management at BCBSMA. “As a leader in e-health initiatives and e-prescribing programs, BCBSMA will continue to focus on the delivery and promotion of technology to enable a delivery system that reliably provides safe, effective and affordable patient-centered care.”

Surescripts Salutes E-Prescribers of the Year This year, Surescripts is recognizing six prescribers for the outstanding leadership they have shown through their own use of e-prescribing. Three users of standalone e-prescribing software and three users of electronic medical record software received Safe-Rx Awards and were recognized as E-Prescribers of the Year:

Standalone E-Prescribing Users EMR Users Dr. Amando Garza (Laredo, Texas) Dr. Narinder Batra (Adrian, Mich.) Dr. Steven Green (Lancaster, Ky.) Dr. Michael Brewer (Springfield, Ill.) Dr. Abdul Kabir (Monroe, Mich.) Dr. Mark Earhart (Watkinsville, Ga.)

”More and more doctors, nurse practitioners and physician assistants are turning to e-prescribing for the safety, efficiency and quality advantages it provides them and their patients,” said Dr. Peter Basch, medical director for ambulatory clinical systems at MedStar Health. “In fact, for many clinicians, their introduction to and use of e-prescribing has helped them emerge as leaders in their communities towards the effective use of health information technology as part of everyday medical care.”

Special Health IT Report: Electronic Prescribing Increasing Despite Glitches

 Dr. Marek Durakiewicz initially welcomed the opportunity to send prescriptions to drugstores electronically, using free computer equipment provided by a state pilot program.

The chief of staff at Hickman Community Hospital in Centerville, Tenn., Durakiewicz recognized the potential benefits of “e-prescribing.” Special software allows doctors to see instantly if the drug they are ordering is covered by a patient’s health insurance plan; if there’s a less expensive, generic alternative, or if the patient is already taking medication that may interact dangerously with the new one. For patients, there’s no piece of paper to misplace.

Advocates say e-prescribing is a key advance toward health care’s digital future because of its potential to reduce medical errors, cut drug costs and save doctors and patients time and money. E-prescribing is growing – the number of doctors doing it is now more than 120,000, 20 percent of all office-based prescribers, according to an industry source. But kinks need to be worked out to spur more rapid acceptance.

Doctors and patients in a number of states have complaints, including Durakiewicz. Malfunctioning hardware and cumbersome security features — such as software that logged him out automatically every 30 minutes — left him frustrated. Patient prescription histories provided by the system weren’t as current as he had expected. In addition, federal restrictions prevented him from e-prescribing certain pain medications.

Now, a year later, he doesn’t use the pilot system at all. Instead, he types prescriptions into another computer and prints them out. “It’s faster,” said Durakiewicz, one of 50 doctors participating in the pilot offered by the state’s Medicaid program and the technology company Shared Health.

Emily Bagley, product development consultant with Shared Health, says electronic prescription histories should be immediately available; paper prescriptions take longer to retrieve. Log-offs, she says, result from federal regulations requiring e-prescribing software to log out doctors at regular intervals to prevent unauthorized use of systems.

There are other obstacles to e-prescribing, which helps explain why currently only about 10 percent of eligible prescriptions nationally are sent electronically. (Prescriptions for controlled substances, such as certain pain medications, aren’t eligible.) E-prescribing requires special computer equipment, which can be costly, and seamless coordination of an immense amount of data from doctors, health plans and pharmacies.

But federal money for health technology in the stimulus package and other incentives are expected to drive greater adoption of e-prescribing in coming years. Another key step occurred in 2008, when two prescription processing networks combined to form Surescripts. The e-prescribing company maintains the largest secure network through which doctors send prescriptions to patients’ pharmacies.

For the system to work, the doctor’s office must have e-prescribing software and an Internet connection; the patient’s health plan must participate, so the doctor can electronically check the patient’s drug benefit, and the patient’s pharmacy must be connected to Surescripts.

Currently, about three-quarters of U.S. retail pharmacies participate in Surescripts and support the network by paying transaction fees. Doctors generally don’t pay to send prescriptions, but they bear the costs of maintaining their computer system with periodic upgrades.

Rick Ratliff, president of the Virginia division of Surescripts, says the network, which processes 15 million prescriptions a month, is extremely reliable. However, with more than 130 different software programs certified to link with the network and many medical practices relatively new to e-prescribing, it’s inevitable that there will be problems, whether with the technology itself or with the people learning to use it, according to the company.

To encourage greater participation, Medicare, the federal health plan for the elderly, in January began giving e-prescribing doctors a bonus of 2 percent of their overall Medicare reimbursement. That incentive may be helping: Surescripts reports in the first three months of 2009 a 49 percent increase in e-prescriptions compared to the last quarter of 2008.

Tennessee — where only 3 percent of prescriptions are sent electronically – is giving grants to more than 1,800 rural doctors to help them buy or upgrade electronic prescribing and medical records systems. The state also is offering training sessions.

Other states are encouraging doctors, too, hoping to contain prescribing costs and improve care. Arkansas is one of seven states that fully link their Medicaid programs for the poor to Surescripts. After the state began heavily promoting e-prescribing in December, the number of doctors using it shot up from 225 to 665 in March.

Pilot programs in states such as Mississippi and Florida have reduced Medicaid costs, mainly by elimination of duplicate prescriptions and increased use of generic drugs.

When it works as intended, doctors and patients are enthusiastic. “I love it,” said Amber Blackwell, a working mother whose Clarksville, Tenn., pediatrician prescribes electronically. “I have an 18-month-old, so I don’t have to carry anything else to keep track of. And when I get to the pharmacy it’s ready.”

Challenges persist, especially at small practices that lack in-house technical support. Cumberland Family Care, a three-office doctor group in Sparta, Tenn., obtained a state grant for e-prescribing software. But the system hasn’t always worked well. “We send about 150 to 200 electronic prescriptions a day,” said Mischelle Ferrell, the practice manager. The failure rate is now about 20 percent.

When that happens, patients arriving at their drugstores may find no record of their prescriptions. “There’s a mother with a kid with a fever at the pharmacy who drove 15 miles and waited in line, and they have no record of the prescription,” Ferrell said. “You’ve got one mad mother on your hands.”

“There will be problems,” conceded Melissa Hargiss, director of Tennessee’s Office of E-Health Initiatives. “But I would say to doctors that this is the best time for providers to start using it, while there’s grant money available to offset the costs.”

AMA approves policies on security breaches, EHRs

Policies on security breaches, open source code, and government subsidies of electronic health-record systems have been adopted by the American Medical Association’s House of Delegates.

The policies concern physicians’ responsibilities in case of computer security breaches and support of electronic health-record systems based on open-source code. Another policy calls for the removal of penalties that are scheduled to affect physicians who are not using electronic prescribing by 2015, and another says that the AMA wants government subsidies for the implementation and maintenance of EHR systems to be adjusted for inflation.

AMA policy now dictates that, in response to a security breach, physicians are to place the interest of patients above those of themselves, their practice or institution. On open-source, delegates approved a resolution calling for the AMA to support law and public policy that makes open source EHR systems that meet certification and “meaningful use” requirements available to physicians at nominal cost.

The Florida delegation had introduced a resolution that would declare federal EHR incentive programs to be “noncompliant with AMA principles” and essentially a pay-for-performance program. After hearing testimony on June 14, a committee drafted a substitute resolution that stated federal programs should be made compliant with AMA principles by removing penalties for nonadoption.

“Resolved, that our AMA support the concept of electronic prescribing, as well as the offering of financial and other incentives for its adoption,” read the new resolution that was approved by delegates, “but strongly discourage a funding structure that financially penalizes physicians that have not adopted such technology.”

Medicare to Pay Bonuses for 'E-Prescribing'

Starting next year, doctors can earn additional money from Medicare if they use electronic prescribing systems, U.S. health officials said Monday.

The bonus program, which will continue for four years, is designed to streamline the prescription process and cut down on errors. In 2009 and 2010, Medicare will give doctors an additional 2 percent bonus on top of their fee for “e-prescribing.” In 2011 and 2012, the bonus will drop to 1 percent, and in 2013, the bonus will drop again to 0.5 percent, officials said.

“There are terrific human and financial costs to illegible prescriptions,” Mike Leavitt, secretary of the U.S. Department of Health and Human Services, said during a Monday afternoon teleconference.

According to the Institute of Medicine, 1.5 million Americans are injured every year by drug errors, Leavitt said. Another study found that each year pharmacists make more than 150 million phone calls to doctors to clarify what was written on the prescription, he added.

“That’s a lot of people needlessly hurt and a lot of time spent trying to sort out bad handwriting,” Leavitt said.

“E-prescribing will help deliver safer or more efficient care to patients,” Leavitt said. He noted that the law that set up the Medicare prescription drug program in 2006 mandated that participating pharmacies be able to accept e-prescriptions.

After five years, bonuses for e-prescribing will be phased out; doctors who haven’t adopted e-prescribing will be reimbursed at lower rates, Leavitt said. There will, however, be exceptions for doctors who have legitimate reasons for not complying.

“We expect this will have a profound effect on the adoption and use of e-prescribing,” Leavitt said.

Medicare started paying bonuses to doctors last year for using the Physician Quality Reporting Initiative, which collects data on the quality of care delivered by doctors. Medicare recently paid the first bonuses to more than 56,000 doctors, totaling more than $36 million. Payments ranged from $600 for individual doctors to $4,700 for group practices.

The new bonuses for e-prescribing will be on top of those paid as part of the Physician Quality Reporting Initiative and other Medicare reimbursements. Medicare expects to save up to $156 million over the life of the e-prescribing program in fewer adverse drug events.

Despite the advantages of e-prescribing, barriers to implementing such systems remain. One of the largest barriers is the cost.

“It is fairly costly for a small practice to begin to change over to e-prescribing,” Dr. James King, a family physician in Tennessee and president of the American Academy of Family Physicians, said during the teleconference. “These incentives will help.”

It’s estimated that it will cost about $3,000 per doctor to initiate an e-prescribing system. It also takes between $80 and $400 a month to maintain and operate a system, Kerry Weems, acting administrator of the U.S. Centers for Medicare & Medicaid Services, said during the teleconference.

Other barriers include state laws that prohibit e-prescribing across state lines, King said. And, there are areas in the country where computer systems are slow and inefficient, he said.

AHA: Stretch Meaningful Use Timeline

The federal government should extend the transition to a fully functional electronic health records system beyond 2015, according to the American Hospital Association.

The AHA has sent a comment letter on the initial proposal of a workgroup of the HIT Policy Committee to define meaningful use of electronic health records to David Blumenthal, national coordinator for health information technology.

“Our members believe that the functional abilities of the EHR that would result from implementation of the draft definition are correct, but that the proposed sequence for adoption is overly aggressive and unrealistic for most,” according to the AHA. “Increasing the requirements for being considered a meaningful user every two years should provide enough time for adoption, but only if the initial requirements are set at an achievable level. The AHA encourages the committee, ONC and the Centers for Medicare and Medicaid Services to develop a ‘meaningful use’ adoption timeline that begins with fewer functional requirements and extends the transition to a fully functional EHR beyond 2015.”

Computerized physician order entry, for instance, should not be required until after 2015 or beyond, the AHA contended in the comment letter. “Most hospitals are not prepared to make such significant advancements under the proposed implementation timeline, so rushing to adopt could compromise patient safety and the success of this effort,” the letter states. “Our members, including those with significant previous HIT investments and CPOE, consider a 2011 CPOE requirement to be unrealistic.”

The AHA calls for the definition of meaningful use in 2011 to focus on getting the majority of hospitals running with a basic EHR. Appropriate functions for 2011 should include clinical documentation of patient demographics, problem lists, medication lists, discharge summaries, and results viewing for lab reports, radiology reports and diagnostic tests, the AHA advises.

The association, mirroring comments of the American Medical Association and some 80 other physician organizations in a separate comment letter, also noted that providers must work during the same time period to migrate to the HIPAA 5010 transaction sets and ICD-10 code sets.

Patients cheer on EHR technology, not afraid of privacy risks

Show me the technology! That is the conclusion of a study from the Beth Israel Deaconess Medical Center (BIDMC) to be released in the Journal of General Internal Medicine (JGIM) in June. The study reveals that consumers who are defined as “internet-savvy” are ready to take a chance on electronic health records (EHR) despite warnings of potential privacy risks.

The study, supported by the Robert Wood Johnson Foundation (RWJF), investigated whether or not patients were comfortable making the leap with their health care providers to the digital age through the adoption of EHRs. In the tech-savvy cities where they held focus groups, the answer was a resounding ‘yes.’ Not a terrible surprise given that they investigated consumers in Boston, Portland, Tampa and Denver—some of the more tech-educated spots in the country. However, investigators did attempt to include a diverse group of people, drawn from both urban and rural areas. Additionally, they included health professionals in their study to compare their perspectives about health technology relative to consumers.

The findings should not come as a major surprise since an estimated 60 percent of households across all states have a home internet connection. Citizens are increasingly interested in managing their lives via computer—EHRs seems a natural progression in this evolution.

Yet, the study findings echo a sense of surprise at the willingness of consumers to give up some of their privacy in order to obtain greater transparency with respect to their health information. In actuality, it may be more of a reflection of the distrust and frustration with the current patient-physician/health care provider relationship where one may deem transparency of much greater importance than whether or not someone uncovers that they have kidney stones…

States take bigger role in promoting EHR adoption

Maryland further strengthened the goals of the stimulus package or the American Reinvestment and Recovery Act (ARRA) this past week by passing legislation that required insurers to provide “monetary” incentives for physicians to adopt electronic health records (EHR).

The bill, signed by Governor Martin O’Malley, is one of the first of its kind to give sharper teeth to the EHR movement. Insurers may choose from a variety of fiscal incentives including increased reimbursement and lump-sum payments, according to Health IT News. The effort is viewed as a double incentive to providers to join the digital transition that promises to increase health care system efficiency while reducing medical errors for patients. Maryland is not alone in its effort to promote the change from paper to portal; other states are reviewing similar measures that would jumpstart implementation.

Included in the Maryland bill is a requirement for the state to bring a piloted health information exchange (HIE) live by October 1. The goal of the HIE, often comprised of business and community representatives, is to provide support to health care system stakeholders with the goal of increasing efficiency and quality.

Wait, have we heard of an HIE before? Yes. For clarification purposes, regional health information organizations (RHIO) and HIEs are terms used interchangeably; the HIE is simply a new name for a RHIO—it has yet to be determined if it is also a newer and better RHIO. Lingo aside, HIE investment is up.

Other states are looking to HIEs/RHIOs to play a prominent role in EHR adoption. New York, Texas, and Florida are all investing in these information exchanges.

In New York, the Western New York Clinical Information Exchange, known as HealthElink, signed on 6 EHR software vendors to provide community pricing to its clients.

In Texas, the legislature passed two pilot health information exchange programs that promote data transfer between local agencies.

Florida, having received a $9+ million grant from the Federal Communication Commission (FCC), is exploring how to expand broadband access across nine rural hospitals to increase the speed and efficiency of health data transfer.

Other states are vying to develop strategies for technology adoption that support EHR implementation as stimulus dollars dangle overhead. Now that EHRs are heavily banked by both federal and state government, HIEs and RHIOs may take a greater role in aiding communities in EHR adoption. These exchanges hope to serve as important providers of data warehousing as well as offering leadership for the development of criteria for data sharing and data quality. States view HIEs/RHIOs as vehicles for transporting dollars toward the development of technology infrastructure and they are moving as quickly as possible to get their take.

FISMA—a roadblock for EHRs?

The Federal Information and Security Management Act (FISMA), passed by Congress in 2002 to better protect the federal government against cyber attacks, mandates information security standards for all federal agencies. This includes the flow of data between the Centers for Medicare and Medicaid (CMS) and their contractors—over 200 hundred of them, processing billions of Medicare claims. The new worry from CMS, according to Government Health IT, is that healthcare providers sharing EHR files will be required to meet FISMA standards, which include an annual security test and FISMA certification.

A CMS spokesperson is quoted as saying that this would be more than “burdensome” for both CMS and health care providers and organizations.

The conundrum is that information will be moving between the HIPPA world (the private sector) and the FISMA world (the government)—that latter of which is much more secure, from a protocol/standards perspective. Federal agencies are held to a higher standard than the private sector with respect to information security.

For a long time, consumer groups have argued that HIPPA is a weak standard for patient information security. Yet, many worry that if FISMA is applied to the private sector, there will be a compliance crisis that will be costly to remedy. But why shouldn’t the transfer of health information be held to the highest security standards? Advocates of a middle ground argue “yes,” but not quite as stringent as FISMA. They standards should be more of a more of a “HIPPA-plus” or “FISMA-lite,” in the words of Vish Sankaran, a program director for the Federal Health Architecture project to connect health information entities.

In other words, get health care providers better engaged in securing healthcare information but do not stunt the growth of the EHR movement by placing the bar too high.

In the end, the Office of Management and Budget will dictate the debate through their determination of what falls under the FISMA umbrella. In August of 2008, OMB issued some guidance, stating that FISMA applies to groups that “possess or use Federal information—or which operate, use or have access to Federal information systems (whether automated or manual)—on behalf of a Federal agency.” OK, that could include a ton of organizations.

Outsourcing Medical Billing

In the past few years there is a dramatic change in the medical field and its treatment. Initially, while processing the insurance claims there are many administrative difficulties during the preparation of insurance policy procedures and dealing with complicated claim forms. To overcome with these obscurity doctors look out for outside help, and hire representatives to advise them, attend information about insurance company seminars, and provide them with regular clear financial reports.

This is process is called as medical billing outsourcing. Outsourcing Medical Billing acquire a profound working knowledge of the technologies and processes that are decisive to successful Business Process Outsourcing and afford a absolute scale of Back Office Outsourcing services in the areas of Medical Billing, Claim Adjudication, Call Center and Financial service. The most of the physician time is saved by means of medical billing outsourcing process. So that, physicians can much more concentrate on curing their patients. A medical billing firm will have the knowledge and experience technocrats to take care of all the medical billing issues. It makes free the other staff to concentrate on other aspects of running the practice which leads to added security to finance and transactions