=============================================================== EPRESCRIBING PERSPECTIVES July 29, 2005 Edition http://www.pocp.com =============================================================== IN THIS ISSUE:
1. Standards are a different ball game today 2. What to make of Open VistA
3. News and Announcement
1. Standards are a different ball game today by Tony Schueth, Editor-in-Chief
Development of ePrescribing standards is monumentally different today than just two years ago. The reason: the Medicare Drug Improvement and Modernization Act of 2003 (MMA).
The MMA, of course, created the Part D benefit. In support of it, Congress called for electronic prescribing standards. In the process of passing the legislation, they learned that it's not just about the transaction between the prescriber and pharmacy. Furthermore, some standards already exist and are in use by the marketplace, others are in development and still others need to be created. But the "devil is in the details," and someone is needed to sort through this often confusing morass of standards.
The US Department of Health and Human Services (HHS) turned to the National Committee on Vital and Health Statistics (NCVHS), a public advisory body to HHS. NCVHS started holding hearings more than a year ago. Its first session was May 25, 2004.
NCVHS efforts have resulted in two letters to the HHS secretary. Those letters and testimony to NCVHS led the Centers for Medicare and Medicaid Services (CMS) to propose rules for those standards that are already being widely used and which should be adopted. The public had the opportunity to comment, and final rules are slated for September.
In the meantime, ePrescribing transactions that do not have adequate industry experience are slated to be pilot tested. Requests for proposals for an unnamed set of them are expected any week now. In past issues of ePrescribing Perspectives, we have identified transactions that we believe will be part of the pilots
(http://www.pocp.com/eRxArchive.aspx).
So, why has the ePrescribing standards world changed? Because there's a driver; that is, a reason to persist and make participation in the process a priority. This is huge! At the NCVHS meeting on Tuesday, July 26, sub-committee members expressed awe of the progress we have made and their gratitude toward volunteers. That was the right thing to do, for standards couldn't be created without the hard work and sacrifice of volunteers, many of which do not have standards development in their job description. That said, let's not forget that it's the politicians that really made this happen. Its their desire to keep the cost of the Part D benefit in check, and reduce medication errors that are at the heart of the revolution.
In 1997, I was cochair of the National Council for Prescription Drug Programs' (NCPDP) Workgroup 11 -Physician-Pharmacy Interface. We were primarily the stewards of the SCRIPT standard (then versions in the 3s), but recognized that ePrescribing needs such ancillary transactions as provider broadcast (the means by which a software company tells pharmacies which physicians are active) and the interface between SCRIPT
and HL7. We just couldn't get the membership to make the priority high enough to achieve progress.
Today, NCPDP has multiple task groups working on these and other transactions. Relatively rapid progress is being made. Experts are coming together and working toward solutions.
Another organization that gets credit for helping is the Agency for Healthcare Research and Quality (AHRQ), which in response to the MMA, is providing some funding for some of the projects. AHRQ money helps us get past the inertia that would sometimes drive relative costly or time-consuming components of standards development.
Make no mistake: consensus-based standards development is still deliberate. It requires processes, checks and balances and work. It moves slowly.
That said, things are happening. If you're a software developer who scoffs at standards development, you'd better start paying attention. If not involved in standards development, be prepared to be at the mercy of those who are. If you're someone who might pay for software, you'd better make sure the solution provider is up on all standards or you'll have a time lag or expense in getting it compliant. If the software company says something like, "Well, standards take forever; it doesn't make sense to wait, so we propose a proprietary solution in the interim and when the standards are complete, we'll convert," be cautious. They may not be in the mix of what's happening, which could put you at a disadvantage. Make sure you have appropriate clauses in the contract that force it to come up to speed quickly, and be patient as you wait for them to adapt.
If you want any help with this or additional insight, drop us a line.
2. What to make of Open VistA
Last week the Centers for Medicare and Medicaid Services (CMS) announced it would make the Veteran's Administration (VA) EMR available for free. What does it mean to ePrescribing?
Well, this is an open-source release of VistA, and is as-such being called Open VistA. That means that anyone can use the software. Nevertheless, vendors will be certified through a non-profit organization called
WorldVistA (www.worldvista.org). It was incorporated in 2002 as a 501c(3)
The biggest challenge is that Open VistA is a VA-centric EMR, optimized for the way the VA operates. For example, inpatient and outpatient are all on the same software platform.
Open VistA has no notion of connectivity, which is troublesome from an ePrescribing stand-point. It can't transmit a prescription electronically to a pharmacy, or request eligibility from a health plan or PBM. That said, a service provider could make available an ASP version of the software that had that capability. We know several of them are thinking about doing that.
OpenVistA has the notion of formulary, but it's just the VA's. Again, a service provider could expand it to accommodate commercial formularies, but RxHub and MediMedia say they have had only a few
conversations. Of course, that could just be because it's early. Time will tell. Bottom line: they have a long way to go before they're optimized for ePrescribing. So, what does this mean more broadly?
been converted to the private, small office environment. It doesn't really have a billing function integrated, nor does it link well with other clinical systems." He also points out that Open VistA is tricky to install. Mr. Holt thinks that Open VistA's availability will ultimately provide downward price pressure on EMR systems. At the same time, he questions the impact, as the cost of the software itself is only a small part of an EMR. We agree.
We also suspect that this may increase interest, getting a physician past inertia associated with cost. We suspect, however, that when the physician starts researching the software, he may find he's better off spending a little more for a commercial system.
Regardless, if you're an ePrescribing stakeholder, it makes sense to take a minute to think about what this means to you - what your play is. If you need our help, give us a ring.
3. News and Announcements
There has been a great deal of activity since our last issue in May (note that we provided a notice of non-publication in the last issue). Consider the following:
· On July 25, ZixCorp and eClinical Works announced a strategic alliance to allow bi-directional data exchenge. ZixCorp is a secure eMessaging, ePrescribing and eTransaction company. eClinical Works is an electronic medical record and practice management firm that won first place in the Toward an Electronic Patient Record (TEPR) ePrescribing competition. (Note: this alliance confirms our suspicion that
eClinicalWorks has been exaggerating its ePrescribing capabilities. Good for eClinicalWorks for addressing its shortcomings.)
· On July 20, Horizon BlueCross BlueShield announced it had added OnCallData to its list of ePrescribing solutions as part of its $5 million Horizon Healthcare Initiative. OnCallData says more than 2000 New Jersey physicians currently have the system. Other solutions that are part of the Horizon Healthcare Initiative are CareMark's iScribe and Allscripts. According to a Horizon press release, Merck also appears to be supporting this initiative.
· On July 19, Manhattan Research released findings that show a 300% increase in the use of PDA-based ePrescribing solutions over 2004, and that 14% of physicians are prescribing electronically most of which have electronic connectivity to pharmacies. It also found that physicians who use the handheld platform wrote 42 more prescriptions per week than those using a desktop or another platform. The study was part of its annual physician survey, "Taking the Pulse v5.0." To learn more or obtain a copy, go to
http://www.manhattanresearch.com/thepulse2005.htm.
· On July 19, ZixCorp announced it had signed a letter of engagement with a major insurer. Since the contract is not signed, it is not at liberty to release the name of that organization. Some companies wait until a contract is signed to make such announcements but the publicly traded Zix chose to make announcements at this stage, and again at signing.
· On July 15, it was announced that draft version 1.0 of the NCPDP-to-HL7 e-Prescribing mapping document is available for review by NCPDP and HL7 members via the standards development organizations' Web sites. This "crosswalk" is just a guidance document, and can be used for electronic prescribing functions where mapping is needed. Two use case examples are between a hospital and community pharmacy where
medications are prescribed upon discharge, or to relay medication history to a prescriber from a payer. It was demonstrated both at the HIMSS conference in February and the NCPDP Annual Conference in March.
Comments are strongly encouraged by August 8.
· On July 11, Integrated Healthcare Association announced it had made progress in its pay-for-performance (P4P) program in 2004. According to an IHA Webcast, there was an increase of 23% in use of health care IT solutions. Twenty percent of IHA pay-for-performance funds are for health care IT. Two hundred twenty-five (225) medical groups are participating, and use of health care IT solutions is self-reported. P4P initiatives are widely considered to be strong drivers of ePrescribing.
· On July 11, ZixCorp announced that Aetna had selected it for a 1,000-physician ePrescribing pilot in New Jersey. They are replicating the metrics of a previous ePrescribing study that found no improve-ment in formulary compliance. Apparently, results from Zix's successful rollout in Massachusetts influenced Aetna to again try using ZixCorp's return-on-investment process. The deal is not exclusive and Aetna is open to
working with other software vendors on ePrescribing projects.
· On July 5, QUOVADX announced that Purkinje, Inc; had purchased its Cloverleaf Integration Suite for interoperability with other software systems. Purkinje is an electronic medical records software company with a robust electronic prescribing suite.
· On June 30, the July issue of the Joint Commission Journal on Quality and Patient Safety contained an article calculating that 3.7 of every 1,000 patient visits in the US were to treat adverse drug events. This is up from 2.9 in 1985. The article, written by Chunliu Zhan, MD, found 1.98 million visits for adverse drug events in 1997 and about 3.24 million in 2001. ePrescribing promises to reduce some of these visits.
· On June 29, it was announced that Ramp Corporation is in Chapter 11. In May, it announced that its financial statements for 2003 and 2004 could not be relied upon and fired CEO Andrew Brown. More recently, it lost its American Stock Exchange listing. Despite all of this, a company spokesperson says it intends to continue operating and is looking to sell one of its lines or merge with another company.
· On June 27, Allscripts made Time magazine in a piece about increased funding for health care information technology.
· On June 21, SureScripts announced that 36% of retail pharmacies are participating in its membership program. It also announced the following newly certified technology partners: ChartConnect, Inc.; DOCS, Inc.; LighthouseMD; McKesson; Mednet Systems; and NewCrop.
· On June 20, RxHub CEO Dave McLean announced a 40% increase in quarter-over-quarter growth of ePrescribing transactions with just over 1.9 million transactions every month. He sees this growth as sustainable as it adds new technology partners. RxHub has 150 million patients in its master patient index (MPI), and is in discussions with 35 to 45 additional entities.
· On June 15, Horizon BlueCross BlueShield announced it had added Allscripts to its list of ePrescribing solutions as part of its $5 million Horizon Healthcare Initiative, which also includes CareMark's iScribe. The program will provide 400 to 500 physicians with Allscripts' TouchWorks solution. Horizon will provide the software and technology to physicians for free.
· On June 14, University Physicians of Stonybrook announced it would be implementing the PatientKeeper ePrescription solution (powered by DrFirst) on behalf of its practices. Physicians are already using
PatientKeeper's charge capture technology.
· On June 6, DrFirst announced it had joined the Collaborative Consortium, LLC, an alliance working on regional health information organizations (RHIO), and founded by MEDecision. Consortium members are
currently providing 20 proposals to RHIOs around the country. Other consortium members include Cardtronic, HealthTrio, HealthVision, Hx Technologies, iMetrikus and Wellogic.
· On June 6, DrFirst announced that it has been selected for Phase II of "Partners in Technology to Improve Patient Safety," an initiative supported by an Ohio Medical Foundation grant. Organizers will be conducting a study connecting nine physicians and one nurse practitioner from Providence Medical Group in four
physician offices with five local CVS and Walgreens pharmacies in the Dayton area. According to a DrFirst press release, Phase II will study the impact of electronic prescribing on enhancing patient safety through decreases in adverse drug events, reducing pharmacy callbacks, streamlining the prescription process and improved formulary compliance. The ease of implementation, overall software evaluation and reducing pharmacy cost trend will also be evaluated. The results of the 14-month study will be derived from reports and feedback from 750 patients, providers and pharmacy participants.
· In the May issue of Pharmacy Times, it was announced that health organizations throughout Maryland had formed the Maryland Safety Through Electronic Prescribing (STEP) program. Its main goal is to fast-forward the voluntary adoption of electronic prescribing. The 27 organizations comprising the Maryland STEP
initiative want to provide a collaborative forum at which leading stakeholders may address obstacles to implementation and barriers to adoption.
Our next issue will be distributed in July. We look forward to continuing publication at that time. ABOUT US
Point-of-Care Partners, LLC is a growing eHealth consulting firm with active practices in ePrescribing and regional health information organizations (RHIOs). We help organizations develop and execute winning strategies based on lessons learned, current trends and key drivers.
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