With the implementation of a new Medicare incentive as of January 1, 2009,

e-prescribing has been thrust into the spotlight. This system of safe, secure prescription upload from practice to pharmacy is intended to reduce error, tampering and miscommunication. How will it affect your prescribing habits?


NOT an E-Mail

E-prescribing is not simply e-mailing a prescription to the pharmacy.

Basically, its a secure electronic system that transmits prescriptions from the doctors office to the pharmacy, says Col. (ret) Francis McVeigh, O.D., Chair of the American Optometric Associations Health Information Technology and Telemedicine Committee.

When you e-prescribe a drug for a patient, you take their data and the data of the drug regimen and transmit it to the pharmacy via this dedicated system.

The first step when committing to e-prescribing is to select a system that fits your practice. You can choose a stand-alone system for e-prescribing only, or you can opt for an electronic medical records (EMR) system with e-prescribing capabilities.

Make sure that you choose one to fit your practices needs. If you dont do your homework first, Col. McVeigh says, You will be frustrated with the system.

If you opt for a stand-alone e-prescribing system, make sure that your staff understands that some duplication of information may be necessary. A stand-alone e-prescribing unit is not interfaced in the medical record, says Ian Lane, O.D., senior vice president of professional services, Eyefinity and OfficeMate. Sufficient demographics (name, age, date of birth, etc.), have to be keyed into the stand-alone [system] to initiate the process. All known drug allergies need to be entered manually, initially. Such duplications between systems may be areas of potential data entry error, adds Dr. Lane.

If you already have an EMR system and select a separate e-prescribing program, make sure to obtain a commitment from the EMR provider that they will integrate your specific e-prescribing system, Dr. Lane says.

On the other hand, if you opt for an EMR system with an included e-prescribing module, repeated data entry may be lessened. All required demographics, medications and documented allergies are automatically uploaded and compared for drug interactions seamlessly and automatically, says Dr. Lane.

Prioritize when deciding what factors of an e-prescribing system most appeal to you. Are you most concerned about the softwares ease of use, or do you need the system to be capable of remote or mobile access? Is it important for your patients that the system compares medications at the time of prescription? Is the system capable of two-way communication?1,2 Weighing the advantages or disadvantages really depends upon what features are being offered, adds Dr. Lane.

Some factors to look for when choosing an e-prescribing system, says Dr. Lane, include:

Drug allergy alerts.

Drug-drug interaction alerts.

Drug formulary with alternate medication suggestions.

Two-way interface.

Access to a wide range of pharmacies, in the event a patient is traveling.


How to Report and Receive E-Prescribing Incentives

As of January 1, 2009, Medicare is offering an incentive for practitioners who e-prescribe. If you are a qualified prescriber, and you use a qualified e-prescribing system, report the e-prescribing quality measure through your Medicare Part B claims on at least 50% of applicable cases during the reporting period (one calendar year). If at least 10% of your total Medicare Part B claims involve e-prescribing, you should receive the incentive for the year.

When reporting, bill these claims appropriately on one of the following denominator codes: 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, G0101, G0108 or G0109.

Next, report one of the three G-codes listed below on more than 50% of applicable cases for the numerator. Each of these three counts toward the incentive. If you used a qualified e-prescribing system for all prescriptions, report G8443. If you had a qualified system but generated no prescriptions during this patient visit, use G8445 (this still counts toward the incentive). Or, if you had a qualified system but were required to prescribe a controlled substance or phone in the prescription due to pharmacy limitations, patient request or legal necessity, use G8446.

If you do this, you will receive an incentive of 2.0% in 2009 and 2010, 1.0% in 2011 and 2012, and 0.5% in 2013, for each year that you report properly.

Department of Health and Human Services. Medicares Practical Guide to the E-Prescribing Incentive Program. November 2008. Available at: www.cms.hhs.gov/partnerships/downloads/11399.pdf (Accessed December 2008).

The Challenges

Any new system brings its own set of challenges. With an e-prescribing system, youll need new software (and maybe new hardware, too). You need to determine the amount of money you can apply toward implementing such a system and what features will serve your practice best.

It depends on the return on investmenthow much money can you put out on this system? asks Col. McVeigh. And, the hardware/software selection is still a challenge. One Web resource I recommend is www.getrxconnected.com/optometric, and another site is www.ehealthinitiative.org.  

Your location may also be a factorif youre in a rural community, the local pharmacy may not be connected yet. Most smaller, non-chain pharmacies are not connected, but the major pharmacies are, says Col. McVeigh.

Other complications also currently bar the way to e-prescribing. For example, no practitioner is permitted to e-prescribe controlled substances, says Col. McVeigh. Also, in the state of New York, the practitioner is still required to handwrite dispense as written on the prescription slip, negating any possible benefits of e-prescribing.

Like any new piece of technology, an e-prescribing system will entail user training. I always tell people, Progress is painful, says Col. McVeigh. You have to believe that it will help your patients, and you need to empower your staff and make them involved in the process.

In order to smooth the transition, have a plan before you implement a system. Has your practice gone through a technological upgrade before? Do you understand the time, training and financial aspects involved? Are you willing to learn how the system interacts with any other software, such as an EMR suite, that you currently use? Will your staff be actively involved in the use of the new software? You must be able to answer yes to all of these questions before undertaking such a major change in the way your practice prescribes medicines to patients.2

In most cases, your provider should offer user training when the system is implemented. The training will be provided by the company via manuals, teleconferencing or a combination of both, says Dr. Lane. Initially, the office and licensed prescribers need to be enrolled in order to verify the scope of practice. Non-doctor staff that can writebut not issue or signprescriptions must be registered, as will staff members who can issue and send a non-signed Rx to the pharmacy.


The Benefits

So, why should you implement e-prescribing procedures? Here are some of the benefits of e-prescribing:

Improved patient care.
Bad handwriting isnt a problem anymore, and errors due to oral miscommunication are reducedits all right there on the screen.

It improves patient safetythere is a risk of adverse drug reaction due to someone misinterpreting a handwritten prescriptionthe chances of a miscommunication on phone calls between practitioners and dispensers are lessened, says Col. McVeigh.

Youll know about any risky drug interactions before the patient gets to the pharmacy. Some e-prescribing systems examine the patients current medications and alert you to any possible complications.

You have drug interaction alert systems, and when you e-prescribe, you have access to previous medications prescribed or entered into the system, says Col. McVeigh. The system will warn you if two drugs in the patients history demonstrate a risk of adverse reaction.

You may even be able to improve your patients compliance with their drug regimens by removing the chance that the patient may forget to fill the prescription or not want to wait to pick it up. Also, the cost to the patient can be reducedwhen you are in the e-prescribing system, youll have the ability to check for generic or lower-cost options.1,2

Streamlined pharmacy communications. With an e-prescribing system, no phone calls for clarification or requests to re-fax the prescription should be necessary. Authorization and renewal requests will still require a physicians response, but its all handled via the secure e-prescribing system.

Improved practice records. When you use an e-prescribing system, your prescriptions are saved into your database, allowing you to run analytical searches. You can query how many patients are taking a certain drug, for example. I can search through the database for every patient I prescribed a certain drug to, says Col. McVeigh.


Get the Facts Straight

The Medicare incentive program, which began on January 1, removed e-prescription regulations from the Physician Quality Reporting Initiative (PQRI) and created a separate e-prescribing quality assurance measure. So, a participating physician can potentially get two separate incentive paymentsone for participating in PQRI and one for being a successful e-prescriber.

The e-prescribing system must be qualified for the incentive program. To be qualified, a system must have the following capabilities:3

It can generate a complete medication list, incorporating data from pharmacies and benefit managers.

It can select medications, warn the user of unsafe drug interactions and transmit prescriptions electronically. (It must not convert the prescription into a fax to send it. If the pharmacy has to convert the document to receive it, your system is still qualified. But, if your system has to convert the document into a fax to send it, then your system is not qualified under the e-prescribing initiative.3)

It can provide information on lower-cost alternative medications. For 2009, Medicare Part D tiered formulary information meets this requirement.

Once the system is in place, what makes a successful e-prescriber? Not only must the e-prescribing system meet the criteria discussed above, but for 2009, the prescriber must also report the e-prescribing quality measure through the Medicare Part B claims on at least 50% of applicable cases during the reporting year. In the future, Part D data may be allowed in lieu of claims-based reporting, but this is not currently a valid reporting method.

Also, on April 1, 2009, Medicares Part D requirements will go into effect and apply to the e-prescribing initiative. These will include use of the National Provider Identifier (NPI) in Part D transactions and uniform standards for medication history, formulary and benefits, and fill status notification. (For more, go to www.cms.hhs.gov/eprescribing and www.ehealth


E-prescribing may just change the way that you care for your patients, but only if you implement the technology and take advantage of it in your practice. Its new, and there are still some kinks to be worked out, just as there are with any major technological implementation. But, if you take the time to understand the technology, youll be able to streamline your medical prescriptions for your patients, saving both them and yourself time and money.


1. E-Health Initiative, Foundation for E-Health Initiative. A Clinicians Guide to E-Prescribing. October 2008. Available at: www.ehealthinitiative.org/erx (Accessed December 2008).

2. McVeigh FL. E-prescribing in the optometric practice. AOA J 2008 Nov;79(11):692-701.

3. Department of Health and Human Services. Medicares Practical Guide to the E-Prescribing Incentive Program. November 2008. Available at: www.cms.hhs.gov/partnerships/downloads/11399.pdf (Accessed December 2008).

Vol. No: 146:01Issue: 1/15/2009