abstract #550 irb approval received category c2 pharmacy outreach using the rand e-prescribing...

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 95899-7413sokkim.lim@dhcs.ca.gov