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April 2008 — Vol. 3, No. 4

In This Issue

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Davies Application Due Dates and New CHO Award


The 2008 Davies Awards are currently accepting applications for several honors. Visit the recently redesigned Davies Web site to download the pre-requisites and the application. Join the healthcare elite and be recognized for your success in deriving value from your EHR system.

Following are the awards and the respective application submission deadlines:

The HIMSS Davies Community Health Organization Award is a new honor, launched at HIMSS08, and it was designed to extend recognition to community health organizations. HIMSS decided to establish a separate Davies Award for CHOs based on the awareness of the unique characteristics of CHOs and the populations they serve.

For more information, e-mail David Collins, Senior Manager, Davies Awards, or call 703-562-8817.

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The inclusion of an organization name, product or service in this publication should not be construed as a HIMSS endorsement of such organization, product or service, nor is the failure to include an organization name, product or service to be construed as disapproval

The Digital Office is a monthly online newsletter published by the Healthcare Information and Management Systems Society (HIMSS).
Copyright© 2008 by the Healthcare Information and Management Systems Society.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission. Contact HIMSS Publications at 230 E. Ohio St., Suite 500, Chicago, IL 60611; 312-915-9237; jlofstrom@himss.org
HIMSS Healthcare Information Systems Initiative
Patricia Wise, RN, MSN, MA
Colonel, USA Ret'd
Vice President, Healthcare Information Systems, HIMSS
For information on the HIMSS Davies Awards or the Ambulatory Care Initiative
David Collins, MHA, CPHIMS, CPHQ
Senior Manager, Davies Award Program, HIMSS
dcollins@himss.org/703-562-8817
For information on The Digital Office
Joyce Lofstrom, MS, APR
Senior Manager, Corporate Communications, HIMSS
jlofstrom@himss.org/312.915.9237


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Special edition: eRX


Understanding the Value of Electronic Prescribing
An Interview with: Patricia L. Hale MD, PhD, FACP


Patricia L. Hale MD, PhD, FACP
Deputy Director, Office of Health Information Technology Transformation
New York State Department of Health

Following is a question-and-answer interview with Dr. Patricia L. Hale who provides an in-depth overview on eRx or electronic prescribing, which is the full electronic transfer of prescription information to the pharmacy. Dr. Hale emphasized this definition at the beginning of her response to these questions. So, faxing a prescription to the pharmacy does not qualify for eRx, as readers will discover in this update from Dr. Hale.

Dr. Hale has worked and lectured extensively in the area of medical informatics for more than 10 years with a special interest in electronic prescribing and medication management. She is also the editor of Electronic Prescribing for the Medical Practice: Everything You Wanted to Know But Were Afraid to Ask, published in 2007 by HIMSS and available in the HIMSS Store.

Q. Can you comment on the benefits of e-Prescribing...that is -how does using e-Prescribing benefit the hospital or practice? the patient?

A. There are so many potential benefits I can't list them here. I would recommend referring to all the benefits on eRx we have put in our HIMSS book, Electronic Prescribing for the Medical Practice: Everything You Wanted to Know But Were Afraid to Ask.

For the hospital or practice (assuming all the problems listed later in this article were SOLVED and true eRx with was available):

1. Increased safety by having accurate medication histories available as patients move between care settings including hospitals, ambulatory offices, nursing homes and home care etc.

2. Decision support that can alert physicians on dangerous drug interactions

3. Cost and formulary information allowing physicians to prescribe less costly treatments, which has been shown to improve patient compliance

4. Cost savings by eliminating the huge number of phone calls that occur between pharmacies and physicians trying to solve questions on paper scripts

5. Increased safety by accurate information on electronic scripts (no handwriting problems) as well as decision support that can prevent prescribing the wrong medication

For the patient:

A. SAFETY, SAFETY, SAFETY is by far the biggest benefit...

Decreased cost plus the convenience of having everyone know your meds list without having to repeat it over and over or try to keep it up to date on a little piece of paper in you wallet. Going to the pharmacy and having your prescription ready without having to wait because multiple issues have to be resolved is another benefit. Read more.

 

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The New Electronic Prescribing Rules
An opportunity to improve patient care and healthcare provider collaboration

By Terri L. Warholak, PhD, RPh
Assistant Professor
Department of Pharmacy Practice & Science College of Pharmacy-Pulido Center
Tucson Ariz.

Rebecca P Snead
Executive Vice President
National Alliance of State Pharmacy Associations
Richmond, Va.

According to the final electronic prescribing rule, effective April 1, 2009, all Medicare Part D sponsors, prescribers and dispensers that electronically send prescriptions and prescription-related information about Part D covered drugs for beneficiaries are required to implement and use the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard 8.1 as the adopted standard.

The standards cover four areas:

  1. Formulary and Benefits Standard: Allows prescribers to communicate with Medicare Part D plan sponsors about which drugs are covered by the patient’s prescription drug benefit plan.
  2.  Medication History Transaction Standard: Allows providers, pharmacists, and Medicare Part D plan sponsors to communicate about prescribed medications a beneficiary has taken or is taking, including those prescribed by other providers. CMS anticipates that this may help reduce the number of adverse drug events. Combined with electronic medical records, e-prescribing opens up communication lines among all members of the healthcare team and gives pharmacists and physicians the information to decrease harmful drug interactions and therapeutic duplications, and to improve medication therapy adherence. 
  3. Fill Status Notification (RxFill) Standard: Allows providers to receive an e-mail from dispensers telling them that a patient’s prescription has been picked up, not picked up, or has been partially filled.
  4. National Provider Identifier (NPI): Requires providers, pharmacists, and Medicare Part D sponsors to use the NPI to identify individual health care providers in Medicare Part D e-prescribing transactions. CMS anticipates that this may help reduce the number of calls pharmacists make to physician offices to identify the individual prescriber.

These rules provide pharmacists and physicians additional tools with which to improve the quality and safety of patient medication use. The true value of electronic prescribing is in promoting collaboration between the prescriber and the pharmacist to assure optimal outcomes for the patient.

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Already There…Implemented E-Prescribing

Dr. Rishi Sud
Franciscan Physicians Network
St. John, Ind.

Rishi Sud, MD, a family physician in St. John, Ind., practices medicine as part of a hospital- owned larger primary care group with a traditional practice providing both outpatient and inpatient care for his patients. He offers patient care in pediatrics, gynecologic services and adult medicine, and for minor procedures.

While the medical group plans to implement the EMR in the next one to two years, the practice began using software from NEPSI in April 2007. “I read an article about NEPSI last April and was interested,” said Dr. Sud. “I've always felt the concept of e-Prescribing would be very beneficial. Since there was no charge for registering and trying it, I started on a trial basis. After hearing very positive feedback from patients, staff, and pharmacy personnel, I now have almost exclusively e-Prescribing with NEPSI.”

NEPSI makes secure, easy-to-use eRx software available to all physicians and medication prescribers in America for free, according to the NEPSI Web site. Based on eRx NOW™ from Allscripts™, the program is straightforward, intuitive and well-supported. Basically, NEPSI offers free eRx to every physician and medication subscriber in the United States.

Dr. Sud explained that ePrescribing has reduced the time needed to write prescriptions, especially for patients requiring multiple refills. “I believe that it is very helpful in reference to efficiency, patient safety, as well as patient satisfaction,” he said. He can send prescriptions wirelessly from a laptop in the patient exam room or from his PDA at the point of care.

The convenience of NEPSI also appeals to Dr. Sud because he can send multiple refills with just a few clicks of the mouse. The program also allows a physician to access a patient’s office chart from home or at the hospital when admitting a patient. NEPSI is accessible through a secure Internet connection without any software to give the physician complete access to patient medications.

Patients also benefit from the immediacy of e-Prescribing because their prescriptions are often ready when they arrive at the pharmacy. “My patients are very pleased with not having to wait in line at the pharmacy twice, once to drop off a prescription and once to pick up,” said Dr. Sud. “Many times, patients have told me that the prescriptions I have just sent are ready by the time they have driven to the pharmacy.”

With physicians throughout the country using e-Prescribing, Dr. Sud believes the long-term challenge for this method will be its “universality.” In other words, with so many choices on the market for EMRs and e-Prescribing platforms, which ones will last and which ones won’t?       

As for the benefits of NEPSI, “it is free,” said Dr. Sud. “It also has won numerous awards for its capabilities, which I find very reassuring. He suggests that physicians begin to incorporate e-Prescribing into their practice before it is mandated by the government.   

“I am very satisfied and happy with the e-Prescribing capabilities NEPSI has provided for me. I've also received excellent personal support on a regular basis. The staff at Allscripts and NEPSI is very diligent and timely in responding to any questions that I have had.”

Visit http://www.nationalerx.com/ for more information on NEPSI.

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HIMSS Endorses E-MEDS Act of 2007

4/14/2008 - On April 11, HIMSS Board of Directors approved the organization’s endorsement of the Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 (S. 2408/H.R. 4296). This bipartisan, bicameral legislation encourages physicians to use e-prescribing in Medicare by providing a one-time payment bonus to physicians for the initial cost of purchasing e-prescribing technology. The bill also provides an extra 1 percent bonus for the administrative costs attached to every Medicare prescription a doctor writes electronically. In order to ensure widespread adoption of e-prescribing, the bill also establishes financial penalties for Medicare physicians who do not begin using e-prescribing by 2011. Read More.

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The NPI is here. The NPI is now. Are you using it?
Important Information for Medicare FFS Providers

A note to readers of the HIMSS Digital Office newsletter:

Members of the HIMSS Financial Systems Steering Committee have been working with the Centers for Medicare and Medicaid Services (CMS) to prepare for the start of the National Provider Identifier being part of the CMS billing system. As part of the preparation, CMS has identified May 7 as an NPI-only Exercise Day. See the following CMS message for more details. Please feel free to forward this message to industry colleagues who should be aware of the exercise date. 

May 7 is “Legacy Free” Day – An opportunity to check your NPI readiness!

CMS, in collaboration with the Healthcare Information and Management Systems Society (HIMSS), has requested clearinghouses that submit claims to FFS Medicare to participate in a one day NPI preparation exercise. Specifically, on Wednesday, May 7, 2008, participating clearinghouses should submit Medicare claims with NPI-only in all provider identifier fields for which a provider uses NPI/legacy pairs.  On May 8, participating clearinghouses will revert back to sending Medicare NPI/legacy pairs as received from the providers.

Through its monthly NPI messages, CMS has been requesting providers to begin testing NPI-only by sending a group of claims with NPI alone in primary provider fields. This “exercise” will result in feedback from your Medicare contractor on your readiness as it pertains to your National Provider Identifiers.

On May 7, participating clearinghouses will send Medicare claims with NPI-only in provider fields which originally contain NPI/legacy pairs from the provider. In other words, clearinghouses will strip the legacy identifiers when they are submitted as part of an NPI/legacy pair. Of course, fields already containing NPI-only will be sent to Medicare, as usual, and secondary provider identifier fields containing legacy-only will be sent to Medicare, as usual.

 This exercise will help Medicare providers evaluate their NPI readiness prior to the May 23, 2008 deadline.

 The outcomes of this exercise are described below:

Or

Again, on May 8, 2008, participating clearinghouses will revert back to sending Medicare NPI/legacy pairs, if sent to them by the provider.

Participating clearinghouses will be soon notifying provider clients about details so pay close attention to Clearinghouse communications.

Need More Information?

Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.

Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.

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The Patient Care Plan

by Chuck Parker
VP, Chief Technology Officer / Business Development
Masspro
Waltham, Mass.

A well-formulated patient care plan can be an effective means to engage the patient in improving his or her condition. This plan should be:

The care plan is created to serve as a guide to outline the appropriate steps needed for the patient to achieve and maintain an optimal state of health. This plan not only serves as a guide for the patient, but also for the patient’s family, caregivers and all healthcare team members (including specialists and when appropriate, community services or programs). It should be reviewed and updated at each visit.

The patient care plan is developed collaboratively by the physician, the staff and patient, and includes two elements, medical management and self-management.

1. Medical Management

Includes the evaluation, treatment, monitoring and management of the patient's disease state, symptoms, and emotional health by the clinical team

2. Self-Management Plan

Includes key activities the patient engages in to manage his or her health and chronic conditions:

Self-management is a developmental process, not an event. Over time, and with support from the care team, patients develop increasing levels of confidence and competence to self-manage. Developing an action plan with the patient is one way to provide this support.

The key steps to providing self-management support are:

The patient action plan specifies one or two concrete activities that the patient agrees to engage in to manage his or her condition. It is specifically focused on the patient's needs, preferences, experiences and readiness to complete the activity. The patient care plan is the road map that provides tangible, measurable patient activities and progress, which the patient and physician track over time. This process is patient-centric with the goal of engaging and supporting the patient in his or her own care.

Many patients have had repeated experiences with failure in being able to follow recommended actions and to make the necessary changes in their lifestyle. To build a sense of competence for managing their health, patients need the opportunity to experience a series of successes. Action plans that are achievable and realistic give the patient the opportunity to experience success and to build confidence for self-management.

A key goal of the action plan is to build confidence. For some patients, early action plans may focus on behaviors that, by themselves, may not be clinically meaningful (e.g., introducing an additional vegetable into their diet every day for the next week), but that will build confidence for taking on larger challenges in the future.

How is this self-management support approach different from what you do now or how you support your patients?

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Vendor Update – How One Solo Practice Defied the Norm with Successful EMR Implementation

by Joanne Halbrecht, MD, FAAOS Boulder Institute for Sports Medicine, PC

Although EMR usage has risen substantially, adoption by solo and small practices lags far behind that of larger medical groups. Only 24 percent of solo practices have implemented an EMR compared to 46.5 percent of groups with 11 or more providers, according to a Centers for Disease Control and Prevention report published in October 2007.

At Boulder Institute for Sports Medicine, a solo provider orthopedic practice, we bucked that trend when we implemented an EMR in August 2007. We were convinced for years that the right EMR could be of great value. Like many small practices, however, there was concern about the high cost of the technology and finding an EMR that would meet our requirements including: affordability, flexibility, a wide range of functionalities and readily available, personalized customer support.

Although we researched EMRs for more than 10 years, it wasn’t until recently that we identified ones that met our practice’s business and clinical needs. After a thorough review process, we selected MicroMD EMR from Henry Schein Medical Systems because of its customizable and pre-built templates, a must for any specialty practice, CCHIT certification, and our success using MicroMD PM for a number of years.

The experience and the results produced by the EMR demonstrate that the technology can deliver multiple, significant benefits to solo and small practices if physicians choose their system carefully. Now, after using an EMR for more than six months, we are well on our way to achieving one of our main goals: cost savings.

By April 2008, the EMR had eliminated the need for staff to perform a range of administrative functions, including filing, scanning and fielding phone calls from physical therapists, patients and others. The resulting efficiency gains have enabled us to trim some 40 hours a week from staffing needs. Moreover, the office has gone completely paperless, resulting in additional savings.

The system also gives us the flexibility to use a tablet PC to capture data during patient encounters, which allows direct, face-to-face patient interaction. And by documenting visits electronically, we have easy access to vital signs, lab results, allergies, medication lists and all other patient data for review during the exam. After visits, encounter notes are also immediately available, eliminating the time and expense of transcription.

Our story at Boulder Institute illustrates how the barriers to EMR adoption are falling even for the smallest of practices.

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