Second of two articles
Proponents of the free, Web-based
electronic-prescribing service announced last week by the National ePrescribing Patient Safety Initiative say the data also can be used to improve quality.
"This is an idea that really surfaced a little over six months ago," said Glen Tullman, Allscripts Healthcare Solutions' chief executive officer. "What really triggered the idea was the (July 2006) release of the Institute of Medicine report saying 1.5 million Americans are injured from preventable medication errors and 7,000 die. We realized we can do better."
Tullman said e-prescribing can reduce those errors, but low physician adoption of the systems is the problem. Tullman said the coalition attempts to address the key barriers to information-technology adoption, including the cost of the systems and the technological problems of system installation and maintenance.
Tullman said Allscripts can offer its eRx Now service anywhere because it is Web-based, and since payers are not funding the service directly, it is not limited to any one supporting payer's market area.
"We don't need any payers to support this from a coverage standpoint. It's not limited to any geographical area," Tullman said. "What the payers are adding is incentives (paid directly to physicians for using the service). We want the payers, because they have a huge interest in going electronic. That's icing on the cake," he said.
Thus far, three plans are associated with NEPSI, but Tullman said talks are under way with other plans.
"This group that we launched with, please don't assume this is the only group," he said. "Some could not pull everything together for our aggressive launch time frame."
Other announcements are expected later, he said.
Many physicians in larger groups already have purchased electronic medical-records systems, virtually all of which have built-in e-prescribing functions. The target market for eRx Now is physician groups of 10 doctors or less where few have EHRs.
Physicians can access the service through desktop, laptop or handheld computers. Sprint will be giving out a limited number of smart phones that also can be used as prescribing tools. Wolters Kluwer Health will be providing drug and patient information through the system as well as the technology for the patient-safety alerts.
Tullman said Allscripts does not intend to get into the business of being a provider of outsourced data storage and retrieval as have some of its larger healthcare IT competitors such as Cerner Corp. and Siemens Medical Solutions USA, but will itself outsource to Tellurian Networks, Newton, N.J., the program's data storage, hosting and distribution of software to physicians using the application service provider model, or ASP, delivery model.
Allscripts declined to name the company it has hired to authenticate the identities of the prescribers using the eRx Now network.
Data stored in the repository will be made available to physicians if they choose to purchase another vendor's EHR, Tullman said. He also said Allscripts will not sell the data derived from the project, though it will aggregate de-identified data to look at regional prescribing patterns.
Participating physicians also will be able to access via the Web a list of pre-configured database queries to look at their own prescribing activities.
According to David Pearah, vice president of product management and operations for the eRx business unit at Allscripts, physicians will be encouraged to include their diagnoses with their prescriptions. Then they will be able to obtain reports on their own prescribing patters from a starter set of pre-programmed queries accessible through the same Web tool they use for prescribing.
The reports will let physicians monitor their medication activity by patient and by provider; the pairing of their prescriptions and diagnosis; the number of times their prescriptions triggered alerts; and the rate they overrode the alert. It will also track when formulary information is available for a patient, the rate of physician compliance with the formulary recommendation and the rate of override.
The tool will also give the prescriber an audit report on who had access to the e-prescribing tool, when it was accessed and what was done.
In addition, Allscripts will be able to aggregate de-identified data to determine such things as whether nurses have different prescribing patterns than physicians and the most common diagnoses for the types of medication prescribed by regions, Pearah said.
"We will pre-populate the list of what prescriptions they are most likely to use by diagnosis," he said. "We can pre-populate that much more intelligently based on the diagnosis. If there are any patterns on a regional basis we can take advantage of that."
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