Beginning March 27, 2015, New York will be the first state to require healthcare practitioners to issue prescriptions electronically. Under the new rule, prescriptions for all medications must be personally signed by the prescriber and electronically transmitted to the pharmacy before the medication can be dispensed. This includes controlled substances (i.e. pain medications), non-controlled substances (i.e. cholesterol medications) and medications prescribed during a patient or resident's discharge.
Although only one state will require ePrescribing in the coming year, others contemplating a similar change will be watching the transition closely and possibly follow suit. Long-term and post-acute care organizations and senior living providers should do the same, considering the benefits of ePrescribing and identifying a technology solution that includes this function.
Evaluating ePrescribing now not only helps these organizations prepare for potential compliance requirements down the road, but also allows them to attain significant quality and patient care benefits.
Benefits of ePrescribing
The use of ePrescribing has dramatically increased in the last decade, with approximately 70 percent of physicians issuing prescriptions through electronic health records (EHRs) in 2014. Like these providers, LTPACs and senior living providers can achieve benefits such as the following by fully embracing ePrescribing:
- Enhanced patient safety. Technology that facilitates ePrescribing will eliminate the need for the pharmacy to manually enter prescriptions because it enables the pharmacy to receive structured, formatted data rather than hand-written (and often difficult to read) prescriptions that may require call-backs for clarification. This not only saves time but also increases accuracy of prescription orders and prevents misinterpretation. Likewise, ePrescribing technology automatically evaluates prescriptions for potential drug interactions, further promoting patient safety while making the process more efficient.
- Increased efficiency. ePrescribing creates efficiencies at the time of admission and discharge by streamlining processes and eliminating hand-writing and faxing. Electronically transmitting prescriptions to the retail pharmacy selected by the resident also ensures adherence to the resident's medication regimen after discharge.
- Higher physician engagement. Rather than relying on telephone orders that can be signed days later, ePrescribing requires physicians to be directly involved in a resident's prescription process on a daily basis. Additionally, because this task can no longer be delegated to nursing or administrative staff, organizations must adjust their workflows to prioritize physician signoff.
- Better care coordination and transitions of care. The technology standard that facilitates ePrescribing—called NCPDP v10.6 SCRIPT—is designed to standardize, structure and manage prescription data for LTPAC and senior living providers. This allows organizations to share information more efficiently and consistently across the care continuum, which benefits organizations, providers and residents alike.
- Reduced readmission rates. By allowing physicians to participate more directly in the prescription process, LTPACs and senior living providers can drive more accuracy and reduce delays in medication delivery, which thus leads to more comprehensive treatment. Additionally, by improving transitions of care with discharge ePrescribing, these organizations can ensure proper adherence to residents' medication regimen, which is the primary cause of hospital readmissions.
Strategies for Getting Started
To launch an ePrescribing initiative, LTPAC and senior living providers should first engage stakeholders as part of an exploratory/implementation team. It is important to include members of the care team—such as nurses and physicians—as well as IT staff, software/technology vendor(s), organization leaders and any other key stakeholders, so everyone in the organization has a comprehensive understanding of the changes that need to be made.
Because prescribers will no longer be able to delegate steps within the prescribing process, LTPACs and senior living providers should determine how ePrescribing will affect workflows for nurses, physicians and other clinicians. ePrescribing is as much a clinical endeavor as a technology implementation, so clinicians will need to be educated accordingly.
Finally, a successful transition to ePrescribing requires selecting technology that supports it. This includes identifying an EHR partner that not only is workflow-enabled with the NCPDP v10.6 SCRIPT standard but also offers clinical decision support by leveraging business and clinical data from pharmacy, lab and radiology systems through interoperability. It should support ePrescribing for all workflows and medications—including controlled and non-controlled prescriptions and discharge prescriptions—as well as a mobile workflow that allows prescribers to approve orders remotely in order to prevent delays in filling prescriptions. The EHR also should be integrated with a recognized clearinghouse for discharge prescriptions, such as Surescripts, for discharge prescriptions and pharmacy, lab and radiology partners for in-stay prescriptions.
Embracing ePrescribing Now
While New York is the only state that will require ePrescribing in a few months, this transition away from paper affords many global benefits for LTPACs and other healthcare organizations. By adopting ePrescribing now, LTPAC and senior living providers will be better positioned to improve workflow efficiencies and comply with possible requirements down the road, while at the same time improving medication management and contributing to safer and more optimal care today.
Louis Hyman is the chief technology officer at SigmaCare.
 ONC analysis of physician prescriber data from Surescripts. Denominator from SK&A 2011 Office Based Providers Database. http://healthit.gov/sites/default/files/oncdatabriefe-prescribingincreases2014.pdf