E.Prescribing Initiative

            The Florida Drug Therapy Management Program for Behavioral Health (MDTMP) is committed to support the use of health information technology, specifically electronic prescribing (e.prescribing) to promote better care of patients, and help clinicians achieve continued quality improvements.

            The potential benefits of health information technology are now well understood and include:

• Improve health care quality
• Prevent medical errors
• Reduce health care costs
• Decrease paperwork
• Promote administrative efficiencies

            Several initiatives at the national and state levels are currently underway to promote the use of e.prescribing. At the state level, in 2007, the Florida Legislature passed HB 1155, which directed the Agency for Healthcare Administration to collect information on the benefits of e. prescribing and e.prescribing software. Section 408.0611, F.S. provides that the Agency is to collaborate with stakeholders to create an electronic prescribing clearinghouse and coordinate with private sector e.prescribing initiatives.

            E.prescribing allows for the electronic transmission of prescriptions and the recording of medication history for use by prescribing physicians at the point of care. E.prescribing is available to physicians who do not have access to internal electronic medical record system, and is often viewed as an entry point into electronic medical records.

            In a recently published report the Agency provides a comprehensive overview of the e.prescribing activities in Florida and reports the following activities:

Wireless Handheld Clinical Devices

In 2003, the Agency implemented the Wireless Handheld Clinical Pharmacology Drug Information Database and E.prescribing program for Medicaid providers. The program uses eMPOWERx as its software platform, and targeted the top prescribing Medicaid physicians as participants in a pilot program. Physicians may use eMPOWERx using either a PDA or desktop PC to retrieve 100 days of medication history of patients at their point of care. The MDTMP was allotted 1,000 PDAs to deploy among the Medicaid physicians who participate in the program.

As of December 2007, Medicaid providers have:

• Sent 850,000 prescriptions across the eMPOWERx systems
• On average prescribers who use eMPOWERx wrote about 25% fewer prescriptions than physicians who did not use the system
• Prescribers who use eMPOWERx save an average of $48 more per month per patient on prescription claims to Florida Medicaid
• Florida Medicaid reports $1.8 - $2 million in monthly savings from electronic prescribing
• During 2006, eMPOWERx users received more than 5.000 drug interaction alerts each week; more than 1,000 of which were of high or very high severity
• Physicians wrote an average of 4,115 electronic prescriptions per month.

Metrics on Electronic Prescribing Information

In 2007 fewer than one percent of prescription written in Florida
 were electronic prescriptions……….

E.prescribing in Florida increased in 2007, although less than one percent of prescriptions written in Florida were electronic prescriptions. Data reported from SureScripts and RxHub for 2007 show 1,546,207 electronic prescriptions were sent in 2007. Some important findings of the state of e.prescribing in Florida are:

• Across the state 63% of all pharmacies in the state are actively receiving e.prescriptions
• During 2007 the number of physicians e.prescribing increased by 80%
• There was a 199% increase in the number of electronic prescriptions in 2007
• New prescriptions make up the greatest number of prescriptions in 2007, at about 47.2%
• Prescription refill orders by physicians accounted for 24.5% of all electronic transactions related to e.prescribing
• The Tampa – St. Petersburg MSA accounts for the largest number of electronic transactions of all types related to electronic prescribing, with 850,619 prescriptions in 2007
• In 2007, Florida prescriptions sent electronically accounted for only 1% of all retail prescriptions in Florida Mental Health Inst.
• Cost savings reported by the Florida Medicaid electronic prescribing program in 2006-2007 were approximately $1.8 - $2 million per month.

Controlled Substances

            Electronic prescribing of controlled substances is not permitted at this time under regulation promulgated by the Drug Enforcement Administration (DEA) and the Department of Justice. Physicians who e.prescribe must maintain dual procedures to prescribe for their patient.

The full report of the status of electronic prescribing in Florida can be accessed at: http://www.fhin.net/eprescribe. In addition the Florida Electronic Prescribing Clearinghouse provides a wealth of e.prescribing resources maintained by the Agency in its website.

            In addition to the state’s efforts, several electronic stakeholders have formed an organization called ePrescribe Florida. The organization’s goals are to increase patient safety, document and promote the benefits of electronic prescribing. For more information about ePrescribe Florida please visit:
http://www.ePrescribeFlorida.com

MDTMP E.Prescribing Quality Improvement Project

            In its efforts to promote e.prescribing and to gain insights about barriers to implementation, the MDTMP has recruited 4 Florida practices to pilot an e.prescribing project from January through June, 2008. From this project we hope to learn from the practices about the implementation process, what are the pitfalls, what worked, was patient care improved, and were there any savings.
We have asked the 4 practices to participate in a best practice conference to share their experiences with e.prescribing. We will post the date, time and place in the near future.

If you have any information/experience you wish to share with us about e.prescribing please email: mmcpherson@fmhi.usf.edu