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Electronic prescribing has been shown to reduce medication errors, improve patient safety and outcomes, and save providers time and money.

Arkansas Medicaid officials and consultants hope the agency's new e-prescribing program will accomplish all those things, too. But the program, which rolls out on Dec. 15, will start small by trying to convince primary care physicians, especially those that generate high volumes of prescriptions, to adopt the technology.

"During the pre-implementation phase, we're going to work with high Medicaid prescribers. We're going to work with probably 10 to get the implementation rolling," said Rebel McKnight of QSource of Arkansas, the healthcare consulting firm providing the state technical assistance with the program.

But eventually, McKnight and others involved in the e-prescribing program, hope that every provider in the state adopts the technology.

Debbie Hopkins, assistant director for Arkansas Medicaid's Division of Medical Services, said the state is not thinking in terms of how many physicians will implement e-prescribing during the program's first year.

The primary goals are to provide quality prescription drug services for Medicaid recipients and to improve patient safety and outcomes, Hopkins said.

Some 17.3 percent of Arkansas's 2.7 million residents are insured through Medicaid.

The Center for Information Technology Leadership has estimated that if e-prescribing were adopted nationwide, the United States could eliminate more than 2 million adverse drug events a year. Patients are hospitalized in roughly 190,000 of those events, and around 130,000 of those events are considered life-threatening, according to the center.

Last year, Mississippi announced that implementing an e-prescribing program – with features similar to those in Arkansas – was saving the state's Medicaid program $1.2 million a month. In addition to cutting drug costs, Mississippi Medicaid spending on hospitalizations from drug interactions dropped by $27,000 a month.

Although the benefits of e-prescribing have been well documented, only a fraction of physicians nationwide have adopted the technology.

Hopkins said Arkansas Medicaid is using a multi-layered approach to persuade physicians to give e-prescribing a chance.

Among other things, Arkansas Medicaid and its partners have held informational meetings, and the state has also included e-prescribing information in their remittance advisories for providers. QSource staff members have attended healthcare group meetings, such as that of the Arkansas Medical Society. QSource has also participated in billing workshops with program manager EDS. Arkansas Medicaid has posted information about e-prescribing on its Web site, www.qsource.org.

Hopkins said the e-prescribing program will probably take the same philosophical approach the state used when it first started allowing providers to submit claims electronically for reimbursement.

"You start with a group that's sort of willing to be the volunteers, coming up as pioneers, and demonstrate the value of the program," Hopkins said. "And word of mouth spreads."

The physicians groups are pretty tight networks, Hopkins said. If the members see e-prescribing works well, makes their practices more efficient, lets them spend more time with patients and less time on paperwork, the physicians will get on board pretty quickly.

According to the National Association of Chain Drug Stores, roughly 5 percent of the more than 3 billion prescriptions written each year are incomplete or unclear and have to be reworked.

That additional effort translates to nearly 150 million clarification phone calls each year, according to NACDS.

Straightening out those problems can be expensive.

John Herzog, account manager of the EDS Arkansas Medicaid account, said a Medical Group Management Association's Group Practice Research Network has estimated that a physician practice can spend $15,700 a year just to manage prescription refills.

A SureScripts study published in 2006 found e-prescribing resulted in a 50 percent reduction in the time consumed to manage refill requests and pharmacy callbacks, McKnight said.

Hopkins said Arkansas Medicaid's e-prescribing program will allow a physician to check a patient's prescription history in real time, while the patient is still in the physician's office.

The program will help ensure that prescriptions are not duplicated while preventing adverse drug interactions, she said.

McKnight said the response from physicians so far has been good. Most doctors are very excited about e-prescribing because it is a small step toward going a complete electronic medical record, she said.

One of the biggest barriers to e-prescribing appears to be the cost of the software, which can vary depending on the vendor and the size of the practice. Many physicians have been reluctant to invest in the technology without concrete numbers showing the return on investment.

Some help may soon be in the offing. President-elect Barack Obama has said he wants to spend $10 billion a year for the next five years, or $50 billion in total, on e-prescribing and electronic medical records. Much of that investment would take place in physician offices.

Herzog said another major barrier to e-prescribing is integrating the software into a physician practice.

The Arkansas Medicaid e-prescribing program is helping physicians by making it possible to ask for assistance online, by logging onto the QSource Web site.

Once QSource receives the application, the company can contact the physicians individually and make onsite visits and assessments of their practices, McKnight said.

"Most of them have an electronic practice management system. Some of them have an electronic medical record," McKnight said. "So we're going out and seeing what they currently have, and then we're helping them make a decision on if they can e-prescribe, what their next step is."

If the physician has an electronic medical record, QSource can help the physician determine if the system's e-prescription component is adequate, McKnight said. Most of the Certification Commission for Healthcare Information Technology-certified EMR systems have an e-prescribing component, McKnight said. But some physicians have older versions of those systems so the physicians may need an upgrade or to add the e-prescribing component.

If the physicians have an older system, QSource helps them contact their vendors and find out if an upgrade is necessary, she said.

Hopkins said it's important for Medicaid patients to realize that the technology will soon be available and to ask their doctors if it's possible to e-prescribe.

"That way they don't have to keep up with a piece of paper to try to get it to the pharmacy. It can all be done electronically," Hopkins said.

For more information, go to www.qsource.org

Tags:

Arkansas Medicaid, Debbie Hopkins, e-prescribing, QSource, Rebel McKnight

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