Electronic prescribing comes full circle with automated refill authorizations

E-prescribing offers many well-known benefits to physicians, pharmacists and patients alike. Beyond the well-known patient benefits, real-time transactions with automated requests and responses promise to create efficiencies by speeding the medication ordering process, reducing or eliminating the back-and-forth communications between pharmacists and clinicians commonly associated with handwritten prescriptions.

With all of these advantages, it would make sense that pharmacists and physicians would desire to leverage an e-prescribing platform for prescription refill authorizations in addition to new prescriptions. Yet their uptake of this capability has been relatively subdued. For example, information generated through Emdeon’s eRx network indicates that 47 percent of physicians who have an e-prescribing solution are not using it for refill authorizations. The reasons for this relatively high percentage aren’t completely clear. Perhaps providers believe they already have their hands full ordering new medications via an electronic data interchange, or EDI, platform. Or maybe they’re afraid that adding e-prescription refill approval transactions will increase costs.

In fairness, e-prescribing refill capabilities are not covered in the Centers for Medicare and Medicaid Services’ requirements for proving that the provider is a “meaningful user” of electronic medical record technology. The current rules are all based on software features related to new prescription requests, which means there is no government-driven financial incentives directly toward electronic refill authorizations. But those providers should be aware that there are distinct administrative operational advantages to electronic prescription refilling that can translate into lower costs for physician and pharmacy. Further, most e-prescribing EDI solutions are based on a flat monthly charge, which means no additional expenses need to be incurred by the provider.

E-prescribing refills equal improved workflow
The traditional prescription refill authorizations process is manual, labor-intensive and unnecessarily time-consuming for both pharmacies and physicians. When an individual runs out of a drug, they will typically notify their pharmacy. The pharmacy then needs to call the individual’s provider, who must review the individual’s chart to ensure that he or she is authorized to continue receiving the medication. The physician’s office will then transmit the authorization back to the pharmacy, either by phone or fax. Finally, a pharmacist will need to reach out to the patient to let them know they are allowed the refill and when they can pick it up.

E-prescribing refill authorizations eliminate the back and forth paper-driven interactions that waste both time and money. Physicians and pharmacies are able to share information securely and reliably via the same EDI network and process as they do with new medication requests. In fact, the National Council for Prescription Drug Programs SCRIPT standard, which is the basis for all meaningful use-compliant transactions, facilitates e-prescribing for not only new orders but also for prescription changes, refills and cancelations.

According to a 2004 Medical Group Management Association report, e-prescribing with pharmacy interoperability can significantly reduce the estimated $10,000 spent annually per physician on phone calls with pharmacies related to prescription refills. A large practice in Kokomo, Ind., with 20 providers and 134,000 annual patient office visits provides a good example of the potential benefits of e-prescribing for refills.

Prior to implementing their solution, the Kokomo provider was receiving 370 daily phone calls, 206 of which were related to prescriptions. Of the 206 prescription-related calls, 97 were prescription renewal requests. The remainder consisted of clarification calls from pharmacists or requests for new prescriptions. The practice learned that its nurses were spending 28 hours per day and its physicians four hours per day handling the calls and pulling patient charts. By implementing an e-prescribing system, the office produced dramatic time savings, allowing the practice to reallocate nursing and chart room staff.

Workflow advantages also can be realized for electronic refill authorizations for controlled substances. Until recently, electronic prescribing of controlled substances, or EPCS, was forbidden by the Drug Enforcement Agency due to concerns over whether or not the prescription could be adequately protected in an electronic environment. Providers and pharmacists also have been reluctant to embrace EPCS capabilities, concerned about the potential time and cost investments required in order to receive the required EPCS certification, as well as potential disruptions that it would have on their traditional workflows.

But just as e-prescribing for traditional medications has gained traction, the adoption of EPCS has grown thanks to maturing technologies that include more sophisticated security controls, such as passwords, biometrics and secure tokens. The vast majority of states have made it legal for physicians to conduct EPCS transactions, including new and refill orders. With the right technology in place, physicians are even able to electronically prescribe and authorize refills for both traditional and controlled substances on a single EPCS platform — a great workflow advantage.

Benefits flow throughout the healthcare system
Obviously, a physician practice must consider whether or not automating prescription authorizations would save time and lower costs in relation to their current activities. The consensus among most organizations that utilize an e-prescribing platform for refills is that it is an indispensable feature. For example, a large practice in Lexington, Ky., has estimated that e-prescribing saves the group $48,000 a year through decreased time spent handling prescription renewal requests, according to a study from Tufts Health Plan and AdvancePCS published in August 2012.

A further study, published in 2010 in the International Journal of Medical Informatics detailed how automated systems cut down on the time spent on medication refills. Researchers from Virginia Commonwealth University and Brown University selected 64 physicians’ offices from six states that were known to have the highest e-prescribing rates. After conducting interviews and focus groups, the study’s authors concluded that using electronic systems for refilling prescriptions trimmed the time that physicians and their staff spent on refills by 50%. “In addition to office time saved, providers reported patient convenience as a major benefit,” read the study. “Both physicians and their staff appreciated the ability to track how patients were filling and refilling their prescriptions.”

The report did detail certain issues physicians were experiencing with managing prescription refills. Among them were technical problems associated with their e-prescribing software, including some reports by participants that pharmacies were not receiving refill orders. Other workflow issues arose for certain physicians, such as the need to re-enter all patient data for each prescription.

If they haven’t already done so, the vendor community must step up and address both technical and workflow issues with their software or transaction platforms that prevent the seamless flow of prescription refill authorization information between providers and pharmacies. As the technology matures, physicians, pharmacies and patients can be comfortable that e-prescribing for both new and refill medication orders can reduce waste by eliminating a paper-based environment, generate cost savings through improved staff efficiency and potentially enhance patient safety by reducing errors and promoting medication compliance.

Lathe Bigler
Senior director of clinical services, pharmacy services division
Lathe Bigler serves as Emdeon’s senior director of clinical services for the pharmacy services division. His focus on developing layers of competitive advantage and increasing market growth are instrumental in Emdeon’s advancement in the exchange of electronic prescriptions and other clinical information. Bigler has more than 15 years of experience in the healthcare and information technology fields, and has held roles in marketing, product management, business development and industry relations with such corporations as NDC Health, Midmark Diagnostics, DrFirst and AltaPoint Data Systems. Bigler has a bachelor’s degree in marketing and business administration.


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