CPOE vs. e-Rx


Vol. 8 •Issue 8 • Page 15
EHR Corner

CPOE vs. e-Rx

CPOE is for inpatients and e-Rx is for outpatients, right? The distinction may seem pretty clear-cut, but it is not.

With requirements for adoption of standards for electronic prescribing (e-Rx) heating up, interest in the technology is intensifying. But many hospital-based IT professionals may be forgetting about or overlooking e-Rx. They may see it as simply a physician tool to check a formulary or drug knowledge base, often via PDA. Or they may consider it strictly the means by which physicians in their offices transmit prescriptions to retail pharmacies. They view e-Rx in contrast to CPOE, which requires robust clinical decision support, point-of-care capture of medication and other orders, and extensive workflow management tools for routing orders through the hospital.

Actually, there’s a lot more to e-prescribing than meets the eye. For example, facilities need e-Rx for inpatients because the discharge order for medications is often a prescription the patient takes to a retail pharmacy. Prescriptions are written in the outpatient and emergency components of hospitals as well. Likewise, CPOE may not be the exclusive domain of hospitals, because large group practices internally route directions for patient services as well.

Emerging standards

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) requires standards to be adopted by CMS for e-Rx. MMA states that e-Rx will be voluntary and applicable to eligible individuals within the Voluntary Prescription Drug Benefit Program, but any prescriptions transmitted electronically must use the standards that will eventually be regulated.

The timeline specifies standards to be implemented by April 1, 2009, preceded by a pilot program to be conducted in 2006, a report to Congress in 2007, and final standards announced in 2008. The law also requires development of safe harbors under the anti-kickback and physician self-referral laws (Stark) to allow hospitals, medical practices, participating prescription drug plans (PDPs), and medical assistance plans to provide physicians with non-monetary remuneration to be used for e-Rx.

What is e-Rx?

MMA provides information about what the e-Rx standards will cover. Standards identified include those for messaging (i.e., transmission of prescription, eligibility, drug information and related medical history, but not for any content unrelated to appropriate prescribing [such as marketing]), vocabulary, knowledge representation and electronic signatures.

These standards must enable transmission of basic prescription data to and from doctors and pharmacies, including electronically sending the FDA’s structured product label. Data about drug utilization history, possible drug interactions, the drug plan (including information about formulary and cost sharing), and lower-cost, therapeutically appropriate alternatives must also be transmittable. These standards suggest that primary responsibility for some of the eligibility and benefits checking and obtaining of prior authorization will be a dual role of the provider and retail pharmacy.

The standards also must comply with the HIPAA privacy rules. PDPs will be required to issue a card that enrollees use to purchase prescription drugs under the plan, which must use formatting standards developed in consultation with the National Council for Prescription Drug Programs.

So, if your plans call for implementing a CPOE system in about five years, and then maybe an EHR in another five years, you may want to evaluate the characteristics of successful CPOE systems, their relationship to EHR systems, and how CPOE and e-Rx compare. You’ll need to establish the level of messaging, vocabulary and knowledge representation truly required to support CPOE and e-Rx systems.

Also consider how e-Rx will affect outpatient areas and how you may be called upon to assist physicians. There’s much to be done by 2009.

Margret Amatayakul (“Margret A”) is president of Margret\A Consulting, LLC, a health information management and systems consulting firm based in Schaumburg, Ill. You can e-mail her at MargretCPR@aol.com, or visit her Web site at www.margret-a.com.

Mike Cohen is president of MRC Consulting Group, a Wheaton, Ill., firm dedicated to helping health care organizations make good decisions and get more value from their information systems investments. He is also a principal in Cardinal Consulting, Inc. You can e-mail him at mike@mrccg.com or visit his Web site at www.mrccg.com.

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