Transcript Electronic Prescribing and the Department of Health Central Pharmacy

Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Electronic Prescribing and the
Department of Health Central Pharmacy
Florida Public Health Association
Medical Director’s Meeting
July 29, 2008
Christopher B. Sullivan, Ph.D.
Florida Center for Health Information and Policy Analysis
Agency for Health Care Administration
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
ePrescribing Today
2.
1.
29%
70%
or
&
Cursive Phone
1%
or
eRx
Fax
(Cursive/Typed)
vs.
Typed
Physician Evaluates Patient
& Prescribes Drug
3.
Manual Entry
By Pharmacist
Pharmacist reviews
prescription
and routes it to the
patient’s insurer.
5.
Payment is collected and
Medication is dispensed
to the patient
MJJ - 2007
4.
Script to Patient Benefit Manager
for Adjudication
Rx Approval
Patient Benefit Manager
Approves Script
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid Wireless Handheld PDA Pilot

In 2002, the Florida Legislature directed AHCA to
develop a wireless handheld drug information
application for prescribers to use at point of care

The system was expected to provide:

Continuously updated clinical pharmacology
information for prescriber reference

Reference to the Florida Medicaid PDL

Individual Medicaid patient medication history

Ongoing education and support for prescribers
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Value of the Wireless Handheld PDA

Florida Medicaid Wireless PDA Pilot makes 100 days
of a patient’s prescription drug history available to
practitioners.

The medication history:

is available at the point of service;

permits immediate utilization and compliance
review;

provides information about coverage and
restrictions;

incorporates an e-prescribing function that permits
immediate transmission of prescription
authorization to the patient’s pharmacy.
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid eMPOWERx ePrescribing
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Outcomes from the Wireless Handheld PDA Pilot

eMPOWERx allows physician participation in
prospective drug utilization review to:

Minimize adverse drug reactions.

Detect overuse or under use of drugs.

Detect duplicate therapies.

Detect potential allergic responses.

Screen for appropriate dosage.

Halt “doctor shopping” for medications
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
eMPOWERx Can
Improve Patient
Adherence
Refill Compliance Indicator
Date of Last Fill
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
eMPOWERx Can Enhance Safety
Automatic
Clinical
Reports
Supported
by Clinical
Content
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Wireless Handheld PDA Drug Interaction Alerts


eMPOWERx Is integrated with a clinical information
database, which includes screening tools to reduce
the potential for medication errors before they occur.

Employs Clinical Pharmacology and clinical report
tools, empowering clinicians to screen a
prescription for adverse effects.

Alerts the provider to potential drug-drug or drugallergy interactions
The ePrescribing component provides Medicaid
Preferred Drug List status information and

Recommendations for alternative medications.
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Lower Drug Costs
Comprehensive
medication
history for well
informed
therapeutic
decisions
Drug
Interactions
Therapeutic
duplications flagged
for further review
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
eMPOWERx E-Prescribing Features

The eMPOWERx system is supported through a Webbased, real-time prescribing system:


Allows providers to write prescriptions from a desktop
computer or a PDA with prompts for the patient’s last
pharmacy.
The desktop version of eMPOWERx includes a data feed
from SureScripts-RxHub.

Physicians can obtain a medication history from both
Medicaid and non-Medicaid sources using the desktop
version.

One significant barrier for the County Health
Departments is the need for extra security and two
factor authentication.
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Outcomes of the Medicaid e-Prescribing
Wireless PDA Pilot Project

Prescribers who used eMPOWERx write 25% fewer
prescriptions than physicians not using the system.

Prescribers who use eMPOWERx save Medicaid an
average of $48 more per month per patient on
prescription claims.

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.
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Lower Average Medicaid Prescription
Claims in the Pilot Program
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Greater Medicaid Cost Savings per Patient in
the Pilot Program
Comparison of the Average Cost of Prescriptions per Patient for PDA and Non-PDA Groups
and the Average Prescription Cost Savings for PDA Users
$350
$330
$294
$290
$284
$281
$275
$272
$270
$290
$286
$280
$275
$274
$274
$274
$263
$258
Average Non-PDA = $276
$254
$250
Average PDA = $228
$242
$230
$230
$210
$240
$239
$228
$243
$233
$228
$229
$226
$225
$222
$218
$216
$203
$190
$170
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20
07
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g
00
l2
Ju
n
Ju
ay
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20
07
20
07
07
20
Ap
r
00
7
07
Average Prescription Cost per Patient, PDA Group
M
ar
2
Fe
b
20
20
07
Ja
n
20
06
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20
06
v
No
ct
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20
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20
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$150
Ju
Average Prescription Cost per Patient
$310
Average Prescription Cost per Patient, Non-PDA Group
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Avoiding Adverse Incidents with Interaction
Alerts October-December 2007
LOW
12%
VERY HIGH
3%
MODERATE
67%
HIGH
18%
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Accessing Medicaid Data through Gold
Standard
o Florida Medicaid Gold Standard eMPOWERx eprescribing software is available to all Medicaid
physicians at no cost.

AHCA is working with Gold Standard and Medicaid to
make eMPOWERx medication history available to
Medicaid physicians through Florida RHIO portals.

AHCA would like to work with the Department of Health
to support the adoption of e-prescribing in the County
Health Departments.
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Opportunities for eMPOWERx
o Duval County Health Department is initiating a pilot
project using eMPOWERx.
o Florida Medicaid is working with the Duval County Health
Department to obtain extra PDAs.
o The eMPOWERx Desktop version has extra benefits with
its RxHub feed, but security is an important issue that
needs to be resolved.
o AHCA and Medicaid would like to reach out to work with
the DOH to make eMPOWERx available to all County
Health Departments in Florida, either directly or through a
data feed to the Central Pharmacy QS1 system.
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
DOH Health Maintenance System
Integration Broker - High Level View (ELR)
Rabies Results
BOLIMS
MERLIN
MUMPS
(Receives Orders,
Sends Result Rpts)
HMS
BOLIMS
Billing Data
(Sends Electronic Orders,
Receives Result Reports)
DOH
Cloverleaf
Integration
Broker
IRL
Private Physicians
(via a common
portal)
(Sends Orders,
Rcvs Result Rpts)
Hepatitis Results
STD
Database
HIV-AIDS
CTRS II
STD Results
HIV-AIDS Results
HIV-AIDS Results
HIV-AIDS
Surveillance
LabCorp
External Partners
(via the Internet)
Reportable
Disease Results
Quest
Diagnostics
Internet
Environmental
Health
RHIO Switch
Bureau of
TB
Integration Broker Role: Receive Data, Translate Format,
Transmit Data to Stakeholders
Gold Standard
eMPOWERx Data
Feed Through the
QS1 System?
CDC
Other Outside
Agencies
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Christopher B. Sullivan, Ph.D.
Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Office of Health Information Technology
2727 Mahan Drive
Tallahassee, FL 32308
Florida Public Health Association - Medical Director’s Meeting - July 29, 2008