Transcript File

E-Prescribe: Adopting Health Care
Information Technology
ADG associates presenting:
Barbara Antuna
Jessica Carpenter
Patrick Esparza
Brian Frazior
E-Prescribing Standards
• E-Prescribing Base Standards
– NCPDP SCRIPT 8.1/5.0
– ASC X12 N 270/271
– HL7 CCD
– NCPDP Telecommunications 5.1
– NPI
• E-Prescribing Composite Standards
– NCPDP Formulary and Benefit Standard
Advance Development Group
NCPDP SCRIPT (8.1/5.0)
• To provide for the communication of a prescription or
prescription-related information between prescribers and
dispensers, for the following:
(A) Get message transaction.
(B) Status response transaction.
(C) Error response transaction.
(D) New prescription transaction.
(E) Prescription change request
transaction.
(F) Prescription change response
transaction.
(G) Refill prescription request
transaction.
(H) Refill prescription response
transaction.
(I) Verification transaction.
(J) Password change transaction.
(K) Cancel prescription request
transaction.
(L) Cancel prescription response
transaction.
(M) Fill status notification transaction.
Source: http://www.cms.hhs.gov/EPrescribing/Downloads/E-Prescribingfinalruleonfoundationstandards.pdf
Advance Development Group
NCPDP SCRIPT
• SCRIPT is a standard created to facilitate the transfer of
prescription data between pharmacies, prescribers,
intermediaries, and payers. The current standard supports
messages regarding new prescriptions, prescription
changes, refill requests, prescription fill status notification,
prescription cancellation, medication history, and
transactions for long term care environments.
Source: http://www.ncpdp.org/pdf/Eprescribing_fact_sheet.pdf
Advance Development Group
ASC X12 N 270/271, HL7 CCD, and NCPDP Telecommunications
• ASC X12 N 270/271
– Used for a prescriber system to request eligibility information
about a patient
• HL7 CCD
– Summarizes a consumer’s registration/medical information
– XML based
• NCPDP Telecommunications 5.1
– This standard supports the flow of eligibility information and
copayment amounts between plan sponsors and dispensers
Advance Development Group
National Provider ID (NPI)
• It is important to note that the NPI is used to
identify the individual prescriber and dispenser in
the electronic prescription process. The NPI was
not created to be used for routing of transactions.
• The electronic prescribing standards are not HIPAA
covered transactions and as such are not required
to use the NPI. Entities covered by the Medicare
Modernization Act are required to comply with the
MMA, including the NPI usage.
Advance Development Group
NCPDP Formulary and Benefit Standard
• E-Prescribing Composite Standards
• The NCPDP Formulary and Benefit Standard provide
patient benefits information to physicians at the point
of care.
• These can include Formulary Status, Payer-specified
Alternatives, Coverage Information, Copay
Information and Drug Classifications.
Advance Development Group
Electronic Prescription Standards Workflow
Hospital EMR
Medical History
1) Eligibility Checking
2) Formulary and Benefits
3) Medical History
Payer\PBM
1) Medication Requests
2) Fill Status Notification
3) Medical History
Prescribing
System
Claim Submission
Pharmacy
Advance Development Group
Electronic Prescription Standards Workflow –
Unidirectional Diagram
Medication
Request
Medication
Request
Prescribing
System
Medical
History
Pharmacy
Fill Status
Notification
Eligibility
Formulary
and Benefits
Medical
History
Payer/PBM
Advance Development Group
Medication Request
Prescribing
System
Prescription
Request
(NCPDP
SCRIPT)
Pharmacy
Prescription
Response
(NCPDP
SCRIPT)
• Defines medication transaction requests between a prescriber and
dispenser
• NCPDP SCRIPT 8.1 standard
• Types of requests
• NEWRX – New order request
• REFREQ – Refill request
• RXCHG – Change request
• CANRX – Cancel request
Advance Development Group
Medication Formulary and Benefits Information
Prescribing
System
Eligibility
Request
(ASC X12N
270)
Payer/PBM
Eligibility
Response
(ASC X12N
271)
Prescribing
System
Formulary
And Benefit
Request
(NCPDP
Standard 1.0)
Formulary
And Benefit
Response
(NCPDP
Standard 1.0)
Payer/PBM
• Provides benefits information
to physicians at the point of
care
• Includes formulary status,
payer specified alternatives,
coverage information, co-pay
information, and drug
classifications
• Two part process:
• Eligibility Checking – ASC
X12N 270/271
• Obtain formulary and
benefit information –
NCPDP Formulary and
Benefit Standard 1.0
Advance Development Group
Medication History
Medication
History
(NCPDP
SCRIPT RXHRES)
Prescribing
System
Medication
History
(NCPDP
SCRIPT RXHREQ)
Medical
History
(HL7 CCD
REQ)
Medical
History
(HL7 CCD
RES)
Payer/PBM
Pharmacies
EMR
• Provides a medication history list
to a prescriber for a specific
patient
• Sources include payers/PBMs,
pharmacies, and prescribers
• NCPDP SCRIPT 8.1 Medical
History standard
• HL7 CCD standard
• Multiple transactions:
• Medical history request –
NCPDP RXHREQ
• Medical history response –
NCPDP RXHRES
• HL7 CCD Request
• HL7 CCD Response
Advance Development Group
Fill Status Notification
Pharmacy
Rx Dispense
Message
(NCPDP
SCRIPT
RXFILL)
Prescribing
System
Acknowledge
Response
• Notifies the Prescriber of when a prescription has been dispensed,
partially dispensed, or not dispensed
• NCPDP SCRIPT 8.1 Fill Status Notification - RxFill
• Two transactions:
• Rx dispense message – RXFILL
• Acknowledgement by Prescriber
Advance Development Group
System Requirements – Function with EMR
• Must connect to the
current EMR
system
• Must provide
administrative and
reporting
functionality
– Patient history,
laboratory results,
available medication
history and allergy
information.
Advance Development Group
System Requirements – Error Prevention
• Must be linked to error
prevention software
– Include a notification
system to flag potential
medication errors
• Must allow the prescribing
provider to override the
error prevention software
– Prescriber documentation
required to do this
• Must allow the integration of
all pertinent clinical
information
Advance Development Group
System Requirements – Medication Classification
• Must categorize medications into
families to assist in checking of
medications.
• Must allow for frequent upgrades and
checks that will not affect the
functionality of the system.
• Must provide information on all
alternative medications, including
pricing information.
Advance Development Group
System Requirements – Prescription Routing/Security
•
Must allow for
prescribers to
print
prescriptions or
submit
electronically to
pharmacy.
•
This transaction
must be done
through a secure
interface that is
HIPPA compliant
and link to and
from participating
pharmacies.
Advance Development Group
System Requirements – Dosing and Prescriber Checks
•
Must perform dose range checks in order to prevent excessive doses from
being ordered or administer.
• Must allow endusers to have the
ability to receive and
respond to
prescription renewal
requests from
pharmacies
Advance Development Group
System Requirements – Additional Security Measures
•
Security must be
in place to
distinguish
between
Providers, nurses
and mid-level
providers and
have a valid
registration to
route
prescriptions
electronically.
Advance Development Group
Questions?