CMS has just announced that it will postpone its implementation of a ruling to prohibit the use of computer-generated faxes of prescriptions for Medicare patients to pharmacies. Earlier, CMS officials set January 2009 as the deadline for prescribers to migrate to an e-prescribing system that provides for the end-to-end electronic transmission of prescriptions (from the prescriber's software to the pharmacist's software: no paper). This ruling was designed to encourage prescribers to use e-prescribing systems. The new deadline has been set for January, 2012 (I think it's telling that the delay isn't 6 or 8 months, but 3 years).
So why did CMS postpone the implementation deadline? There are a number of reasons.
First of all, less than half the nation's prescribers have adopted an e-prescribing system. Why? Again, there are a number of reasons. Good e-prescribing systems, systems that conform to CMS standards (http://www.cms.hhs.gov/eprescribing) are not typically standalone systems—they're part of an integrated electronic medical record (EMR) system, and EMRs tend to be expensive—both in terms of capital outlay and in terms of workflow change and adoption. There are some standalone systems out there (some are even free), but their limited capabilities are designed to frustrate the user into buying the vendor's EMR. Some docs (more than I would have imagined when I entered this field five years ago) are technophobic. Still other providers (the ones who have Beta VCRs in their basements) are waiting to see how "it all shakes out" so they don't bet on the wrong technology.
Another reason that CMS postponed the deadline is because it takes two to tango: just because a prescriber can generate an electronic prescription doesn't mean that a pharmacy can receive it. Even though many major chain pharmacies across the nation are SureScripts certified and can theoretically receive e-scripts, very few actually do. This is especially true for independent pharmacists, who have to pay an intermediary to receive electronic prescriptions (this intermediary is a creature of the chain pharmacies, so the playing field is definitely tilted). The bonus / penalty will only work if everybody is connected and works together, and CMS is ignoring pharmacists in its bonus structures.
Still another reason for the postponement is to be found in the mired bureaucratic tangle that is our federal government. HHS strongly advocates health information technology (HIT), including e-prescribing. It has spent many of our tax dollars encouraging doctors to adopt HIT. Simultaneously, the DEA declares it illegal to send any prescription for a controlled substance electronically. Hence, had the Jan 2009 deadline been implemented, providers would have been in the awkward position of having to... let's see... electronically prescribe legend drugs for Medicare patients (and receive a 2% bonus), and, uh, handwrite prescriptions for controlled substances (and be penalized 2%). The net economic effect probably would have been about sixes, but the increase in workload would have cost millions. Our tax dollars at work.
Fortunately, the DEA has issued a proposed rule for changes to the way controlled substances are prescribed (see Part IV, Department of Justice, Drug Enforcement Administration, 21 CFR, "Electronic Prescriptions for Controlled Substances; proposed rule," pages 36,722 - 36,782 (yes, your read that right: 36,722 - 36,782)). These rules, if implemented, will make it possible for providers to e-prescribe controlled substances. It remains to be seen if the ponderous machinery of our government can get the changes implemented before January, 2012.
Incentives
It is important to understand that although the penalties for paper prescriptions have been postponed, the incentives haven't. As of January 2009, all "pure" electronic prescriptions for Medicare patients will be eligible for a 2% reimbursement bonus. A monthly 2% increase in Medicare reimbursements doesn't amount to much more than lunch money, but why leave money on the table?
More importantly, why not take advantage of the proven advantages of e-prescribing? Automatic drug / drug interactions, legible, consistent prescriptions, automatic documentation, and on-line help features make e-prescribing a very attractive entry point for HIT. To learn more about CaduRx e-prescribing, call 1-801-870-7555 or visit us at www.cadurx.com.
Most people would agree that cell phones have enhanced their lives and if they have ever tried to step away from this handy little device, life would cease to go on... how could it? It wasn't twenty years ago when you had to be a VIP in order to afford a phone, let alone really need one.
Today we have elementary age children with cell phones in their school bags. How times have changed...
Now, EMR's aren't exactly like cell phones, however for the health care provider segment of life in this world, an EMR is as revolutionary in practice as cell phones are for the soccer moms.
Several years ago while in a tire shop waiting a "normal Joe" walked in and needed some tires. He picked out the brand and size and went through closing of the sell. One of the questions asked by the sales rep was, "We can dispose of your tires for and additional $2". The "Joe's" response to this was "Of course" and the sales rep counters with, "It is kind of a pain but it is convenient." The "Joe" lights up and says, "Damn right, I am American and we pay for convenience... because we can."
Convenience is really something that we seek out and pay for. The whole "time is money" plays into this, as well as the stress and tediousness of a particular task. Something that simplifies and eases the process (of course after we learn the how and why) is worth money to us.
EMRs are a significant way to conveniently manage your relationships with patients, as far as the actual things you must do and have to maintain your responsibilities to each patient.
So what do EMR's do?
* Scheduling
* Maintain Demographic and Insurance Information
* SOAP Notes
* Customizable Templates (not all)
* HIPPA Compliance
* Scanned Images (X-rays, etc)
* Billing (not all)
* Electronic Prescribing (not all)
* Accessible Anywhere - Online (not all)
If you just consider the ease of entry that can and does take place when inputting information; hand writing versus data entry on a PC (or Mac). Think of writers, the invent of the PC has changed their lives with the ease of getting their ideas "down on paper".
When you considering templates and customizable structuring to adapt to you needs and common practices, having pre-populated information to add a few directed comments and updates regarding the patient is a major time saver and convenience. That alone is worth the time to review and consider an EMR solution.
There are many more reasons to look into EMR's. Most come with experience.
If you have never looked into one, check out CaduRx.