electronic prescribing and the department of health central pharmacy

Florida Agency for Health Care AdministrationFlorida Center for Health Information and Policy Analysis

Florida Public Health Association - Medical Director’s Meeting - July 29, 2008

Electronic Prescribing and theDepartment of Health Central Pharmacy

Christopher B. Sullivan, Ph.D.Florida Center for Health Information and Policy Analysis

Agency for Health Care Administration

Florida Public Health AssociationMedical Director’s Meeting

July 29, 2008



ePrescribing Today

MJJ - 2007

1.

Physician Evaluates Patient & Prescribes Drug

Pharmacist reviews prescription

and routes it to the patient’s insurer.

2.

Payment is collected andMedication is dispensed

to the patient

5.

4.Script to Patient Benefit Manager for Adjudication

Rx Approval

Patient Benefit Manager Approves Script

3.

29%

Cursive

or Phone

& or

Fax (Cursive/Typed)

eRx

70% 1%

Manual EntryBy Pharmacist

vs. Typed



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



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.



Medicaid eMPOWERx ePrescribing



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



Refill Compliance Indicator

Date of Last Fill

eMPOWERx Can Improve Patient

Adherence



Automatic Clinical Reports

eMPOWERx Can Enhance Safety

Supported by Clinical Content



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 drug-allergy interactions

The ePrescribing component provides Medicaid Preferred Drug List status information and

Recommendations for alternative medications.



Lower Drug Costs

Comprehensive medication

history for well informed

therapeutic decisions

Therapeutic duplications flagged

for further review

Drug Interactions



eMPOWERx E-Prescribing Features The eMPOWERx system is supported through a Web-

based, 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.



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.



Lower Average Medicaid Prescription Claims in the Pilot Program



Greater Medicaid Cost Savings per Patient in the Pilot Program

Average PDA = $228

$233

$243$240

$228$229$226

$239

$225

$242

$228$230

$222

$203

$218$216

Average Non-PDA = $276

$274$274

$290$286$280

$275

$284

$274

$294

$281$275

$272

$254$263

$258

$150

$170

$190

$210

$230

$250

$270

$290

$310

$330

$350

Ave

rag

e P

resc

rip

tio

n C

ost

per

Pat

ien

t

Average Prescription Cost per Patient, PDA Group Average Prescription Cost per Patient, Non-PDA Group



Avoiding Adverse Incidents with Interaction Alerts October-December 2007

VERY HIGH3%

HIGH18%

MODERATE67%

LOW12%



Accessing Medicaid Data through Gold Standard

o Florida Medicaid Gold Standard eMPOWERx e-prescribing 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.



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.



DOH Health Maintenance System

Gold Standard eMPOWERx Data Feed Through the QS1 System?



Christopher B. Sullivan, Ph.D.

Agency for Health Care AdministrationFlorida Center for Health Information and Policy Analysis

Office of Health Information Technology2727 Mahan Drive

Tallahassee, FL 32308

electronic prescribing and the department of health central pharmacy

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