national progress report on e prescribing year 2011

7/29/2019 National Progress Report on E Prescribing Year 2011

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THE naTionalprogrEss rEporTon e-prescribing and interoperable HealtH care

Year 2011


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eutty

tecy

hyc d tet chce

e tdd

cbt

vcy


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2001

2006

2007

2008

2009

2010

2011

2012

2003

2002

2004

2005

the evolution of e-prescribing

58 percent (317,000) of a office-based

phsicians actie e-prescribe.

EPCS state-b-state approa

adancin.

American Recoer and Reinestment Actproided $19 biion toards adoption of heathinformation technoo.

CMS reeases proposed reuations defininmeaninfu use of EMRs. E-prescribin is a kecomponent.

Medicare aunches MIPPA e-prescribin incentieproram.

Rhode Isand announces 100 percent of its phar-macies are enabed for e-prescribin.

SureScripts-RxHub is reaunched as Surescripts.

Center for Improin Medication Manaementaunched.

E-prescribing becomes legal in all 50 states and D.C.

Nationa E-Prescribin Safet Initiatie aunched. SureScripts, RxHub, Informed Decisions and the

AMA aunch ICERx.or to assist ictims of naturadisasters.

CMS piot-tests proposed Medicare Part De-prescribin standards.

First annua Safe-Rx Aards reconize tope-prescribin states.

Institute of Medicine reeases piotaPreentin Medication Errors report.

Approximate 2,500, or 4% of office basedphsicians, e-prescribe.

Office of the Nationa Coordinator for HeathInformation Technoo (ONC) estabished.

SureScripts aunches e-prescribin commu-nit adoption prorams.

RxHub beins netork operations.

190,000 or 36% of office-based phsicians noe-prescribe.

Surescripts announces netork expansion toao cinicians to exchane a tpes of cinicamessaes ith their peers.

The U.S. Dru Enforcement Administration aosthe option of issuin prescriptions for controed

medications eectronica. Patient Protection and Affordabe Care Act passes.

CMS issues Medicare Part D e-prescribinincentie reuations.

DEA proposes rue to ao e-prescribinfor controed substances.

Medicare Improements for Patients andProiders Act (MIPPA) passesincudese-prescribin incenties.

RxHub and SureScripts mere to formSureScripts-RxHub.

First proposed foundation standardsreeased for Medicare Part D e-prescribin.

HHS issues Stark exemptions and Fraud &Abuse safe harbors.

SureScripts, RxHub hep aunch.katrinaheath.or to supportictims of Hurricane Katrina.

Institute of Medicine endorses NationaHeath Information Infrastructure.

Medicare Modernization Act proidesincenties for e-prescribin adoption.

SureScripts beins netork operations.

RxHub founded. SureScripts founded.


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introduction

a lette fm thepedet d CEo

This remarkabe roth in adoption and use has transformed one of the most common transactions in heath care into amainstream eectronic heath care too. Eectronic routin of prescriptions on the Surescripts netork accounted formore than one in three prescriptions that ere picked up b patients at communit pharmacies. As states impemente-prescribin for controed substances (EPCS), these ne tpes of transactions i drie additiona use of e-prescribin.

This sure in adoption and use underscores the aue of e-prescribin. In 2011, Surescripts coaborated ith pharmaciesand pharmac benefit manaers on a stud to quantif the benefits of e-prescribin. we examined de-identified data setsrepresentin oer 40 miion prescription records and compared eectronic prescriptions ith paper, phoned and faxedprescriptions to measure the impact on first fi medication adherence.

This first-of-its-kind data anasis consistent shoed that hen a phsician adopts e-prescribin there is a 10 percentincrease in her/his patients first fi medication adherence. The stud aso demonstrated that the improement in patientfirst fi medication adherence can produce an estimated sains, oer 10 ears, beteen $140 biion to $240 biion inheath care cost sains and improed heath outcomes.

Another Surescripts stud shos that the majorit of e-prescribin adopters from 2008 are aread meetin the stae 1meaninfu use e-prescribin measure. Man are aso positioned to meet the proposed stae 2 measure.

Surescripts is committed to faciitatin the broader shift toard coaboratie care and expandin our netork to estabishmore efficient, meaninfu and poerfu as to communicate and share cinica data eectronica. we are eerainour core capabiities, and our eadership and experience to promote eectronic heath information sharin amon proidersacross the care continuum. we beiee that doin so i promote additiona meaninfu use, hie hepin to oer costs

and improe quait for phsicians, pharmacies, patients and a heath care constituencies.

Reards,

Hy tPresident and CEO, Surescripts

B the end of 2011, 58 percent of office-based phsicians in the UnitedStates had adopted eectronic prescribin on the Surescripts netork.A itte more than three ears ao, this fiure as ess than 10 percent.This increase is a critica miestone in the nationide effort to adopte-prescribin and achiee meaninfu use of heath information

technoo.


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i

The Eoution of E-Prescribin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1A letter from the President and CEO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Executie Summar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4E-Prescriber groth in the U.S. 20082011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

p 1: e p u

The Three Components of E-Prescribin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Impact of E-Prescribin: Medication Adherence . . . . . . . . . . . . . . . . . . . . . . . . . . 9Prescription Benefit Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

The vaue of Prescription Benefit Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Medication Histor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Prescription Routin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Ho to Improe Use of Prescription Reneas . . . . . . . . . . . . . . . . . . . . . . . . . . . 14EHR s. Standaone E-Prescribin Softare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Coaboration Dries Quait Improements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Future of E-Prescribin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

p 2: e p a

The Cass of 2008: Trackin the groth of Meaninfu Use. . . . . . . . . . . . . . . . . 18Prescribers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20E-Prescribin Phsicians b Speciat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

E-Prescribin Phsicians b Practice Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22PharmaciesCommunit and Mai Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Paers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

p 3: a s

About Surescripts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ibcAcknoedments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ibc

contents

WWW.SURESCRIPTS.C

tHe national progress report on e-prescribing and interoper able HealtH ca

Year 20


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introduction

n p r Y 2011 a-a-gThis report proides heath care industr stakehoders ith a unique ie of e-prescribin in the United States. Thereport oes beond the remarkabe sustained roth seen in 2011 to te a compein stor, throuh raphics andanatica data about the sti reat potentia of e-prescribin and coaboratie care for pharmacies, prescribers,pharmac benefit manaers (PBMs) and other heath care stakehoders.

Executve summy

m th o t off- phy e-p

2011, u f o t 2008

E-Prescribin entered the mainstream of heath caretechnoo in the United States ith 317,000 office-basedphsicians, or 58 percent, no actie e-prescribin(F 1). B the end of 2011, more than one in to office-based phsicians used e-prescribin, ersus one in tenthree ears ao.

F 1: 2011 Office-based Phsicians who E-Prescribe(The darker the area, the reater number of actie e-prescribers)

F 3: E-Prescribin Increases First Fi Medication Adherence

e-p i H iv F F m

ah. sv a e u $240 b v

10 YSurescripts coaborated ith pharmacies and pharmacbenefit manaers on a stud comparin eectronic pre-scriptions ith paper, phoned and faxed prescriptions.The data shoed a consistent 10 percent increase inpatient first fi medication adherence amon phsiciansho adopted e-prescribin technoo (F 3). Onefindin as that the improed medication adherence frome-prescriptions can ead to 10-ear estimated sains ofbeteen $140 biion to $240 biion, measured in heathcare cost sains and improed heath outcomes.

Before e-prescribing

Number picked up out of 100

ritten prescriptions

With e-prescribing

Number picked up out of 100

ritten prescriptions

69.5 Rx

Picked Up

76.5 Rx

Picked Up

Pic ke d u p A ban do ne d

Abandoned Abandoned10%

INCREASE

F 2: Prescription Routin Use 20102011

570 m p w r ey

B the end of 2011, an estimated 36 percent of prescrip-tions dispensed ere routed eectronica, up from 22percent at the end of 2010. More than 570 miion ere

routed eectronica in 2011, ersus 326 miion in 2010.This represents a 75 percent increase in just one earstime (F 2).

2010

75%

2011

474 million

96 million

269 million

57 million

Ne Prescriptions

Prescription Renea Responses


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8/286

E-pecbe gwth the U.s. 20082011

2008 2009 2010

2008

1 10phy e-p 1 4

phy e-p

1 3phy e-p

The Centers for Medicare and MedicaidSerices (CMS) issues Medicare Part D

e-prescribin incentie reuations. The Dru Enforcement Administration

(DEA) proposes rue aoin e-prescribinfor controed substances.

Medicare Improements for Patients andProiders Act (MIPPA) passes; incudese-prescribin incenties.

RxHub and Surescripts mere to formSurescripts-RxHub.

2009

American Recoer and Reinestment Actproides $19 biion to promote the adop-

tion of heath information technoo. CMS reeases proposed reuations

definin meaninfu use of eectronicheath records (EHRs). E-prescribin is ake component.

Medicare aunches MIPPA e-prescribinincentie proram.

Rhode Isand announces 100 percent of itspharmacies are enabed for e-prescribin.

Surescripts-RxHub is re-aunched asSurescripts.

2010

introduction

190,000or 36%of office-based phsi-cians e-prescribe.

Surescripts announces netork expansionto ao cinicians to exchane a tpes ofcinica messaes ith their peers.

The DEA aos the option of issuin pre-scriptions for controed medicationseectronica.

Patient Protection and Affordabe CareAct passes.


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i 2011, 58 pecet f offce-Bed phyc

Ued E-pecb

2011

m h 1 2phy e-p

2011

Surescripts announces 58% of a office-based phsicians e-prescribe.

56,900+ pharmacies no connected to the Surescripts netork.

Office of the Nationa Coordinator (ONC) announces proposed criteria for Meaninfu Use Stae 2.

ONC announces 123,921 Eiibe Professionas hae reistered for EHR incenties.

WWW.SURESCRIPTS.C


Year 20


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part 1:ElECTroniC prEsCriBing UsE

E-prescribin is buit around three ke components that ao pharmacists, prescribers and pharmac benefitmanaers (PBMs) to obtain maximum efficienc, sinificant cost sains and aue:

1. p f fy f increases compiance and proides oer-cost choices.

2. m hy utiization eads to a more cinica appropriate prescription.

3. e means a prescriptions are sent to and receied b a pharmac, encourain morefirst fi adherence.

Part One of the 2011 Nationa Proress report examines the roin eidence supportin the adantaes ofe-prescribin, beinnin ith Surescripts Medication Adherence Stud and fooed b ke insihts pertaininto benefit information, medication histor, and eectronic routin. It ends ith a reie of current trends andfuture deeopments.

Heathcare proiders and prescribers can access a three components of e-prescribinthrouh endor certified softare on the Surescripts netork.

The Thee Cmet f E-pecb

medication HistorY

beneFit inFormation electronic routing

Ambuator & Acute

Prescription Benefit for Ambuator;Eiibiit Serices for Pharmac

and Medicaid

Process Ne Prescriptionsand Reneas

Prescription benefit information, medication histor and eectronic routin reduce costs,add efficienc, and proide continuit of care.


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In 2011, Surescripts partnered ith PBMs and retai pharmacies to compare the effectieness of e-prescriptionsand paper prescriptions on first fi medication adherence. As part of the stud, e anazed de-identified data setsrepresentin oer 40 miion prescription records.

e-p iv F F ah 10 p wh c p pThe data shoed a consistent 10 percent increase in patient first fi medication adherence (i.e., ne prescriptionsthat ere picked up b the patient) amon phsicians ho adopted e-prescribin technoo.

e-p c p sf Hh c svThe anasis suests that the increase in first fi medication adherence combined ith other e-prescribin benefitscoud, oer the next 10 ears, ead to beteen $140 biion and $240 biion in heath care cost sains and improedheath outcomes.*

E-Prescribin shoud be considered a poerfu too in the heath care sstems efforts to address medicationadherence and improe patient outcomes.

K mjkk, phd,vice President of Strate and InnoationSurescripts

The Surescripts research is an important contribution...In a hue stud, the hae shon a cear ink beteene-prescribin and first fi medication adherence.

w H. shk, md, msHsSpeciaist in Medication AdherenceHarard Medica Schoo

*A 2011 stud found that eer doar spent on improin patient adherence to medication can resut in three to ten doars of sains from reduced donstream medica costs for

certain diseases.

The imct f E-pecb Medct adheece

$140$240BIn heath care sains oer the next

10 ears due to e-prescribin

Without e-prescribing

Number picked up out of 100 ritten prescriptions

With e-prescribing

Number picked up out of 100 ritten prescriptions

69.5 Rx

Picked Up

76.5 Rx

Picked Up

Picked up Abandoned

Abandoned Abandoned10%

INCREASE

WWW.SURESCRIPTS.C


Year 20


12/2810

part 1: ElECTroniC prEsCriBing UsE

opporTUniTY ForprEsCriBErs To UsE

BEnEFiT inForMaTion

inCrEasED 87 pErCEnT

E-prescribin is reaizin its potentia to empoer pre-

scribers and pharmacists to deier hiher quait care,better medication therap manaement and improedorkfo efficiencies.

At the same time, it is enabin them to sinificantreduce prescription costs. Eiibiit can be quickchecked eectronica at the time of prescribin to hepprescribers choose medications that are on formuarand coered b a patients dru benefit.

Eectronic responses for prescription benefit informa-tion re 87 percent in 2011.

Approximate 62 percent* of patient isits inoedone or more of these responses in 2011.

On aerae, the response rate to requests for pre-scription benefit (the rate at hich information for thepatient can be returned to the prescriber) as approx-imate 80 percent in 2011, up from 69 percent in 2010.

KeY statistics

prescription beneFit inFormation

Contributing Factors:

Active Prescribers (pg. 20)

Number of E-Prescribing ApplicationsCertified for this Service (pg. 15)

74,000

43

156,000

78

234,000

137

390,000

157

Prescription Benefit Responses

54 million

2008 2009 2010

87%789 million

2011

125%422 million

248%188 million

*Accordin to the Auust 2010 Nationa Ambuator Medica Care Summar, an estimated 1.037 biion isits ere made to office-based phsicians in 2010 (data reated 2011).


13/28

Prescription benefit information is an important component of e-prescribin. Surescripts orks ith the nations pharmacbenefit manaers (PBMs) and paers to offer prescribers access to their patients prescription benefit information in rea timedurin an office isit. The Prescription Benefit serice puts eiibiit, benefits and formuar information at a prescribers fin-ertips at the time of prescribin. This enabes prescribers to seect medications that are on formuar and are coered b thepatients dru benefit. It aso informs them of oer-cost aternaties such as eneric drus.

Pharmacies sae time and resources hen the receie an appropriate eectronic prescription that eiminates unnecessarphone cas from pharmac staff to phsician practices reated to dru coerae.

Benefit information is broken into to components: eiibiit and formuar. Eiibiit determines hat insurance coeraefor prescriptions is aaiabe for a specific patient. A formuar ist is a pre-approed ist of preferred eneric or brand nameprescriptions that is coered under a heath care pan. The ist is determined b the insurance compan and chanes frequent.

bf if e:

Accurate prescriptions for eiibe dru therapies Improed patient safet

Potentia oer co-pas for patients resutin in improed adherence

Increased efficiencies for PBMs, pharmacies and prescribers

Improed dru spend manaement for paers

Near 253 miion coered-ies are connected throuh PBMs, paers and state Medicaid aencies on the Surescripts netorkhich is open to a pharmacies, paers and heath care participants. Patients can hae mutipe prescription coerae.

There ere 789 miion eiibiit responses in 2011 on the Surescripts netork. These behind the scenes eectronic connectionsto prescription benefit information add up to a more comprehensie ee of care from prescriber to pharmac. PBMs and paersain from the stron compiance enerated hen benefit information is used. Benefit information aso heps create positieoutcomes and decrease heath care costs. Thats ho e-prescribin can drie don the cost cure.

The Vue f pect Beeft ifmt

pHYsicianDru Therap Decision Made

Reies Benefit and Seects TherapE-Prescription generated

patient encounter

pHarmacY

p:

Ne PrescriptionPrescription Renea

requ

estfor

patientin

formationsenttopayer&harm

acy

resp

onse

torequestforinformationsenttophysicianpbm/paYer

pv p:

Prescription BenefitPrescription Histor

3

3

1

2

4

5

6prescriptionroutedtopharmacy

prescriptionrenewalandrequestresponse

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Year 20


14/2812


MEDiCaTion HisTorYWas aVailaBlE For onE

in THrEE oFFiCE VisiTs

in 2011

when a patient consents to share their medication histor,

prescribers can secure request and receie this infor-mation, hich aos them to better treat the patient.Medication histories are enerated secure usin certifiedendor softare under a appicabe as pertainin tosecurit and priac.*

Eectronic medication histor deieries increased 72percent in 2011.

Approximate 31 percent of patient isits eneratedan eectronica deiered medication histor in 2011.

In 2011, more than 15 miion medication historiesere deiered to cinicians orkin in acute careenironments to support transitions in care.

KeY statistics

medication HistorY




74,000

42

156,000

76

234,000

133

390,000

154

Medication Histories Delivered

16 million

2008 2009 2010

72%395 million

2011

184%230 million

395%81 million

*For information on Surescripts handin of persona heath information, pease reie our Priac Poic on http://.surescripts.com/about-us/commitment-to-priac.aspx.


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MorE THan 570 MillionprEsCripTions WErE

ElECTroniCallY roUTED

in 2011, a 75 pErCEnT

inCrEasE oVEr 2010

Prescribers are e-prescribin in record numbers. In

2011, e-prescription routin on the Surescripts netorkincreased 75 percent to 570 miion. More phsicians areexchanin prescription information eectronica andbi-directiona ith pharmacies usin endor softarecertified b Surescripts.

B the end of 2011, an estimated 36 percent* of pre-scriptions dispensed ere routed eectronica, upfrom 22 percent at the end of 2010.

More than 570 miion prescriptions ere routed eec-tronica in 2011 ersus 326 miion in 2010, a 75 per-cent increase.**

Of these, approximate 24 miion eectronic prescrip-tions ere routed to mai order pharmacies in 2011, athree-fod increase oer 2010.

KeY statistics

prescription routing




74,000

80

156,000

134

234,000

196

390,000

Connected Community Pharmacies (pg. 23) 76% 85% 91% 91%

304

Prescription Routing Transactions

2008 2009 2010

75%

2011

474 million

96 million

NEW PRESCRIPTIONS PRESCRIPTION RENEWAL RESPONSES

55 million

13 million

156 million

35 million

269 million

57 million

*Cacuation based on 52 miion e-prescriptions dispensed as a percentae of 144 miion tota prescriptions dispensed. Tota prescriptions is based on ne and renea prescrip-tions dispensed in December 2011. These fiures excude prescriptions for controed substances.

**Requests for prescription reneas are not represented in this section, as prescription renea requests do not ead direct to the issuin of prescription orders.

WWW.SURESCRIPTS.C


Year 20


16/2814


As e-prescribin routin statistics demonstrate, eectronic routin of prescriptions is current the most usedcomponent of e-prescribin compared to medication histor and prescription benefit information. Eectronicreneas aone accounted for 95 miion responses on the Surescripts netork in 2011.

Prescribers and pharmacies can help increase efficiency and reduce interruptions to prescriber and pharmacy orkflos.

tk v f h ffy f

q.

r h - y hy

f v.

e h f y hyy --.

r hz

q y.

Efficienc is a ke benefit of e-prescribinconnectiit, hich sinificant reduces thenumber of faxes and phone cas pharmaciesneed to make.

Proide the fooin detais hen reportinerrors: transaction date, name of prescriber,messae ID, prescriber SPI, pharmac NCPDP ID.

Pharmac softare endor shoud keep pre-scriber fies up-to-date as ne prescribersbecome actiated for e-prescribin. Store-b-store data updates in each store shoud beconsistent.

Prescribers shoud respond to renea requestsithin 24 hours. In an emerenc, a foo-upca in the eent of a deaed response isappropriate.

Hw t imve the Ue f pect reew

prescribers

pHarmacies


17/28

EigHTY-TWo pErCEnT oFaCTiVE prEsCriBErs UsE

EHr To E-prEsCriBE

Prescribers e-prescribe usin either eectronic heath

record (EHR) softare or standaone e-prescribin soft-are. Standaone e-prescribin softare performs onthe e-prescribin function. B comparison, e-prescribinis one of man functions such as documentation andchare capture that are interated in EHR softare.

Eiht-to percent of actie prescribers used EHRs fore-prescribin in 2011, compared to 79 percent in 2010.

Fort-seen percent of certified and depoedEHR softare as used for a three ambuatore-prescribin sericesprescription benefit infor-mation, medication histor and eectronic routinat the end of 2011.*

Some s tandaone e-prescribin sof tare endorsicense the use of their products to companies that

proide EHRs. At the end of 2011, 228 EHRs usedembedded standaone e-prescribin softare thatas certified for connection to the Surescripts net-ork, compared to 148 EHRs in 2010.

KeY statistics

eHr Vs. standalonee-prescribing soFtware

Vendor Software Certified and Deployed for E-Prescribing

EHR STANDALONE

Prescription Routing

264

2011

40

161

2010

35

Prescription Benefit

135

2011

22

110

2010

27

Medication History

132

2011

22

105

2010

28

All Three Services

127

2011

20

95

2010

25

Percentage of Active Prescribers Using EHR vs. Standalone E-Prescribing Software

2008 63% EHR

2009 70% EHR

2010 79% EHR

2011 82% EHR

*Certification for a three e-prescribin serices is comprehensie of certification for prescription benefit information, medication histor and eectronic routin serices. Routinserices incude connectiit to retai and mai order pharmacies and the abiit to manae prescription reneas eectronica.

WWW.SURESCRIPTS.C


Year 20


18/2816


iduty Cbt Dve Ctuu imvemet

Eectc pect Quty

QualitY tip 1: t v f hy k f f, h s n F.

QualitY tip 2: m h yy h , h, h f (f ).

QualitY tip 3: Qy qf y h . wh , qy hh qy qf h f h qy.

i: Spittin directions beteen the SIg and Notes fieds can causeuncertaint or ead to errors at the pharmac. Suppementar or con-fictin Si information often resuts in orkfo disruption at thepharmac and b extension at the prescribers. A pharmac ca back

for carification purposes coud, in a orse-case scenario, resut in apotentia patient safet incident.

In the United States, loastatin is commercia aaiabe in threestrenths. Prescribers shoud identif the proper strenth.e..:loastatin 40m tabet

ex f i u: Amoxiciin 250m/5m, 1 EA. In thiscase, the pharmacist does not kno hether prescriber meant 1 fuidounce or 1 botte. Een if the prescriber meant a botte, sendin anonmetric quaifier miht sti resut in confusion because Amoxiciin250m/5m ora suspension comes in three botte sizes: 80, 100 and150 m. Use instead Amoxiciin 250m/5m, 150 m.

Exampes of improper use:

Si fied1 po dailY, Notes fiedtk y.

The correct Quantit Quaifier makes it cear thatthe prescriber ants the pharmac to dispense150 m botte:

u ax 250/5, 150

10 20 40

Surescripts is focused on continuous improements in the quait of the miions of e-prescriptions and heath informationtransactions that are transmitted dai oer its netork and on utiizin industr standards that emphasize the need for aheath care technoo proiders and users to be part of the quait effort. As the industr eader in e-prescribin, our oa hasbeen ambitious from the start: to achiee 100 percent reiabiit of e-prescribin transactions from the time a prescription isprepared b a prescriber to the time the medication is dispensed b the pharmac.

B actie manain quait throuh coaboration and communication ith prescriber technoo endors, pharmacies, pharmacbenefit manaers (PBMs) and reuators; and b creatin, impementin and enforcin quait improements, the end-to-endquait of e-prescribin is reaizin continuous improements.

Constant monitorin of transactions heps to define and measure the safet, accurac and competeness of the e-prescriptionsthat fo throuh the Surescripts netork. Continuous improement is achieed b orkin ith participants, identifin theroot causes, and puttin permanent and meaninfu chanes in pace that reduce an incidents of non-conformance ith ouruideines. Cinica improements resutin from this sstemic approach to quait hae produced up to a 25 percent reductionin the number of issues identified ia the netor k.

Proress is bein made throuh education, trainin and recommended improements to prescriber softare. Beo are threeexampes of ho Surescripts is coaboratin ith the industr to continuous improe quait and the e-prescribin experiencefor prescribers, pharmacists and patients.

Surescripts cinica quait proram team of pharmacists, pharmac technicians, prescribers, technooists, and Six SimaBack Bets (Trained Quait leaders) are fu enaed in quait improements that incude increasin efficienc, aue andthe user experience.

F f s ff y qy, h s Qy off (qy@.) v ../qy.


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Futue f E-pecb

E-Prescribin groth Dries Industr Coaboration on Ne Standards and CapabiitiesSurescripts has been collaborating ith the nations pharmacies, PBMs, prescriber and pharmacy technology vendors,

and groups involved in creating industry standards on improvements and innovations that ill drive the future of e-pre-scribing. we are committed to expanding support for and enabling electronic exchange of all types of clinical information.

epcs: e p f c sIn September 2011, Surescripts bean the initia depoment of EPCS in states here EPCS is ea. Proress i be drien ban industr-ide coaboration beteen pharmacies, technoo endors, pharmac benefit manaers, Surescripts and othernetorks to pan and impement support for U.S. Dru Enforcement Administration and state pharmac board r ues.

To support the depoment of EPCS, netork participants must adhere to major DEA requirements:

p :

Use an e-prescribin appication that is audited and certified for this purpose. Compete a compiant identit-proofin process. Use a secure, to-factor authentication process to sin e-prescriptions for controed substances.

sf v h h hv v h f y :

Compete Surescripts certification and DEA-required third-part audits before connectin to the Surescripts netork for EPCS.

ph :

App updates to their softare sstems to ensure DEA and Surescripts NCPDP SCRIPT adherence for EPCS.

a s w H mv c iy FThe abiit to communicate eectronica to other heath care proiders beteen (or ithout) EHRs, and across reiona net-orks and heath sstems means that heath care proiders can exchane cinica information more quick and efficienthie improin patient care. Cinica interoperabiit soutions hep b aoin phsicians and other heath care proiders tosecure send and receie cinica information eectronica ith peers oca, reiona and nationa. Surescripts and manother oranizations hae coaborated ith the federa oernment to create the standard protocos needed to make this tpeof eectronic cinica communication possibe. The Surescripts netork supports a federa and state poicies and standardsfor heath information exchane, incudin priac and securit standards (such as HIPAA and state a), technoo interoper-abiit standards (such as Direct) and messae tpes (such as Hl7).

e p ahz f p dEectronic prior authorization (ePA) is ieed as a a to

address the need for prescribers to obtain approa for pre-scriptions that are subject to cosed formuar, step-therapreimen, off-abe use or other pan benefit parameters andeiminate the inefficiencies of paper-based prior authorizationprocesses (PA) that create sinificant administratie burdensfor prescribers and pharmacies.

In October 2011 the Nationa Counci for Prescription DruProrams (NCPDP) reactiated its Prior Authorizationworkfo-to-Transactions Task group. In addition, industrpiots ere initiated and coaboration throuh NCPDP contin-ues to date. Humana, Aadia, CvS/Caremark, Surescripts,CoerMMeds, McKesson and Ibeza are reiein draft stan-dards, coaboratin on enhancements, and shoud soon pro-

duce an ePA standard that i be usefu to a.

Standardized proce-dures for requestinPA. Impementation

are needed.

Standardized informa-tion and impementa-

tion uideines areneeded for consistent

communications.

Modified PAprocessin; Minimize

frequenc ofunnecessar PA.

Provider Pharmacy Payers

Collaboration on Standardized Procedures and Proper

Use of ePA Needed for all Stakeholders

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part 2:E-prEsCriBing aDopTion

The C f 2008: Tck the gwth f Mefu UeAs much as 60 Percent of Phsicians who Started E-Prescribin in 2008 Meet Stae 1 Meaninfu UseE-Prescribin Measure; 38 Percent of This group woud Meet the Proposed Stae 2 E-Prescribin Measure*

summarYA recent anasis of a cohort of phsicians ho adopted and bean usin e-pre-scribin in 2008 produced four findins. Summar of findins: 1) Estimates shothat the majorit, as much as 60%, of those prescribers hae successfu met thestae 1 meaninfu use e-prescribin measure*; 2) 38 percent of these earusers oud meet the proposed stae 2 meaninfu use e-prescribin measure*if it ere no in effect; 3) phsicians use of e-prescribin increases oer time(see Fiure 2) 4) that e-prescribin as utiized at a hiher rate b prescribersho used EHR softare compared to standaone softare users.

bacKgroundIn order to spur idespread adoption of certified eectronic heath record (EHR)technoo, the federa oernmentthrouh the Heath Information Technoofor Economic and Cinica Heath Act (HITECH)is proidin up to $30 biion inincenties for prescriber adoption and meaninfu use of certified EHR techno-o. The Centers for Medicare and Medicaid Serices (CMS) is responsibe foradministerin the EHR incentie proram and deeopin objecties and mea-surement criteria that eiibe proiders must meet in order to quaif for an EHRincentie pament(s).

E-Prescribin is one of the core objecties for stae 1 of meaninfu use, hichrequires more than 40 percent of an eiibe proiders prescriptions to be routedeectronica.

To date, CMS has made cose to $4 biion in paments to eiibe proiders andhospitas that hae met the meaninfu use measure of certified EHR technoo.CMS is proidin reportin in a transparent manner on paments made, to hom,and hich EHR endors the use.

metHodsSurescripts anazed prescriber adoption and utiization data from the Surescriptsnetork. Prescriber demoraphic data as matched to SK&A prescriber data inorder to sement b speciat and practice size. we used areate IMS Heathdata about prescriber oume to create modes of estimated aerae tota pre-scription oume per prescriber b speciat and matched that to our ist of pre-scribers. The data shoed a count of 48,993 prescribers ho adopted and beanusin e-prescribin beteen Januar 1, 2008 and December 31, 2008. The dataas further semented b e-prescribin sstem (EHR ersus standaone) andspeciat tpe for 39,798 actie e-prescribers (Fiure 1). Prescribers practiced in50 states and nine districts and U.S. territories. Modes ere deeoped to ana-ze actie e-prescribers use and the number of ear e-prescribers ho oudhae met the stae 1 meaninfu use e-prescribin measure and proposed stae2 measure (not in effect) b fourth quarter 2011.

resultsB December 2008, Surescripts estimates that beteen 6,927 and 8,129 prescrib-ers (17.4 percent to 20.4 percent of actie e-prescribers) met the more than 40

2008 e-prescribing

adoption bY Quarter

Q1 2008 5,626

Q2 2008 7,074

Q3 2008 10,092

Q4 2008 17,006

t 39,798

e-prescriptions per

actiVe e-prescriber

(aVerage per montH)

Q1 2008 49

Q2 2008 78

Q3 2008 82

Q4 2008 94

Q1 2009 125

Q2 2009 132

Q3 2009 139

Q4 2009 153

Q1 2010 160

Q2 2010 160

Q3 2010 163

Q4 2010 178

Q1 2011 198

Q2 2011 197

Q3 2011 200

Q4 2011 213

F 1: Adoption and Use of E-Prescribinb Quarter Q1 thru Q4 2008

F 2: Use of E-Prescribin per ActieE-Prescriber per Quarter 2008-2011


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percent stae 1 meaninfu use proram measure. B December 2011, these numbers increased to 21,392 to23,877 prescribers (53.8 percent to 60.0 percent of actie e-prescribers), Fiure 3. The modes aso suest that15,146 prescribers (38.1 percent) oud hae aread met the proposed 65 percent threshod in the proposed stae2 meaninfu use measure (not current in effect).

The resuts aso found that e-prescriptions per actie e-prescriber increased oer time. In first quarter 2008, theere an aerae of 49 per month. B fourth quarter 2011, the had reached an aerae of 213 per month.

Fami practitioners demonstrated the hihest indiidua utiization ees ith 316 e-prescriptions per month. Theaso appeared to hae the hihest ee of successfu meetin the stae 1 meaninfu use e-prescribin measureof an speciat ith an estimated speciat utiization rate of 69 percent to 74 percent. The ere fooed b inter-nists at 303 e-prescriptions per month and a speciat utiization rate of 67 percent to 72 percent (Fiure 3).

The majorit of prescribers (80.2 percent) ho adopted and bean usin e-prescribin in 2008 did so usin an inte-rated EHR softare sstem. The data indicates that phsicians usin EHR softare had sinificant hiher e-pre-scription utiization ees (+53 percent) than prescribers usin standaone e-prescribin sstems. Up to 67 percentof the e-prescribin phsicians usin an EHR ere more ike to meet the stae 1 meaninfu use e-prescribinmeasure ersus an estimated 44 percent to 50 percent of e-prescribers usin standaone e-prescribin sstems.

discussionThe requirements for stae 1 meaninfu use e-prescribin measure hae been ide commented on and debatedb heathcare stakehoders, as the hae sinificant impications in terms of proider adoption, use, and reim-bursement. The EHR incentie proram is a primar mechanism the oernment is usin to infuence the use ofheath information technoo to improe heath care outcomes and oer costs.

This anasis of adoption and use data suests that a majorit of proiders* ho bean e-prescribin in 2008 (54percent to 60 percent) are in a position to meet the stae 1 meaninfu use e-prescribin measure hie 38 percentof this roup oud meet proposed stae 2 meaninfu use e-prescribin measure.

sy n fp

av uz(mhy)

p f pm mf u(s 1)

Fy p 12,416 316 69% to 74%

i 6,474 303 67% to 72%

p 2,627 157 55% to 67%

g p 2,293 139 33% to 43%

cv d 1,994 135 58% to 70%

o/gy 1,453 91 59% to 70%

ohh 1,082 62 27% to 27%

pyh 822 114 38% to 45%

g 771 88 38% to 54%

o/gy 762 83 51% to 59%

oh 9,10495

33% to 36%

eHr v. s e-p

eHr 31,902 222 60% to 67%

s e-p 6,976 144 44% to 50%

ESTIMATED PERCENT OF EARLY USERS OF E-PRESCRIBING BY PHYSICIAN SPECIALTY WHOHAVE SUCCESSFULLY MET THE STAGE 1 MEANINGFUL USE E-PRESCRIBING MEASURE

WWW.SURESCRIPTS.C


Year 20

F 3: Estimated Stae 1 Meaninfu Use E-Prescribin Measure Met b Ear Users from 2008*

*References to meetin stae 1 meaninfu use e-prescribin measure or stae 2 meaninfu use e-prescribin measure, as proposed but not current in effect, aso assume that the

user met the requirement for participatin as an eiibe proider.


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FiFTY-EigHT pErCEnToF oFFiCE-BasED

pHYsiCians

E-prEsCriBE

In 2011, 390,000 phsicians, nurse practitioners and

phsician assistantsthe majorit of prescribersmade e-prescribin a mainstream heath care informa-tion technoo in the United States. Prescribers useeither standaone e-prescribin softare or an eectronicheath record (EHR) to e-prescribe. A prescribersdescribed in this section of the Report used prescriptionroutin serices. A portion of these prescribers asoused prescription benefit information and medicationhistor serices.

B the end of 2011, 390,000 prescribers routed pre-scriptions eectronica, up from 234,000 at the end of2010. This represents about 54 percent of a office-based prescribers.*

Of these 390,000 prescribers, 317,000 ere phsicians.

Surescripts estimates that approximate 58 percentof actie office-based doctors nationide aree-prescribin.

KeY statistics

prescribers


% of Active Prescribers Using EHR (pg. 15) 63% 70% 79% 82%

Prescribers Routing Prescriptions

2008 2009 2010 2011

67%

390,000

74,000

109%

156,000

50%

234,000

*Based on tota count of 718,193 office-based prescribers, per SK&A data. Surescripts counts of actie e-prescribers represent those that used ambuator prescription routin

serices ithin the ast 30 das of 2011. A sma proportion of these prescribers hae been reistered b hospitas and other oranizations that do both ambuator and acute care.


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ninETY-onE pErCEnToF THE naTions

CoMMUniTY pHarMaCiEs

aCCEpT E-prEsCripTions

Surescripts orks ith communit pharmacies in the

United States. Communit pharmacies incude chainpharmacies and independent oned pharmacies. Inaddition, PBMs and some chain pharmacies operate maiorder pharmacies.

Prescription routin connectiit ies prescribers theabiit to send ne prescriptions eectronica to thecomputer sstem at the pharmac of the patients choice.Pharmacies ain the abiit to send prescription renearequests to the practices e-prescribin softare forreie and an eectronic renea response, hich proidesefficienc to the prescriber and pharmac, and conenienceto the patient.

Ninet-one percent of communit pharmacies in theUnited States ere connected for prescription routinin 2011.*

More than 98 percent of chain pharmacies and 79 per-cent of independent pharmacies ere connected to theSurescripts netork for prescription routin in 2011.

There are 62,461 communit pharmacies in the UnitedStates represented b both chain and independentoned pharmacies.** Of these, about 64 percent arechain pharmacies and 36 percent are independentoned (incudin those that are part of buin roups).

Six of the arest mai order pharmacies ere abe toreceie prescriptions eectronica.***

KeY statistics

pHarmaciescommunitY andmail order


Community Pharmacies Connected 76% 85% 91% 91%

Independent Pharmacies Connected 46% 62% 73% 79%

Community Pharmacies Connected for Precription Routing

2008 2009 2010 2011

CHAINS INDEPENDENTS

36,000

10,000

39,000

14,000

39,600

16,000

39,300

17,600

*In addition to retai and mai order pharmacies, Surescripts aso connects some pharmacies associated ith federa and state oernments and ith medica deice manufactur-ers. For a ist of e-prescribin pharmacies, o to .Surescripts.com/connected-pharmacies.htm.

**Based on NCPDP data anasis.

*** CvS Caremark, Express Scripts (wePoint, NextRx), Medco Heath Serices, Prescription Soutions, Prime Therapeutics (Prime Mai) and wareens Mai Serice.

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TWEnTY-FoUr sTaTEssHoWED inCrEasEs in

aCCEss To prEsCripTion

inForMaTion in 2011 WHEn

sElECTing MEDiCaTion

THErapY

Priate paers and their associated pharmac benefit

manaers (PBMs) proide important prescription benefitand medication histor information to prescribers throuhendor softare connected to the Surescripts netork.

The aaiabiit of prescription benefit information andmedica histor ao prescribers to treat patients moreeffectie.

As more prescribers enabe medication histor and pre-scription benefit information, dru formuar compianceand patient safet i improe on a state-b-state as eas a nationa basis.

For a ist of paers and PBMs that are connected to Surescripts, peaseisit http://.Surescripts.com/about-us/connected-paers.aspx.

More than 66 percent of patients in the United Statesat the end of 2011 ere proided access to prescriptionbenefit and medication histor information (on behafof paers and pharmacies).*

B the end of 2 011, participation b paer s ine-prescribin aoed prescribers to ocate and access

near 253 miion member records (patient-ies)from participatin heath pans.**

In 2011, Surescripts proided access to more than30,000 formuar fies, incudin formuar status,coerae, co-pa and aternatie medication istsmaintained b participatin heath pans.

KeY statistics

paYers

percentage oF patients For wHom paYers can proVideprescription beneFit and medication HistorY inFormation

4150%

31-40%

21-30%

5160%

6170%

71 80%

8190%

91100%

AL

CT

RI

VT

MA

NH

DE

MD

NJ

MI

AR

LA

MS

IL

IA

MN

NY

PA

WV

VA

NC

SC

IN OH

KY

FL

GA

AZ

ID

TN

MT

WY

WI

ND

SD

CO

NM

TX

OK

ME

KS

NE

MO

CA

OR

WA

NVUT

AK

HI

DC

PR

*Cacuated b takin the number of records, ess 19 percent for patients ho hae more than one source of prescription benefit coerae, and diidin it b the U.S. popuation of 309miion. Fiures incude the District of Coumbia, Puerto Rico and U.S. territories. U.S. popuation fiures are from Annua Estimates of the Resident Popuation for the United Statesand Puerto Rico, Popuation Diision, U.S. Census Bureau Reease, Ju 1, 2010. Surescripts suests that paers can proide a medication histor for an estimated 95 percent of the

patients for hom it can proide prescription benefit information. This is because some pharmac benefits, hen offered as a care-out, are not associated ith a caims-basedmedication histor.**This fiure is incusie of records from a 50 U.S. states and the District of Coumbia.



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part 3:aBoUT sUrEsCripTs

abut suect

The Surescripts netork supports the most comprehensie netork of heath care oranizations in the UnitedStates. Pharmacies, paers, pharmac benefit manaers (PBMs), phsicians, hospitas, heath informationexchanes and heath technoo firms re on Surescripts to secure share heath information across theheath care continuum.

guided b the principes of priac, securit, neutrait, choice, transparenc, coaboration and quait, Surescriptsoperates the nations arest heath information netork. B proidin patient medication information for routine,recurrin and emerenc care, Surescripts is committed to sain ies, improin efficienc and reducin thecost of heath care.

For more information, o to .Surescripts.com and foo us at titter.com/Surescripts.

th s e p nkSurescripts connects prescribers in a 50 statesthrouh their choice of certified e-prescribin softareto thenations eadin paers, chain pharmacies and independent pharmacies.

An e-prescribin softare proiderincudin those offerin standaone e-prescribin soutions and those thatinterate e-prescribin capabiities into eectronic heath record sstemsma connect their customers toSurescripts secure nationide e-prescription netork, as on as the hae successfu competed Surescriptsimpementation and certification process. This process aidates that the certified softare is abe to send andreceie eectronic messaes in accordance ith industr standards.

Surescripts certifies softare used b prescribers, pharmacies, and paers/PBMs for three main serice capabii-ties: prescription benefit information, medication histor and prescription routin.

WWW.SURESCRIPTS.C


Year 20

ackwedemet

Surescripts oud ike to thank Circe Square Inc., the Nationa Association of Chain Dru Stores Economics Depart-ment and SK&A for their expertise and sinificant contributions to the 2011 Proress Report on E-Prescribin.

F f s, v .s. f ./s.

Designed by Curran & Connors, Inc. / www.curran-connors.com


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2800 CRySTAl DRIvE

ARlINgTON, vIRgINIA 22202

T: 866.797.3239 | F: 703.921.2191

920 2ND AvENUE SOUTH

MINNEAPOlIS, MN 55402

T: 866.797.3239 | F: 651.855.3001

national progress report on e prescribing year 2011

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