Centers for Medicare & Medicaid Services Special Study – Pilot Testing of Electronic Prescribing Standards

This project, part of five grants awarded by the Agency for Healthcare Research and Quality to conduct electronic prescribing (e-prescribing) pilots, tested e-prescribing standards within small, community-based practices. In addition, the study evaluated the impact of e-prescribing on workflow, patient safety, and drug utilization. Five standards listed in the objectives below were tested.

The main objectives of the project were:

• To assess the impact of electronic prescribing on workflow in small, primary care practices.
• To measure the impact of electronic prescribing on patient safety and drug utilization in those practices.
• To test initial standards including Medication History, Fill Status Notification (RXFILL), Prior Authorization (ePA), Structured Sig, and RxNorm.

The study evaluated 25 e-prescribing primary care practices associated with University Hospitals Medical Practices in Cleveland Ohio, and 22 non-e-prescribing practices located throughout northeast Ohio. The two groups were compared in order to establish differences in culture, workflow, and efficiency, and their impact on adoption of e-prescribing. Production tests were conducted to determine the functionality of the Medication History, RXFILL, and ePA standards, and to obtain prescribers’ opinions their use. Laboratory tests were conducted to assess the functionality of the Structured Sig and RxNorm standards.

The study team found a significant lack of interoperability between the existing New Order Transaction (NEWRX) standard and RXFILL due to the lack of an originating order number. Medication History was found to be a mature and stable transaction. There was major concern about patient identity matching. Transactions of ePA were successful, and the process was well-received by office staff. However, when ePA was expanded to additional drugs and health plans, substantial work on the part of health plans and RxHub was required. It was noted that Structured Sig and RxNorm are not ready for adoption in their current state. The evaluation indicated that e-prescribing has a positive effect on patient safety. The study concluded that more analysis is required in order to accurately assess the impact of e-prescribing on cost, formulary compliance and generic usage.