Lumetra Healthcare Solutions

One of the visions of the California Health Care Safety Net Institute, the research and educational affiliate of the California Association of Public Hospitals and Health Systems, is the promotion of e-prescribing (eRx) as part of electronic health records as a standard of care. Lumetra Healthcare Solutions, under a subcontract with Manatt Health Solutions, has been assessing the impact and lessons learned of pilot programs at Kern and San Mateo Medical Centers, both of which implemented an eRx program last year.

Results of the study will determine how and when eRx is rolled out to other safety net institutions here in California.

Lumetra Healthcare Solutions was charged with several tasks:

• Conducting workflow assessments prior to implementation.
• Offering technical assistance during implementation and system go live.
• Developing and capturing operational efficiency measures for the project.
• Measuring the return on investment of eRx for clinics and internal and independent pharmacies.

Nationally, the focus on eRx continues to increase and this project, as with others, has yielded some remarkable successes:

1. Volume of electronic prescriptions and user adoption has increased rapidly over a six-month period of time, providing value through the elimination of ‘legibility’ issues. Within two months of eRx adoption, approximately 1,500 e-prescriptions were transmitted weekly, and the e-prescription volume increased by as much as 75% over the next 3 months.
2. Crowded pharmacies and patient wait times for medications have been reduced, based on the rapid routing of eRx data, especially to the internal pharmacies of public hospitals.
3. Time has been saved for patients’ receiving refills due to the following:
4. Pharmacy callback time is decreased when a physician writes a script knowing which appropriate formulary medication will be covered.

• The ability to link the patient’s medication profile with their electronic medical record, thereby reducing the time needed to search for the patient’s chart and deliver it to the physician’s desk, and
• Minimizing the time needed for the physician to read through the chart to get to the appropriate area of the file.

Although the study is still ongoing, several ‘lessons learned’ and key recommendations have arisen:

1. Pharmacy involvement at a detailed level has been critical for success. In particular, the need to perform full cycle testing of eRx routing and understanding data transfer between the eRx and pharmacy systems is vital to a smooth transition. Pharmacist, physician, and staff input in workflow are crucial to building a system that is functional for the everyday staff.
2. Preparedness for transaction costs within internal pharmacies and those pharmacies associated with the 340b drug pricing program is critical in creating expectations for financial impact. In the case of public hospitals, one must assess the costs, both business and technical, of SureScripts routing versus other direct means of prescription routing, where an internal pharmacy is involved.
3. Coordinate with the software vendor so as to leverage system reports and metric tracking of target areas for rapid cycle improvement that may include everything from system configuration enhancement to additional user training.
4. Create an environment of open feedback and adaptation in order to refine the prescribing and routing workflow process over time. Regular meetings must be scheduled during the actual ‘go live’ period to address workflow issues and bugs before staff can create ‘work-arounds.’ Current state and future state workflow mapping, while effective, may never catch ‘what if’ realities that occur on an ad hoc basis
5. Understanding and coordinating the drawbacks of eRx relating to the prescribing of controlled substances and how this variance in workflow integrates into the new electronic environment. (Note: the DEA has published an interim final rule on March 31, with a comment period of 60 days, to permit electronic prescriptions for controlled substances.)

Failure to address any of the points noted above can result in additional cost and frustration, time, and effort.