This is a complete article from the Federal Telemedicine NEWS.
   Get FREE Subscription Here.

The Capitol Hill Steering Committee on Telehealth and Healthcare Informatics speakers on December 5th highlighted the new FCC Rural Health Care Pilot program, provided new thoughts on e-prescribing, and explained how a large multi-subspecialty academic physician practice effectively uses technology.

Jake Jennings, Associate Chief, Wireline Services Bureau, FCC said that deploying broadband to connect healthcare systems is one of the Commission’s top priorities. The FCC Rural Health Care Pilot Program (RHCPP) recently released $417 million in funding to help construct 69 statewide regional broadband telehealth networks in 42 states and three U.S. territories. The RHCPP program will support the connection of more than 6,000 public and non-profit healthcare providers nationwide to the networks.

Some of the projects will develop large networks, some small networks, but essentially the program will provide connections to isolated regions. The projects will also help to provide opportunities for rapid response to public health emergencies if there is a bioterrorism attack, a pandemic, or a disease-related outbreak.

Jennings continued to say that applicants were encouraged to design and provide for self-sustaining networks. All of the projects were competitively bid and are subject to reviews, oversight, and audits. Applications came from many states and some projects cover the entire state like California. After the pilot is concluded, hopefully the findings and the results from the pilot program may lead to a permanent program.
 
Harry Reynolds, Vice President, Blue Cross Blue Shield of North Carolina, gave details on the BCBSNC e-prescribing program called “ePrescribe”. The goal in 2007 is to have existing providers increase their use of e-prescribing by 50%. There are no immediate plans to deploy the system to additional providers until improvement is demonstrated among existing providers.

The program’s three vendors DrFirst, Allscripts, and ZixCorp targeted high volume prescribers in primary care and high-prescribing specialties. The project cost $2.1 million to provide for 1000 doctors and costs up to $1,200 per targeted provider. BCBSNC provided up to a one year subscription to an electronic prescribing application, provided installation, workflow consultations, and training.

The results for the 950 prescribers currently participating show:

• Over one million e-prescriptions have been written for North Carolinians since February 2006
• 50% of e-prescriptions received a drug-drug interaction warning causing 10% of the prescriptions to be changed or cancelled
• 1% of e-prescriptions received a drug-allergy interaction warning causing 35% of the prescriptions to be changed or cancelled
• 32% of the e-prescriptions received a formulary alternative message causing 15% of the prescriptions to be changed or cancelled
• Over 50,000 total prescriptions were modified due to information that was available to the doctor
  
  

The feedback shows that provider recruitment was slower than anticipated compared to the vendor’s experiences in other markets. Results showed that there was more electronic medical records used with eRx penetration in North Carolina than projected, managing processes and data among the three vendors took significantly more time than anticipated, plus detailed tracking is important to do to report on the project and for budgeting purposes.

In general, it was found that e-prescribing makes a positive difference and provides for improved safety and lower costs. Provider feedback showed that the system’s overall satisfaction in delivering new and renewing prescriptions is very high at 70% to 80%. There has been praise for the system and one pharmacist reports that the system is truly making a difference in minimizing prescription errors and hopes that more physicians will use e-prescribing.   

John Carroll, working as a consultant to the Association of Public Health Laboratories, discussed how the Public Health Laboratory Interoperability Project (PHLIP) can help the Public Health Laboratories to communicate and speak the same language. Public Health Laboratories at all levels are facing challenges in efficiently and need to effectively share data among themselves and with their clinical and private sector partners.

Since October 2006, PHLIP participants have established the framework and infrastructure to support the electronic exchange of laboratory data between six states (Colorado, Florida, Iowa, Michigan, Nebraska, Virginia) and CDC. Carroll pointed out that what PHLIP is doing for Public Health Laboratories compares to what the banking industry did in the last century to enable everyone to use their ATM card everywhere.

Harmonizing vocabulary and standardizing messaging is very important. Right now, 100 laboratories working separately could all correctly code their local tests and test names using LOINC and SNOMED. However, this process could generate 100 different electronic messages for the same tests and the 100 laboratories still wouldn’t be able to share data.

So it is vital that the tests performed at Public Health Laboratories be systematically summarized and categorized. The benefits for standardizing information would improve data quality and accessibility, reduce unnecessary or redundant lab testing, improve the efficiency for exchanging lab information, and assist in providing active surveillance. Right now, work groups are not only working on vocabulary and messaging but also on messaging implementation, data exchange, and state to state exchange.

Bob Elson, M.D., MS, Chief Medical Officer Eclipsys, formally directed the Cleveland CMS e-prescribing pilot, a year long project designed to characterize e-prescribing adoption and workflow in small physician practices as well as testing e-prescribing transactions for inclusion in the final Medicare e-prescribing rules.

The pilot program conducted through an interagency agreement between CMS and AHRQ was funded as a Special Study Contract with Ohio KePRO to focus on 25 e-prescribing primary care practices associated with University Hospitals Medical Practices (UHMP) in Cleveland, Ohio as well as 22 non e-prescribing practices located throughout Northeast Ohio. The eRx package was offered free to all UHMP practices and there were minimal equipment requirements. The goal was to assess the impact of electronic prescribing on workflow and measure the impact on patient safety and drug utilization.

The pilot program found that out of the 25 practices that adopted e-prescribing, there were about 100 physicians that were potential users. Also, small community-based practices are able to rapidly adopt eRx with advanced transaction capabilities, and the practices found that benefits included lower costs, reduced return phone call volume, and provided for more staff satisfaction. The pilot program found that physicians in practices that emphasize quality of care, autonomy, and are business orientated have higher use rates.  

Dr. Elson referred to SureScripts new National Progress Report on e-prescribing that indicates while there is a strong growth in e-prescribing, the technology remains under adopted and underutilized. In 2007, 35 million prescriptions and refills were transmitted electronically using the SureScript network, and it is anticipated that 100 million e-prescriptions will be transmitted in 2008.

Currently, there are over 35,000 healthcare providers actively using e-prescribing through the SureScript network. According to the report, 97% of the chain pharmacies and 27% of individually-owned pharmacies now use e-prescribing. Of the community pharmacies that are not currently using e-prescribing, SureScripts estimates that 86% have the capability to e-prescribe but right now only 2% are sending in new prescriptions and renewals electronically.

According to SureScripts there are more than 150,000 e-prescribers in the U.S. using software electronic medical record systems to send new prescriptions and process renewals by fax instead of electronically. Most of these physicians are unaware that their EMR is generating only faxes to pharmacies and not electronic messages. There is a need for these physicians to develop true e-prescribing in the next 18 months.

Stephen Badger, CEO, George Washington University Medical Faculty Associates described technology use from the viewpoint of a large multi-subspecialty academic physician practice affiliated with George Washington University in Washington D. C.
He reports that the practice with over 300 physicians and sees over 1,500 patients per day by using electronic health records and a patient portal for communication.

The technology has enabled the entire ambulatory practice to go paperless, allows lab results to be sent electronically to physicians for review and follow-up, allows for phone messages to be sent electronically to the physicians, and very importantly enables problem lists and allergies to be loaded and shared across practices when using e-prescribing.

The use of technology improves practice performance in a number of ways:

• Claims are electronically sent to 80% of the payers, and funds are electronically wired into accounts for 70% of the payers
• Biometrics is used to sign-on and to verify tasks while enhancing security
• Reporting capabilities are robust to allow business and clinical data to be mined
• Voice recognition is used
• Clinical devices connected to the electronic health record system improve training and ease the capture of data. For example, EKG’s vital signs, and weight are interfaced into the EHR with two key strokes, eliminating the potential for data entry errors by staff.
  
  

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), and Representatives Eric Cantor (R-VA) and Rick Boucher (D-VA). Three new Honorary Co-Chairs including Representatives Bart Gordon (D-TN), David Wu (D-OR), and Phil English (R-Pa) were added in 2007. The Steering Committee also coordinates many activities with the House 21st Century Health Care Caucus, Co-Chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

For more information on future sessions, contact Neal Neuberger, President, Health Tech Strategies at (703) 790-4933 or email nealn@hlthtech.com.