The slow road to e-Rx: Is it even feasible right now for LTC?May 8th, 2013 by
A goal of the American Recovery & Reinvestment Act of 2009’s HITECH Act is to encourage the use of electronic prescribing for medications or e-prescriptions. This requires parties to establish standard nomenclature and exchange standard messages.
Creating this environment in the long-term care (LTC) world is turning out to be very slow and difficult for a couple of reasons.
First of all, e-prescribing is a subset of CPOE (computerized provider order entry). When the HITECH Act was written, there were very specific standards set for CPOE in regards to ambulatory physician offices and hospitals. But no standards were set for the LTC environment – either because it was overlooked or ignored.
This presents a problem for vendors who want to design and sell software to LTC. These companies can only offer products that their clients find useful. Inventing a standard for LTC and then writing one is something that software companies are reluctant to do because they know sooner or later LTC standards will be set.
Second, LTC facilities aren’t required at this point to follow any standards. The Certification Commission for Health Information Technology (CCHIT), which in the past has created very high standards for hospitals and ambulatory physician offices, has developed standards for LTC but these standards have yet to be recognized by the government. As you may recall, the demanding standards that CCHIT set for physicians and hospitals were eventually “dumbed down” by the Office of the National Coordinator (ONC) when it created the “official public standards” recognized by the government.
So why should anyone in the LTC realm strive to meet the more exacting CCHIT standards when they consider what happened with the ONC?
In the absence of official LTC standards, most LTC facilities and their pharmacies have not supported e-prescribe.
Over 90 percent of LTC facilities don’t use any EHRs that conform to any national standards. In fact, most LTC patients come from the hospital – and their drug orders come with them – on paper. If LTC physicians want to e-prescribe, they will have to enter all of these medications – typically 10 to 15 — into their system. This usually occurs before they even see the patients, which has been called an “insurmountable task” by the physicians we’ve surveyed.
The first public standard is beginning to penetrate the realm of LTC. This standard, which comes from the National Council of Prescription Drug Programs (NCPDP) 10.6, is not mandatory for use, but is required if LTC facilities choose to support e-prescribe. It’s essentially an updated standard that includes more elements that are necessary for prescriptions in the LTC world, such as room number, specific medication dispensing times, etc. The November 2014 adoption date for this standard was finalized as part of the 2013 Medicare Physicians’ Fee Schedule.
Unfortunately, there is no silver bullet when it comes to figuring out e-prescribing in the LTC setting. The inherent challenges and need to address them are probably the reason I ended up being selected as an advisor for the Centers for Medicare and Medicaid’s Innovation Advisors Program. My project is to create a model for e-prescribing in the LTC world.
We’re now working on how do we get all of these activities standardized.