VITL’s electronic service purported to cut costs and limit errors from illegible prescriptions
Program incentivizes doctors to use ePrescribe instead of paper scripts
MONTPELIER – Puzzled Montpelier Pharmacy customers found the aisles thronged with men in suits Friday morning. An elderly woman looked around and asked, “What’s going on?”
The occasion was the announcement that Senator Patrick Leahy has secured a $1 million federal grant for Vermont Information Technology Leaders. Much of the grant will be used to make electronic prescribing available at no cost to Vermont physicians through a statewide initiative called ePrescribe Vermont.
The grant – a fifth of VITL’s current budget – will also be used to help some 40 independent retail pharmacies adopt the technology needed to receive electronic prescriptions and to enable Vermont hospitals to accept electronic laboratory orders from physicians.
Leahy is known as “Cyber-Senator” because of his enthusiasm for technology, his press secretary, David Carle, observed, and he’s long been a leader in issues involving medical records privacy. In 1994, Leahy held Congress’ first hearing on computerized medical records, and he was the author of the privacy protections in the Health Insurance Portability and Accountability Act. His staff meets four or five times a year with VITL’s coalition, Carle said. He added that in fiscal year 2008, Leahy secured a grant of nearly half a million dollars for VITL.
VITL was created by the legislature in 2005 to develop the state’s health technology plan and health information exchange. The state-funded nonprofit is now building the infrastructure for Vermont’s chronic care information system, the backbone of the Blueprint for Health, and to ensure that the Blueprint can be fully implemented, it is helping physicians make the transition to electronic health records.
According to the Institute of Medicine, 1.5 million Americans are harmed by preventable medication errors every year, and 7,000 die. Many of those errors can be traced to illegible prescriptions. The IOM estimated the financial cost of medication errors to hospitals alone at $3.5 billion a year, and in its 2006 report, it recommended e-prescribing as a way to reduce such errors.
VITL’s chief executive officer, Dr. David Cochran, noted in introducing ePrescribe Vermont at the pharmacy that not only does electronic prescribing eliminate legibility problems, but the e-prescribing software checks for drug interactions and allergies – a feature that can prove a life-saver for patients who take a number of medications prescribed by different physicians.
VITL laid the groundwork for ePrescribe Vermont two years ago when it implemented its medication history service.
Insurers keep electronic records of all the prescriptions they pay for, so individual medication histories exist for everyone who has filled a prescription paid for by insurance. In 2007 VITL developed a system that enables emergency rooms to access (with patients’ permission) electronic insurance-claims data and to receive a list of prescriptions that the patient filled. The list is known as an electronic medication history. A doctor sending an electronic prescription uses the same VITL service.
Because VITL persuaded all four major Vermont payers – Blue Cross/Blue Shield, MVP Health Care, Cigna and Vermont Medicaid – to participate in the project and make their claims data available, medication histories, formulary information and benefit details are already at hand for more than 500,000 Vermonters. At 82 percent of the population, this is one of the highest rates in the nation.
Dr. Anthony Williams, an internist who has a solo practice in Berlin, said he has been using electronic prescribing “avidly” for six months. “Primarily, I do it for patient safety,” he explained. “It’s hard when you’re tired or sleep-deprived or you’re busy – you don’t always pick up on these things.” A lot of the cost savings will come from fewer patients ending up in the emergency room because of mistakes, he said.
VITL negotiated a statewide license with Allscripts that allows all Vermont physicians to use its ePrescribe software. Allscripts ePrescribe is a Web-based, stand-alone product – that is, it’s not part of an electronic medical record – that can be used on any device that has a Web browser, including an iPhone.
Allscripts is a national clinical information technology company that has 170 employees at its Burlington site. According to VITL, the company leads the nation in the number of end-users and prescriptions delivered electronically. Allscripts will provide telephone support to ePrescribe Vermont users, and VITL will provide on-site training and support.
Williams gave an e-prescribing demonstration with a laptop and a large screen set up on the pharmacy’s counter. “I got a C in handwriting in middle school – I was destined to be a physician,” he quipped.
Williams illustrated ePrescribe Vermont’s features using three examples from the imaginary Allscripts family.
Jane Allscripts had a strep throat, and Williams decided to give her a prescription for Erythromycin. He clicked on “type,” a tablet; hit “sig” for the directions; and selected the number of pills. A Drug Utilization Review screen popped up showing Jane had already received Erythromycin.
Doug Allscripts, the next patient, also had a sore throat. Williams attempted to prescribe Erythromycin for Doug, but the Drug Utilization Review popped up again: Doug was taking Coumadin, and the two prescriptions would produce a severe interaction.
Williams could override the program, but instead he deleted the Erythromycin from the electronic “script pad,” clicked on Amoxicillin, printed out directions for the patient and sent the prescription to the Montpelier Pharmacy.
The last patient, Betty Allscripts, had a bad sinus infection. Williams decided to give her Vantin, a good, but expensive, antibiotic. A red smiley-face popped up, along with formulary alternatives suggested by Betty’s insurance company. Williams chose a cheaper drug.
The system is quick, Williams noted. “I can generate a prescription as quick, if not quicker, using this system as opposed to writing a paper prescription, so time is not a barrier,” he said.
In addition to improving patient safety, there’s a monetary incentive to switch to e-prescribing: Medicare pays a 2 percent bonus for using the technology – an incentive that can amount as much as $4,000. But by 2012, the payments will turn into penalties. VITL hopes to have all physicians in the state using ePrescribe Vermont before then.
Currently, 18 percent of about 1,600 practicing physicians in Vermont prescribe electronically. Leahy compared the adoption of e-prescribing to the adoption of e-mail. “Ultimately, everybody’s going to have to use it because it’s efficient. It’s going to save money.”
Patients are enthusiastic about the technology because their prescriptions are ready by the time they get to the pharmacy, Williams said. That and the Medicare incentive make adopting the technology “a classic no-brainer,” he declared.
