E-Prescribing

Background

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 had a profound legislative and regulatory impact on e-prescribing. The act provides a prescription drug [Page 371]benefit (under Part D) to Medicare enrollees and also includes the requirement for standards to be adopted for the voluntary use of e-prescribing as well as proposed relief to antikickback laws that may support various e-prescribing arrangements. Additionally, the act tasked the National Committee on Vital and Health Statistics with recommending appropriate messaging standards for the exchange of e-prescribing data. The committee developed an initial set of recommendations for e-prescribing data standards in September 2004, and they have been through the regulatory process, with a final rule issued in November 2005.

Utility of the Systems

There are several major factors that affect the utility of e-prescribing systems in actual practice. Specifically, the data in the systems must be accurate. Clinicians will be making decisions based on the data; thus the source systems must provide accurate data through working interfaces. Second, the software must be reliable. Clinicians must be confident that the software works as intended. Medication and patient data must be readily available at the point of care when the clinicians intend to make decisions. Third, since clinicians often use acute care for discharge and emergency department prescriptions, uniform standards in both acute care and ambulatory environments must exist. The HL7 interface standard is currently used in most acute-care systems while the National Council for Prescription Drug Programs data and transmission standards are used in most retail pharmacy systems. There is a need for cross-communications to promote full interoperability of systems. Finally, the systems must be maintained with regular updates. Clinicians must be confident that all data content is regularly updated as scheduled.

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