MIME-Version: 1.0 Content-Location: file:///C:/B10812B9/joint_session_summary.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" SOS Rx – eHealth Initiative

DRAFT (1= 1/2/04)

 SOS Rx – eHealth Initiative 

Summary = on Joint Session on September 15, 2004: How to Engage Patients in Promoting Electron= ic Prescribing

 

Introduction

 

On September 15, 2004, SOS Rx and eHealth Initiative h= eld a joint meeting to look at the consumer’s role in electronic prescribing (E-prescribing).  This joint collaboration was an outgrowth of an earlier acknowledgement this past spri= ng that the eHealth Initiative (EHI) and SOS Rx could work together to explore ways to accelerate the adoption of E-prescribing.  Even prior to this meeting, each organization has independently expressed an interest in advancing this objective. 

 

From inception, the SOS Rx Coalition identified E-prescribing as a key element in health care systems change that could significantly improve outpatient medication safety.  And, in April 2004, the EHI issued= a comprehensive report on E-prescribing, including recommendations for design= and implementation of E-prescribing.  In 2005 EHI plans to look at incentives for clinicians to adopt E-prescribing = and work with various stakeholders to promote its growth.  

 

The meeting on September 15, 2004 included representat= ives from 12 organizations that are either part of the SOS Rx coalition or eHeal= th Initiative (and in some cases both). =   These organizations included the National Association of Boards of Pharmacy, American Association of Colleges of Pharmacy, AHRQ, Laxor, Nation= al Consumers League, EHI, Markle Foundation, Express Scripts, Pfizer, Healthvision, Surescripts, and RxHub

 

Stemming from this meeting, the SOS Rx Coalition will continue to refine its project on E-prescribing which focuses on accelerati= ng the use of E-prescribing by:

1) Adopting guiding principles of E-prescribing that d= efine and encourage a patient role

2) Promoting various ongoing initiatives supportive of= those principles and

3) Disseminating information to patients about the pot= ential benefits of E-prescribing.

 

 

Executive Summary

The stated meeting objective was to identify –fr= om a clinical and systems perspective - how to make the case to consumers that t= hey should care about E-prescribing.  Ultimately, the group was tasked with identifying strategies for engaging consumers in this issue.

 

This group of experts on E-prescribing worked to ident= ify why patients should care about E-prescribing, how they currently interact w= ith the prescribing process of the health care system, and what benefits they c= ould expect to derive from E-prescribing.  These elements can form the foundation for future target research an= d an outreach campaign.  This campa= ign will be designed to educate consumers about the potential benefits of E-prescribing and motivate them to advocate for E-prescribing with their he= alth care providers. 

 

MEETING PROCEEDINGS

I.  Preliminary issues

 

The meeting was structured as a round table forum, at = which participants considered the following issues:

 

  1.   It was decided that this meeting w= ould not attempt to wordsmith a definition, but would use the EHI definition (any system that uses a computer to assist in creating a prescription), and acknowledge that more advanced features (e.g., fully integrated electronic = health record) would be preferable.

     

    B.     Focus of the meeting

    The group decided to examine the “pain points” in the prescribing process  that are likely to exist fo= r most consumers.  The group then pro= ceeded to set up a framework to look at those pain points, keeping in mind that the end goal is to educate consumers about E-prescribing and motivate them to advocate for E-prescribing with their health care providers

     

    C.     Issues to keep in mind

    i.      =             &nb= sp;  Consumers can be a catalyst or barrier to change. <= /p>

    ii.      =              Doctor–patient relationship comes into play h= ere – how do we empower consumers to talk to their health care providers?=

     

    II.  Identifying the Pain Points= for Consumers in the Prescribing Process

     

    1. Purpose Statement – What consumers should expect from E-prescribi= ng process?

    “When a decision is made to request a re= fill or prescribe a medication, my clinician will interact with tools and proces= ses in real-time that check my existing medications, check for appropriateness,= and transmit the information to the appropriate dispensing pharmacy in a way th= at is legible, validated, and minimizes my inconvenience of time, unnecessary costs and my risk of adverse events.”

     

    1. Identifying Key attributes of the Prescribing System for consumers<= /li>

    The following key attribute= s were identified as a helpful framework for thinking about consumer “pain points.”  Once establish= ed, the group decided to return to these points for further discussion later in= the meeting.

    ·        Cost

    ·        Safety prevention of errors

    ·        Quality – the right drug is prescribed=

    ·        Convenience – will I have to wait?

    ·        Confidence /knowledge  - about my medication 

    ·        Access

     

    C.     Current Consumer Issues in t= he prescribing process

    -&nb= sp;       Correct drug – is this the right drug = for me and my condition?

    -&nb= sp;       Will it interact with other products I am taking?  Am I allergic to it? =

    -&nb= sp;       Who do I contact about side effects or other issues with drug, and how do I contact them?

    -&nb= sp;       How do I take the drug?

    -&nb= sp;       Where can I learn more about the drug? 

    -&nb= sp;       How do I obtain the drug?

    -&nb= sp;       What will it cost me? 

    -&nb= sp;       My doctor should know that I am taking this  - s= o why do I have to repeat many times what I am taking?

    -&nb= sp;       Will my prescription be ready on time?

     

    The group agreed that the big task in this campaign wi= ll be to show consumers how E-prescribing can improve the prescribing system and benefit consumers regarding the above issues.

     

    The Process  - Flow Chart   

    The group looked at the prescribing process and develo= ped a flow chart for prescriptions. This flow chart serves to outline the differe= nt roles for consumer, provider, and pharmacist.  There are two starting points for prescriptions:

     

    1) New Prescription (provider initiated at the offi= ce visit)

    Health care provider examines lists (lists of drugs appropriate for the condition)

    Health care provider reviews the rules

    Health care provider transmits/communicates informatio= n from the patient

     

    2) Request for Refill (initiated by consumer) <= span style=3D'mso-tab-count:1'>     

    Consumer is alerted by some process to refill a medica= tion

    Consumer makes the decision to request a refill         &= nbsp;           &nbs= p;            &= nbsp;   

    Consumer communicates to the prescriber –either knowing they need a refill or with a question on the refill

     

    Both then go to –

     

    3) Pharmacist  - (refill or new prescripti= on goes to the pharmacy)

    Checks the list of medications the consumer is already taking (based on what was filled in that specific pharmacy) 

    Consults rules

    Adds information

    Communicates with the patient

    Offers advice

     

    In summary, the flow chart highlights the three stakeh= olders in the medication management process.   Each of these stakeholders h= as roles and accountabilities to the other stakeholders.  The consumer initiates requests for refills, the provider initiates new medications, and the pharmacist dispens= es and advises.  The pharmacist a= lso may send reminders, and is the main point of contact for the consumer.   

     

    III. Consumer Rewards from E-prescribing

    After completing the flow chart, the group turned to discussing the specific rewards consumers could expect to gain from having providers use an E-prescribing system.    The group first examin= ed consumer expectations from the current prescribing process.

      

    A.   Consumer Expectations of the Current Prescribing Process =

    Consumers currently expect that:

    • They will have to wait when they pick up a prescription
    • They will have to pay too much (i.e., more than expected co-pay) for prescr= iptions
    • The drug they get is what was prescribed for them
    • The doctor was right in prescribing the medication for them
    • The doctor has a record of all the medication they take
    • Their pharmacist can read their doctor’s handwriting on the prescripti= on
    • They will be properly instructed on how to take the medication

     

    The campaign will need to make the case that E-prescri= bing is safer, more convenient and might save the patient money (see rewards below).  It was suggested that= the campaign could show that the current prescribing system is unsafe (but not = in a scary way), inconvenient, and more costly to consumers.

     

    B.  Co= nsumer Rewards from E-prescribing

    1. Cost Rewards

    -=       =    With E-prescribing it is more likely the doctor will know what drugs are covered by the patient’s insurance plan and what drugs are not.

    -=       =    The patient may have had to pay a lot of money in t= he past for a non-covered “best” drug, when there were alternative= s my doctor did not know about.

    -=       =    There is a higher probability that the doctor will = know more about the costs of drugs and the availability of generics at the time = or prescribing.

    -=       =    A conversation between patient and doctor on costs = and drugs can happen up front at the doctor’s office  (it is too late when the patient i= s at the pharmacy picking up the prescription).

    -=       =    Efficiency of E-prescribing will reduce costs for t= he general health care system

     

    1. Safety Rewards

    -        Legibility – with E-prescribing the patient knows their pharmacist will be able to read the prescription.

    -        There can be a discussion up front if there = is an issue with a prescription.  For example, when a drug has been recently made available in different strength= s, the prescriber may not indicate which strength, unless they know about the change.  With E-prescribing, t= he prescriber will know any changes at the time of prescribing. 

    -      =   Decision support tools available with E-prescribing will make sure that any new warnings are conveyed to the prov= ider and patient.  

    -        There will be improved compliance with medications because of the messages E-prescribing systems can send out reminding of refills, etc.   &= nbsp;        

    -        There will be more assurance that patients w= ill get the drug they need when they need it.

     

    1. Quality Rewards

    -&nb= sp;       Increases likelihood that the prescribed dru= g is the right one to  solve the patient’s problem.  

    -        Enhances patient disease management and identifies potential problems. 

    -        Fosters dialogue between patients and provid= ers to determine the right drug.

     

    1. Convenience Rewards

    -&nb= sp;       Patient prescriptions will be ready and there will be no need to wait in line

    -        Patients will not have to carry a paper prescription that they may lose.   

    -        Patients can actually get the prescriptions = they need because any issues with their health plan coverage have been taken car= e of up front at the doctor’s office.

     

    1. Confidence/Knowledge Rewards

    -        Patients know how to use their medications through instruction, custom messages, or automatic reminders from an electr= onic system

    -        Patients know what they are taking <= /o:p>

    -        Patient fears about the prescribing system a= re reduced

     

    IV.  D= iscussion

     

    Conference: Based on group discussion, it was determin= ed that a conference is not necessary, as the meeting generated sufficient substantive feedback on the E-prescribing process.  The group indicated a need to move= ahead with a public education campaign.

    Next Steps:    

    -&nb= sp;       Send out draft of meeting report to participants.

    -&nb= sp;       Send meeting report to larger SOS Rx workgro= up on E-prescribing

    -&nb= sp;       Discuss meeting report and next steps at the= SOS Rx Oct. 6th meeting

    -&nb= sp;       Develop a strategy and timeline for the development of a public education campaign on E-prescribing

    -&nb= sp;       Obtain funding for campaign 

    -        Collaborate with audience research firm to g= ain a better understanding of how to effectively develop consumer messages about e-prescribing

    -        Formulate E-prescribing campaign messages

    -        Work with various stakeholders (employer gro= ups, healthcare providers, pharmacies, government, etc.) on developing and disseminating messages  =

    -        Continue collaboration with EHI <= /o:p>