Physicians across the country have been slow to embrace electronic prescribing, despite its advantages for patient safety and office efficiency. But our physician services organization, Medical Network One (MNO), has persuaded most of our 345 primary-care doctors in six Michigan counties to adopt e-prescribing. The key to our success has been going from office to office to show physicians and staffers how e-prescribing can benefit them and how to adapt their workflow to it.
As of March 2008, 244 MNO physicians have access to prescribing electronically. From October 2007 through March, our physicians wrote 96,481 e-prescriptions for the 71,053 patients enrolled in the system. That’s 37% more than they wrote during the same period a year earlier.
MNO’s involvement with e-prescribing began in 2005, when we became the first physician organization to join the Southeast Michigan e-Prescribing Initiative (SEMI). This is a coalition that includes the Big Three auto makers, Blue Cross Blue Shield of Michigan, and a number of healthcare providers. SEMI aims to minimize prescription medication errors and to improve patient safety.
When we looked at the existing e-prescribing products, we were impressed by RelayHealth because it offers a secure, web-based messaging platform with minimal hardware requirements. All the physician practices needed was a computer and an Internet connection. The SEMI provides an incentive of $500 per physician when he or she agrees to adopt the system, and another $500 after using e-prescribing. So in effect, most physicians who took up e-prescribing received a $1,000 bonus to buy equipment, if necessary.
My own office has three computers, including desktops for billing and scheduling and another for receiving lab results. Using those computers, we can access the e-prescribing software and our patient medication lists. So we’ve been able to e-prescribe without purchasing extra computers; and, via the Internet, we can view our patient data whenever and wherever we need it.
Blue Cross Blue Shield of Michigan provides ongoing incentives for raising generic drug usage, deploying health information technology, and improving chronic care. MNO also has a risk-sharing arrangement with Blue Care Network (HMO) that includes pharmaceutical costs. Because e-prescribing enables us to monitor generic and brand name prescriptions, it helps save money for our whole network. Also, we view e-prescribing as a step toward adoption of electronic health records. For both of these reasons, MNO pays the doctors’ monthly subscription and training fees for the RelayHealth service.
Despite the fact that it cost physicians virtually nothing to try the online connectivity service, many initially feared that e-prescribing would be too difficult and would slow them down. We’ve overcome those fears by having our representatives explain the benefits of e-prescribing to practice staffers. The most influential factor in any office is the staff, because they’re the ones who need to understand how the system works. If they decide e-prescribing is going to help them, the physicians will be more likely to adopt it.
It’s also important to remember that every office is at a different level in terms of technology adoption and efficiency. You have to tailor everything to that level so that each office can figure out how to improve its own workflow. We’ve approached the e-prescribing initiative the same way that we handle disease management. MNO’s disease management organization, the Michigan Institute for Health Enhancement, has contracts with several health plans to supply disease management services to patients with chronic conditions. Besides offering self-management programs in areas like weight loss and diabetes, MNO has persuaded many physicians to accept “chronic care travel teams.” Including RNs, registered dieticians, diabetes educators, and exercise and behavioral specialists, these teams go into practices to meet with chronic disease patients as part of their regular office visits. We help the offices modify their workflows to accommodate these visits, just as they do with e-prescribing.
Having patient-physician connectivity has helped us reach out to chronic-disease patients in other ways. For example, my diabetic patients can record their blood sugar levels a few times a month and e-mail them to me, using the secure messaging. The patients like this because they don’t have to take time off from work, and their compliance has improved.
The online service also enables my patients to communicate their non-urgent symptoms with me through clinically structured interviews, eliminating the need to come into my office for routine conditions. I can even prescribe a medication for the patient, if deemed necessary, when I respond. An increasing number of insurers cover RelayHealth’s “webVisit” and the service allows me to collect a copay or fee for each consultation. I’ve set the charge at $25, which is hardly more than the copays in many plans. While I don’t make as much off of this distinct online service as I would from in office visit, it opens up time slots for patients who really need to be seen.
The e-prescribing system also helps me deliver higher-quality care. It tells me whether a medication is in the formulary of a patient’s plan, and alerts me if that pill might cause an adverse reaction with another drug the patient is taking.
E-prescribing has increased our efficiency, as well. For example, the service transmits our prescriptions electronically to local pharmacies. The local pharmacies with electronic capabilities also send our office refill requests electronically. This is a big improvement from receiving refill requests via fax and receiving calls from the pharmacy--another time-saver. Some patients even request prescription refills online.
The ability to view a patient’s medication record online has enhanced efficiency by reducing chart pulls. And it’s quite easy to click through refills when the patient’s record is right in front of me. The MGMA has estimated that administrative work related to prescriptions costs the average doctor about $15,700 a year.
My biggest reward from e-prescribing, aside from avoiding medication errors, is to see how pleased my patients are when I tell them that their prescription will be waiting at the pharmacy. Patient satisfaction is not something you can put a dollar value on, but I can’t think of anything more valuable to my practice.