E-prescribe With EMR

1
E-prescribe With EMR

• By
• Sandra Herr, RN

2
E-prescribing

• -electronically generated prescription
• -ability to utilize EMR (electronic medical
  record)
• -accurate, error-free and understandable
• -improving the quality of patient care
• -reducing medication errors
• -use of palm pilot or computer

3
Nursing Role in E-prescribing

• -patient safety
• -renew prescriptions
• -time management
• -accurate medication reconciliations
• -recognize drug interactions
• -more interaction with patients

4
Advantages vs. Disadvantages

• -time saving -expensive software
• -integrated EMR -limited usage
• -fast -extensive training
• -legible -complexity
• (Kilbridge and Gladysheva 2001)

5

• Hardware in E-prescibing
• - PC with internet access
• - DSL or Cable Modem
• - Palm Pilot
• - Two way internet linkage

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Dsl mODEMdigital subscriber line

• - transceiver
• - connects a computer to a fax or phone line
• - high speed internet access
• - ability to use a phone while e-prescribing
• - can use exisiting phone line connection

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E-prescribe Software

• - All scripts
• - Dr. First
• - MedPlus, Inc
• - Surescripts
• - ZixCorp
• - RxNT
• - Prematics
• - Misys eScript
• 
  (AMCP.org)

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SURESCRIPTS

• - used daily in all 50 states
• - merger of RxHub / Surescripts
• - formed with CVS Caremark Corp, Express Scripts
  Inc and MedCo Health Solutions, Inc
• - connects over 10,000 pharmacies nationwide

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Usability of E-prescribe software

• - user centered design and focus
• - ongoing education
• - simplicity
• - safe
• - secure
• - fast

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Information system for e-prescribe AND emr

• Reflect on any experiences you may have had
  recentlythoughts?

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E-Prescribe and EMRCLINICAL INFORMATION
SYSTEM(cis)

• -Patient centered
• -Integrated health care
• -Comprehensive

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Users and functions

• Used By
• -Physicians and nurses
• -Billing/financial
• -Administration
• -Clinics
• -Pharmacy
• -Laboratory
• -Radiology
• -Clergy (hospital based)
• -Social Service

• Functions
• -Accurate Medication Reconciliation
• -Documentation
• -Billing
• -Continuity of Care
• -Discharge planning
• -Patient centered care
• -Error reduction
• -Increased patient safety
• -Spiritual/social

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Configuration for the cis

• MAINFRAME
• -interface between hardware and user
• -sharing of resources
• -simplifies development of applications
• -multitasking system
• -saves data to memory
• -shared data

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Data standards and disease/procedure
classification system

• Data Standards
• -Healthcare level 7(HL7)
• -American Society for Testing and Material
• -Healthcare Informatics Standards Planning Panel
• -Workgroups for Electronic Data Exchange
• -American National Standards Institute (ANSI)
• (Goedert 2006)

• Disease/Procedure Classification System(s)
• -International Statistical and Classification of
  Diseases and Related Health Problems (ICD-9 or
  ICD-10)
• -Systematized Nomenclature of Medicine (SNOMED)
• (Devine, Hansen, Hollingworth, Sullivan 2007)

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Thoughts - recommendations

• -patient safety
• -decrease in medication errors
• -continuity of care
• -team collaboration
• -time saving
• -cost effective
• -patient centered
• HIGHLY RECOMMEND EMR AND E-PRESCRIBE
• FUTURE OF HEALTHCARE

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ADVANTAGES AND DISADVATAGES OF E-PRESCRIBE AND
EMR

• A HEATHCARE WAVE FOR THE FUTURE

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ADVANTAGES vs. Disadvantages

• Prevents medication prescription errors
• Eliminates illegible prescriptions
• Provides for real-time communications between
  doctors, pharmacies and patients
• Provides critical drug alerts
• Patient specific information readily available
• Provides drug pricing information
• Provides payer coverage and preferred drug
  information
• Complete patient medication history
• Reduces fraud and crime
• Increases health care professional work
  efficiency and reduces administrative costs
• Speedy refills

• Lack of integration with patient
• record
• Likelihood that it will be replaced when EMR is
  adopted
• Reduced staff time spent on refill process
• Lack of integration with patient record
• Initial cost to implement
• Implementation and extensive training of staff
• Educational costs to train staff
• Need for extensive training time for all staff
  and outside vendors
• Unwillingness of staff compliance and/or
  acceptance to change
• Selection based on criteria and need
• Development of an integration system with outside
  vendors and pharmacies

• (Aspen, Wolcott, Bootman, Cronenwett, 1996)

• (Bizzarro, 2009)

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Ethical / legal issues regardinge-prescribe

• -potential revenue sources from partnering with
  device vendors
• -objective outcome by E-prescribing vendors
• -vendors ties to the pharmaceutical industry
• - Will HIPAA regulations limit what can be done
  with data

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Nursing competencies for e-prescribe

• -registered nurse
• -computer skills
• -informatics knowledge
• -informatics skills

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Functions and responsibilities

• -education and training
• -mentoring for new/seasoned staff
• -super user in EMR (electronic medical record)
• -community liaison for pharmacy and physician
  practices
• -accessibility to staff
• -continued research and
• education

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References

• California Health Care Foundation. (2001).
  Retrieved September 17th, 2009 from
  http//quality.chcf.org/documents/hospitals/EPresc
  ribing.pdf
• U.S. Department of Health Human Services
  (2009). Retrieved September 18th, 2009 from
  http//www.cms.hhs.gov/eprescribing/
• Centers for Medicare and Medicaid Services
  (2008). Retrieved September 18th, 2009 from
  http//www.medicare.gov/Publications/Pubs/pdf/1138
  2.pdf

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REFERENCES

• - FREE electronic prescribingfor every physician
  in America. (2008). Retrieved October 9th, 2009
  from http//www.nationalerx.com
• Bringing high-speed e-medicine to Pa. physicians.
  (2008). Retrieved October 8th, 2009 from
  http//www.physiciansnews.com/spotlight/808pa.html
  
• Dermatology Online Journal Volume 7 Number 1.
  (2001). Retrieved October 11th, 2009 from
  http//dermatology.cdlib.org/DOJvol7num1/media_rev
  iew/ephysician/goldblum.html
• Surescripts. (2009). Retrieved October 11th,
  2009 from http//www.surescripts.net/the-company.h
  tml
• Indiana University University Technology
  Services (2005-2009). Retrieved October 11th,
  2009 from http//kb.iu.edu/data/ajfr.html

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REFERENCES

• -Electronic Health Record . (2009). Retrieved
  October 29th, 2009 from http//en.wikipedia.org/wi
  ki/Electronic_health_record
• -Operating Systems. (2009). Retrieved October
  29th, 2009 from http//en.wikipedia.org/wiki/Opera
  ting_system
• -The Evolution of EMR Standards. (2006).
  Retrieved October 30th, 2009 from
  http//www.healthdatamanagement.com/issues/2006050
  1/13354-1.html
• - Implementing an Ambulatory e-Prescribing
  System Strategies Employed and Lessons Learned
  to Minimize Unintended Consequences . (2007).
  Retrieved from http//www.ahrq.gov/downloads/pub/a
  dvances2/vol4/Advances-Devine_83.pdf

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references

• Guideposts to the FutureAn Agenda for Nursing
  Informatics. (2007). Retrieved November 19th,
  2009 from http//www.jamia.org/cgi/content/abstrac
  t/14/1/.
• e-Prescribing Technology Issues and Policy
  Implications in a Dynamic Market. (2001).
  Retrieved November 20th, 2009 from
• http//gateway.nlm.nih.gov/MeetingAbstracts/ma?f1
  02273470.html.
• Integrating evidence into clinical information
  systems for nursing decision support. (2007).
  Retrieved November 21st, 2009 from
  http//www.ijmijournal.com/article/S1386-5056(07)0
  0162-1/abstract.
• AMA announces partnership with e-prescribing
  vendor. (2009). Retrieved November 22nd, 2009
  from http//www.ama-assn.org/amednews/2009/07/27/b
  isd0730.htm
• Preventing Medication Errors Quality Chasm
  Series. (1996). Retrieved November 22nd, 2009
  from http//www.nap.edu/catalog.php?record_id1162
  3
• e-Prescribing Briefing Managed Care Pharmacy 101
  New York Health Plan Association (2009).
  Retrieved November 22nd, 2009 from www.hixny.org
  .