Progress of electronic prescribing standards

Posted: December 8th, 2009 | Author: George Getty III | Filed under: Standards | No Comments »

The shift to e-prescribing systems was formalized in 2003 with the passage of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). One of its features is an outpatient prescription drug benefit for Medicare beneficiaries, or what is commonly referred to as Part D, which began in 2006.

The law mandated the use of “electronic prescription program” should any Part D plan providers and pharmacies voluntarily choose to prescribe using computer systems. It also called for the establishment of standards for the electronic transmission of prescriptions and certain other information for covered Part D drugs.

Health and Human Services Michael O. Leavitt reported in 2007 that Prescription Drug Plan (PDP) sponsors, Medicare Advantage (MA) Organizations offering Medicare Advantage-Prescription Drug (MA-PD) plans and other Part D sponsors “must support and comply with electronic prescribing standards when communicating with prescribers who want to use e-prescribing technology.”

Indeed, the importance of technical standards was underscored by a recent study, “Interoperable Electronic Prescribing In The United States: A Progress Report,” published by the Health Affairs journal last month.

“These standards are important because they are the key to systems’ interoperability and to achieving policy goals. They also create a level playing field among vendors’ offerings, so that purchasers can buy with confidence,” researchers wrote.

When the MMA was passed six years ago, the U.S. Department of Health and Human Services determined that “adequate experience existed for three basic e-prescribing standards,” the report said. These include the SCRIPT standard for transmitting electronic prescription requests between prescribers and pharmacies (please see Table below).

In 2006, the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) conducted pilot studies to include more standards, paving the way for the adoption of three additional standards for Part D e-prescribing, which took effect on
April 1, 2009.

The Health Affairs report summarized the three add-ons as follows:

• Formulary and benefit transaction standard. Use of this standard gives prescribers information about which drugs are covered by a beneficiary’s drug benefit plan.
• Medication history transaction standard. Use of this standard provides prescribers with information about the medications a beneficiary is already taking, including those prescribed by other providers, to help reduce the number of adverse drug events.
• Fill status notification. This allows prescribers to receive an electronic notice from the pharmacy telling them that a patient’s prescription has been picked up, has not been picked up, or has been partially filled. Its use is expected to improve the monitoring of medication adherence in patients with chronic conditions.

The report said the final rule also adopted the National Provider Identifier (NPI) for e-prescribing under Medicare Part D, and it retired National Council for Prescription Drug Programs (NCPDP) SCRIPT 5.0 in favor of the upgraded NCPDP SCRIPT 8.1.12.

Meanwhile, the pilot tests in 2006 also concluded that the following three standards were not yet ready for use. These are:

• RxNorm drug nomenclature. This standard—developed and maintained by the National Library of Medicine (NLM)—provides standard names for clinical drugs (active ingredient + strength + dose form).
• Structured and Codified Sig. This standard provides uniform and codified patient instructions for taking medicines (e.g., take one tablet twice a day)
• Transactions for electronic prior authorization (ePA) of medications. This set of standard-based transactions enable more efficient preapproval from health plans for certain medications and justification of those that are viewed as expensive.

Overview of Current E-Prescribing Functions and Standards

Function	Standard	Status
Coverage eligibility checks between prescribers and plan sponsors	ANSI ASC X12N 270 (inquiry) and 271 (response) v4010, and Addenda	Mandated in e-prescribing Final Rule, based on adequate industry experience
Prescription drug coverage information	NCPDP Formulary and Benefit Standard, v. 1.0	Mandated in e-prescribing Final Rule, based on results of pilot-testing
New prescriptions and renewal requests to pharmacies	NEWRX and refill request functions of NCPDP SCRIPT, v. 8.1	Mandated in e-prescribing Final Rule, based on adequate industry experience
History of prescriptions filled and covered by current health plan	Medication History function of NCPDP SCRIPT, v. 8.1	Mandated in e-prescribing Final Rule, based on results of pilot-testing
Prescription cancellation and change requests	Cancel and Change functions of NCPDP SCRIPT, v. 8.1	Mandated in e-prescribing Final Rule, based on adequate industry experience
Fill status inquiry for prescriber to determine status of a specific prescription	Fill Status function of NCPDP SCRIPT, v. 8.1	Mandated in e-prescribing Final Rule, based on results of pilot-testing
Exchange prior authorization requirements	ANSI ASC X12N 278 plus HL7 prior authorization attachments	Not mandated in e-prescribing Final Rule, based on results of pilot-testing
Represent identity of drugs that can be prescribed (for use within any of the transactions shown)	RxNorm (updated weekly)	Not mandated in e-prescribing Final Rule, based on results of pilot-testing; updated standard being reevaluated
Represent instructions to the patient	NCPDP Structured and Codified Sig Format, v. 1.0	Not mandated in e-prescribing Final Rule, based on results of pilot-testing; updated standard being reevaluated

Source: Friedman M, Schueth A, & Bell D. (2009). “Interoperable Electronic Prescribing In The United States: A Progress Report.” Health Affairs, Mar-Apr;28(2):393–403.

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