Friday, October 3, 2008

E-prescribing guidelines

In an October 3 press release, the Blue Cross Blue Shield Association provided some useful guidelines that serve as reminders of the varying safety, health, and business interests affected by these technologies. Some place great emphasis on what vendors must provide, some argue (indirectly) for simpler formularies and prior-authorization rules, and one addressed the choice between retail and mail order pharmacies.
I attempt below to quote these guidelines verbtim:
  1. E-prescribing systems must ensure patient safety.
    • Drug – Drug Interaction Check: E-prescribing systems must have the ability to alert providers to the possibility of at least severe interaction with patients' other active medications and dispensed drug history and to guard against duplicate medication therapy.
    • Drug – Allergy Check: E-prescribing systems must inform providers of potential conflicts with or patient allergies to prescribed drugs. Together, the physician and the patient can make an informed – personalized – decision based on the potential side effects and specific conditions.
    • Drug Dosing Decision Support: E-prescribing systems must provide a safety check to offer providers maximum dose checking and drug instructions (i.e. route of administration).
    • Drug and Dosing Guidance: Preferred e-prescribing systems also provide drug and dosing guidance based on age, weight, pregnancy, and lab results.
  2. Patient Medication History: E-prescribing systems must be able to check available sources in real-time and make a patient's medication history available to the provider at the time the prescription is written at the point-of-care. This includes all active medication, as well as dispensed drug history.
  3. Formulary Status: E-prescribing systems must ensure that providers have access to the up-to-date formulary and insurance information (including patient eligibility and authorization), allowing them to prescribe preferred therapeutic and generic alternatives, as well as get coverage information such as co-payments and relative cost.
  4. Renewals: E-prescribing systems must ensure that providers can easily refill existing prescriptions and be able to accept electronic renewals from pharmacies.
  5. Electronic Transmission: E-prescribing systems must be able to transmit prescriptions electronically to and from pharmacies whenever possible. Faxed prescriptions should be used only as a back-up method but should include all aspects of a fully informed decision support tool before faxing (including drug – drug interaction, drug – allergy checks, adult and pediatric dosing checks, and medication history).
  6. Drug Reference Guide: E-prescribing systems must provide access to an accurate, comprehensive drug database with the ability to look-up dosing and usage guidelines, side-effects, indications and contraindications at the time the prescription is written at the point-of-care and can be printed for the patient.
  7. Transaction Certification: E-prescribing systems must be certified by a recognized e-prescribing connectivity entity.
  8. Utilization management (UM): Preferred e-prescribing systems have the ability to assist the physician in administering step-therapy, quantity limits, and other UM programs through incorporation of information from the pharmacy benefit manager (PBM) and decision support within the application.
  9. Mail Order: Preferred e-prescribing systems enable providers to send prescriptions electronically to the patient's mail order pharmacy


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