They may not have known it, but for a number of years most employees covered under pay-direct (a.k.a. drug card) plans have had their prescriptions captured and monitored by real time drug adjudication systems that incorporate sophisticated control, security and safety logic. These controls have collectively been referred to by the employee benefits industry as DUR, for Drug Utilization Review. DUR systems check a patient’s current and newly prescribed medications for drug-drug and drug-allergy interactions, multiple doctoring, quantity restrictions and internal plan cost controls such as those for mandatory generic substitution, reimbursement limits, co-payments and maximums.
Enter ePrescribing. ePrescribing is a process that electronically generates, authorizes and transmits prescriptions from doctors to pharmacists. ePrescribing takes DUR to a new level of sophistication in the areas of safety and efficiency. eHealth, the electronic health record deployment entity of Ontario’s Ministry of Health and Long-Term Care, has committed $2.1 billion to the rollout of the ePrescribe system. A key component of eHealth Ontario’s Medication Management strategy, the plan is to have the electronic health record in place in all Ontario health care offices by 2015. Paper prescriptions are soon to be history.
To put the ePrescribing stakes in perspective, one U.S. source claims that paper prescriptions generate 900 million callbacks a year by pharmacists who can’t read physicians’ writing or who question the need for the drug being prescribed. That represents a staggering 30% of the annual prescriptions written in the United States. Extrapolate those numbers to Ontario alone and it becomes a lot clearer why medication morbidity and mortality should command more of our attention as consumers of medication. One estimate is that every year almost 400,000 Ontarians suffer a preventable reaction to medication.As is often the case with innovation, it took the public sector’s legislative and funding clout to champion a better solution. This is the good news. The bad news is that it took so long to do so in the face of compelling statistics and the availability of the prerequisite technologies and telecommunications infrastructure. Canada’s $30-billion employee benefits industry, for instance, has also taken limited steps along the ePrescribing path. Dominated by giants Sun Life, Manulife and Great West Life, whose collective market share approaches 70%, and their sub-contracted drug claim adjudicators, such as Telus Health Solutions, the industry has made some progress in getting ePrescribing functionality out to physicians. Perhaps market concentration can go hand in hand with innovation after all.
In fairness to our policy makers and private industry, the benefits of ePrescribing as a standalone capability pale in comparison to its benefits when it is integrated with the EMR (electronic medical record) capability. Here’s where ePrescribing works its magic. Reliance on EMRs to enhance the DUR function means that more information about the patient can be referenced in real time. Physicians and pharmacists can check diagnoses, body weight, age, drug appropriateness, correct dosing, contraindications and adverse reactions, and detect duplicate therapies in the doctor’s office or at the pharmacy counter before the drug is prescribed, and certainly before it is dispensed. The ePrescribing Demonstration Project is in the first trial implementation, in which two family physician practices were selected to pilot the system. Outcomes are expected to provide valuable lessons for a broader rollout. The project will provide pharmacists with access to electronic medical records to view pending prescriptions and a subset of clinically relevant information, as well as validate key electronic prescribing outcomes at the two sites.
The two sites selected for the project are the Group Health Centre in Sault Ste. Marie and the Georgian Bay Family Health Team in Collingwood. Both are advanced EMR users. During the trial, eHealth Ontario will examine workflow, change management requirements, regulation guidelines and the impact on physicians, nurse practitioners, pharmacists and patients. Participants include 16 general practitioners, five specialists and seven nurse practitioners from Group Health Centre and 24 general practitioners and four nurse practitioners from Georgian Bay Family Health Team. On the dispensing end, 22 pharmacies in Sault Ste. Marie and 17 pharmacies in Collingwood, Wasaga Beach, the Blue Mountains and Clearview (which includes Stayner, Nottawa, Duntroon and Creemore) are participating.
Each site will define an agreement procedure to manage patient consent to participate. The College of Nurses of Ontario, the College of Physicians and Surgeons of Ontario and the Ontario College of Pharmacists have been consulted regarding secure prescription authentication and patient choice, and have issued a joint letter of support for the project.
