PFHSE Excellence in Practice Concept Paper

Wyoming Health Information Organization

PFHSE Excellence in Practice

Concept Paper ? January 31, 2006

Background and Need Wyoming presents a unique blend of geographies that encompass wide-open rangeland, towering mountains, monumental national parks, and weather extremes to match. Due in part to this unique geography, Wyoming, with approximately 500,000 people spread over a little under 100,000 square miles, is one of the most sparsely populated states in the nation. As such, access to needed medical services can be a significant challenge. With the objective of utilizing technology to exchange healthcare information, collaborative healthcare partners have sought to improve the quality and access to healthcare by achieving such goals as fewer hospital admissions from the emergency department, fewer readmissions, reduction in medical errors, shortened hospital length of stay, enhanced revenue from proper coding, and test duplication avoidance.

In 2003, the Wyoming Legislature created the Wyoming Healthcare Commission (WHCC) to develop strategies to improve health care and reduce health care costs for Wyoming citizens. In 2004, the legislature passed Enrolled Act 31, directing the Commission to create an Information Technology Technical Management Subcommittee (IT2) to study and plan for statewide interoperable electronic health records (EHR) implementation by Oct. 15, 2005. John Snow, Inc. (JSI) was selected by WHCC and IT2 to assess Wyoming’s electronic health records readiness and make recommendations for rapidly increasing the utilization of technology to access patient health information. In the summer of 2005 more than 50 representatives of local, state and federal government, business, medical care providers, and healthcare purchasers and payers gathered and formed the nonprofit Wyoming Health Information Organization (WYHIO).The stakeholders chose an interim board of directors representing a broad cross-section of interests in the state’s healthcare delivery system. WYHIO is positioned to evaluate and endorse projects and processes that will integrate with the unfolding Wyoming health information network. The WyHIO sees ePrescribing as a high-priority initiative and need for Wyoming given the high number of real-world models demonstrating an excellent return on physician, pharmacy and patient time investments.

As part of the EHR feasibility study, feedback was gathered from key stakeholder interviews and from focus groups held throughout the state, Wyoming physicians view electronic prescribing as the single most popular and acceptable medical computing application. Many of them also view it as potentially the most valuable first step toward medical practice automation. Even providers who do not see any immediate value for a full-scale electronic medical record in their practice tend to be enthusiastic about the advantages of electronic prescribing because it promises to reduce some of their office workload.According to the Wyoming Board of Medicine, there are 801 registered physicians in the state of Wyoming. The Wyoming Board of Pharmacy lists 139 registered pharmacies. Of the thousands of prescriptions filled every month, many require direct contact between the pharmacy and the provider who signs the prescription for clarification, confirmation or to complete missing information. In addition, thousands of refill requests need to be processed by pharmacies and physician offices, requiring another round of communication. The overall prescribing process can be cumbersome and time consuming. One Wyoming primary care physician recently estimated receipt of 20 telephone messages on average per day about prescriptions he has written.

The WyHIO ePrescribing Initiative is needed to increase efficiency, accuracy and appropriateness of medication to benefit patients, physicians, pharmacists and payers. ePrescribing is a major step to the statewide interoperable electronic health records implementation.

Purpose of Project To facilitate adoption of technology in the physician office, a statewide e-Prescribing initiative is proposed, beginning with a pilot implementation to demonstrate viability. Physicians and allied health professionals participating in the initiative will send prescriptions electronically to pharmacies through personal computers, PDAs or tablet devices. The practitioner will have the ability to review drug interactions, review formulary requirements and access a disease reference database. The WyHIO will assist the practices in installation of the system, training, matching incentives and ongoing support.

While significant technical, legal and operational issues need to be resolved before a national electronic prescribing plan goes into effect, developing such systems for electronic prescribing is a national and state priority. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173) specifies the development of national standards for enabling the exchange of basic prescription data to and from prescribers and pharmacists, as well as standards for information exchanged about a patient's drug utilization history, possible drug interactions, the drug plan (including information about the formulary and cost-sharing), and information about lower-cost therapeutically appropriate alternatives.

Description of Project The system is designed to prevent medical errors due to illegible handwriting, decrease the need for time consuming telephone communications between the pharmacy and prescriber, and improve the turn around time filling prescriptions at the pharmacy.

The project will establish the baseline of preferred drug list use and use of generic drugs in the Medicaid program prior to initiating the project and will analyze these measures after adoption of e-Prescribing. These measurements will be made at 6 months (after an initial pilot), and after a prescriber has used the system for at least a full year after the rollout of the statewide project. Provider adoption will be tracked at the same intervals using a survey process to assess characteristics of early adopters.

Impact Sponsoring an ePrescribing initiative will streamline the prescription process by integrating payers, pharmacies, and providers. ePrescribing is being widely implemented through regional initiatives and is supported by accepted HIT standards. An ePrescribing system represents a low risk/high reward opportunity relative to other initiatives that may be considered.

Transmitting drug prescriptions electronically to pharmacies has been shown to reduce errors caused by handwriting and reduce the considerable time currently expended between pharmacies and prescribers in clarifying prescription information. In addition, with the cumulative electronic collection of prescription information, it is possible to develop a history of all medications that have been dispensed for an identified patient. This permits automated checking of interactions between drugs – a vitally important patient safety process. Moreover, accurate medication lists can be time and even lifesaving at the point of patient care.

Further, drug utilization data can be valuable for disease management of chronic conditions, and is indispensable information for measuring costs of care. Other uses of accurate patient medication lists include facilitating drug alerts and recalls, and identifying prescription drug abuse. Payers, who administer formularies with different coverage for different drugs can expect greater compliance when coverage information is available at the time of prescribing. JSI received positive feedback on ePrescribing from groups of physicians and pharmacists in Wyoming, who tend to view electronic prescribing as potentially delivering significant efficiencies for their daily practices.