Electronic Prescribing to Exclude Faxes, Says CMS

Computer-generated faxes no longer would count as true electronic prescribing under proposed modifications to Medicare Part D regulations, a move that at least one e-prescribing service provider is calling a watershed event in the move toward automation of healthcare information.

The e-prescribing change is but one provision in a sweeping proposal from the Centers for Medicare and Medicaid Services (CMS) that would impose a controversial 9.9 percent reduction in Medicare physician fees for 2008 and expand pay-for-performance initiatives. Although physician groups are rising in opposition to the fee cut, the e-prescribing community is excited about a plan to remove faxing from the CMS definition of electronic prescribing.

According to CMS, “Computer‑generated faxing retains some of the disadvantages of paper prescribing. For example, the pharmacy incurs the administrative cost of keying the prescription into the pharmacy system and there is a potential for data entry errors that may have an adverse impact on patient safety.”

The rule change would encourage prescribers to adopt the SCRIPT data standard developed by the National Council for Prescription Drug Programs (NCPDP). “With improved and more readily available standards‑based e‑prescribing products, CMS believes that eliminating the exemption will encourage e‑prescribers and dispensers to move as quickly as possible to using the SCRIPT standard,” the agency says on its Web site.

“The one thing that gets lost in all of this is that electronic prescribing not only enables the elimination of that fax that goes to the pharmacy, but there are two-way communications that happen over time for patients in particular who are taking medications that continue,” says Rick Ratliff, chief operating officer of e-prescribing connectivity network SureScripts (Alexandria, Va.). Communications might include refill authorization requests and even elusive data on whether patients actually picked up their medications.

“Unless we enable the electronic connectivity between the physicians and the pharmacies just for electronic prescribing, it’s going to be difficult to do some of the more advanced kinds of functions,” Ratliff says. “That’s where the real excitement is.”

Among users of standalone e-prescribing software on the SureScripts network, nearly 100 percent of their prescriptions are sent electronically, Ratliff says. But many e-Rx programs tied to electronic medical records rely on faxing.

“What we would hope is that this would be a motivator to ensure that those systems get upgraded to the right level so that they can get connected into the network,” Ratliff says.

The rule, both currently and as proposed, does not have any financial incentive to switch to e-prescribing, nor are there any penalties for noncompliance. All it says is that CMS prefers electronic transmission. “I think implied in that is that incentives could be in place at some point in the future,” Ratliff says.

CMS is accepting public comments on the proposal until Aug. 31 at www.cms.hhs.gov/eRulemaking. The agency promises a final rule this fall, to take effect Jan. 1, 2009.

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