The Push for E-communication

The times they are a-changin’. Just in the past few days, a huge merger and a CMS proposed rule were announced that may potentially pave the way for widespread adoption of e-communications in healthcare.

CMS Proposal

According to a June 30 Modern Healthcare article, the new rule proposed by CMS would allow physicians to bill for follow-up, inpatient e-consultations. In fact, CMS proposes new codes that will be “specific to the telehealth delivery of follow-up inpatient consultations” and are to be used “by providers who are consulted by a patient’s attending physician regarding care but are not available for a face-to-face encounter.”

In other noteworthy e-related news from CMS, the 2009 Medicare Physician Fee Schedule (MPFS) includes several provisions that may help promote the use of EHRs and reduce treatment errors. CMS is also proposing several improvements to the Physicians Quality Reporting Initiative, including accepting data via clinical registries and EHR systems. Finally, CMS has announced it is in favor of retaining provisions “that would allow for use of computer-generated faxes in instances of temporary/transient transmission failure or communication problems that preclude the use of the adopted NCPDP SCRIPT standard, and add an exemption for computer-generated faxes used by dispensers to request refills from providers that are not capable of receiving and processing refill requests using the adopted NCPDP SCRIPT standard.” Comments on the proposed rule will be accepted through August 29, with responses coming in a final rule to be issued by November 1. Revised policies and payment rates will take effect January 1, 2009.

E-prescribing Merger

In an effort to promote technology adoption by physicians, two e-prescribing networks, SureScripts-owned by retail and independent pharmacies—and RxHub-owned by three major drug benefit managers—announced yesterday that they were merging. It’s hoped this move will increase e-prescribing adoption, thereby helping to cut costs and reduce medical errors. Currently, just 2% of the 1.5 billion prescriptions written each year in the US are submitted electronically to pharmacies, according to a Washington Post article on the merger. American Health Information Community testimony from late last year pegged overall e-prescribing adoption rates at lower than 20%.

The merged network, currently going under the oh-so-creative name of SureScripts-RxHub, combines the routing of prescriptions to pharmacies done by SureScripts and the sending of prescriptions to mail-order firms and providing of insurance coverage information offered by RxHub. Now, physicians, pharmacies, and benefit players (like insurance companies) will all be connected, allowing physicians not only to send prescriptions, but review a patient’s insurance coverage and drug history. According to the Post article, analysts and physicians have said the network will help create the ever-elusive national EHR system that would really make EHR adoption worth the time and effort. “A standalone e-prescribing system is really just on the road to a full electronic medical record,” said Sean Wieland, health technology analyst, Piper Jaffray. Plus, patient and physician users won’t pay a per-prescription cost for using the service.

"I can think of 4 billion reasons why this merger makes sense," said John Driscoll, president of new markets for Medco Health Solutions, Inc, referring to the estimate number of prescriptions written in the US each year. "This merger sets aside historic economic and political differences to do what is necessary to advance paperless prescribing and the secure exchange of critical information between providers instantly elevating the quality of care."

Looking Forward

It seems that the issues that have held back the adoption of e-prescribing and EMRs/EHRs—weak incentives, legal obstacles, and privacy concerns—may be abating, with the above news and recent legislation that would provide financial benefits to physician e-prescribing adoptersand the potential ending of a ban by the DEA on e-prescribing for controlled substances announced on June 27.

Do you see the value in adopting e-prescribing? Will the above news make a difference? If not, tell me why. If you’ve already adopted the technology, tell me what convinced you to make the plunge. I’m always fascinated by hearing how the latest healthcare technology affects the end user, you. So, start a dialogue with your colleagues and post a comment below.