E-prescribing Honors: Three States Earn Top Marks for Adoption

Despite calls for e-prescribing to address preventable medication errors, adoption remained flat through the early 2000s. Rates skyrocketed, however, from 7 percent of physicians in December 2008 to 48 percent in June 2012, according to the Office of the National Coordinator for Health IT (ONC). While all states experienced rapidly increasing e-prescribing activity, three stand out.

Minnesota, Massachusetts and South Dakota earned the top three spots respectively in the 2012 state-by-state e-prescribing rankings published by Surescripts, a nationwide e-prescribing network. While the separate states implemented unique strategies to facilitate adoption, each drove rates higher by collaborating with stakeholders, assessing local healthcare landscapes, identifying needs, securing resources and leveraging local strengths.  

Minnesota

In 2004, Minnesota established a statewide e-health initiative, a public-private partnership between the newly created Center for Health Informatics within the Minnesota Department of Health (MDH) and various healthcare stakeholders. A health IT advisory committee decided that “e-prescribing was an important starting place,” according to Marty LaVenture, MPH, PhD, director of health informatics and e-health at MDH.

A statewide assessment revealed gaps in e-prescribing capabilities, especially in rural areas. Prior to passage of the federal HITECH Act, state grants and some federal dollars were allocated to develop broadband infrastructure in rural areas to connect providers and pharmacies. The state also established a low-interest loan program that community pharmacies and small provider practices could tap to supplement implementation costs. All debts repaid to the program are made available to others that may need them. “One-time grants are wonderful, but they run out,” LaVenture says. “Having an ongoing fund directed toward this effort has been helpful.”

These efforts preceded a 2008 state law mandating e-prescribing by 2011 and EHR adoption by 2014. Although penalties for failing to comply were never established, possibly because the HITECH Act negated the necessity, the state law created a sense of “urgency and focus,” LaVenture says. Different stakeholders had different motivations for adopting e-prescribing, but it facilitated collaboration toward a common objective that was “really about doing the right thing.”

The number of e-prescribing transactions shot upwards over the next several years. There were fewer than 100,000 e-prescribing transactions throughout the state during December 2008 and more than 1.5 million in December 2012, according to LaVenture. From 2009 to 2011, the percentage of providers routing prescriptions electronically increased from 38 percent to 82 percent, patient visits involving prescription benefit requests increased from 26 percent to 88 percent and eligible prescriptions routed electronically increased from 21 percent to 61 percent.

Having earned the top spot for e-prescribing, Minnesota is turning its attention to other health IT areas. “We want to take the lessons we’ve learned from e-prescribing and make sure we apply them to other aspects of healthcare reform, like EHR adoption,” LaVenture says.  

Massachusetts

“We’re lucky here in Massachusetts,” says Laurance Stuntz, director of the Massachusetts eHealth Institute (MeHI), a private-public collaborative established by state legislation to foster health IT adoption and effective use. “E-prescribing has a long history in our state.”

While Minnesota leapfrogged Massachusetts to occupy the top spot in the 2012 Surescipts Safe-Rx rankings, the Bay State owned the title in each of the previous five years. More than 85 percent of providers routed prescriptions electronically, 57 percent of prescriptions were routed electronically and 71 percent of patient visits involved a prescription benefit request in 2011. Those numbers are up from 57 percent, 32 percent and 40 percent, respectively, since 2009.

Leadership from the state’s vibrant healthcare community was key to achieving a high rate of e-prescribing adoption, according to Stuntz. Partners HealthCare and Beth Israel Deaconess Medical Center, both influential healthcare providers in Boston, were two of Massachusetts’ e-prescribing pioneers and forged a path for others to follow, but commercial health payers were another significant impetus behind the surge in e-prescribing.

In the early 2000s, several of the state’s payers and providers created a partnership to share the costs of building the Rx Gateway, an e-prescribing network built into an existing health information exchange. Beth Israel and Partners piloted the Rx Gateway in 2006 and the service was eventually made available to all providers for the cost of a single interface.

Payers’ efforts to advance e-prescribing in the state didn’t stop at the Rx Gateway. In 2001, Tufts Health Plan began offering providers free personal digital assistants with e-prescribing capabilities; in 2002, Tufts Health Plan and Blue Cross Blue Shield of Massachusetts (BCBSMA) entered an initiative that was later joined by Neighborhood Health Plan to subsidize the costs of e-prescribing-enabled mobile devices for providers. In 2008, BCBSMA also announced that participation in its physician incentive program would require e-prescribing capabilities by 2011—one year earlier than the Centers for Medicare & Medicaid Services’ (CMS) deadline for its e-prescribing incentive program.

“We’ve basically said to ONC that we’re done,” says Stuntz. “We’re moving on to statewide health information exchange.”

South Dakota

In spacious, sparsely-populated South Dakota, three large providers cover 80 percent of the state’s population. E-prescribing became an early focus for these organizations’ health IT initiatives in the mid-2000s and as they expanded e-prescribing efforts, smaller physician practices and independent pharmacies got on board. “When large health systems are moving forward and their pharmacies have adopted a health IT tool, then the independent pharmacies follow suit,” says Holly Arends, clinical IT manager at HealthPOINT, a regional extension center in Madison.  

There was virtually no e-prescribing activity in the state in 2007, when the Agency for Healthcare Research and Quality awarded a grant to Sioux Falls-based Avera Health, which chipped in $735,838 of its own money, to facilitate e-prescribing adoption in rural areas. Avera, which provides care services at 300 locations in the state, hired a pharmacist to manage the project and invested in a web-based e-prescribing portal, hardware and infrastructure for primary care clinics and seven communities’ pharmacies.

“The tool in and of itself doesn’t make the healthcare experience better,” says Chris Sonnenschein, PharmD, executive director of IT clinical support at Avera. To ensure provider, pharmacist and patient satisfaction, Avera put “boots on the ground” to help weave e-prescribing into existing workflows and educate users on how to discuss e-prescribing with patients. Community pharmacies also were offered a yearly stipend to continue e-prescribing for the duration of the grant.

From 2009 to 2011, the adoption rate of provider e-prescribing increased from 25 percent to 68 percent, patient visits involving a benefit request increased from 33 percent to 78 percent and the proportion of prescriptions routed electronically increased from 14 percent of all prescriptions to 39 percent.

While Avera started its e-prescribing initiative prior to the implementation of the CMS e-prescribing incentives program, it was a relief for the state’s health IT advocates. “When the HITECH Act passed, we were already on the journey,” Sonnenschein says. “It didn’t spur us to action, but it did two things: it substantiated the journey we were on and gave us some incentive money to keep moving.”
 

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