CMS Proposes Changes to the E-prescribing Standards

Electronic prescriptions, with their many advantages, may be on the verge of gaining popularity in the United States. E-prescribing is the process by which providers electronically transmit patient prescriptions directly to a pharmacy of the patient’s choice, thereby eliminating the need for paper prescriptions. While currently only about 10 percent of hospitals in the United States use electronic prescription systems, with recent regulation, patient care studies and lobbying efforts — all designed to increase the use of electronic prescriptions — that soon may change. E-prescribing was authorized under the Medicare Prescription Drug Improvement and Modernization Act of 2003. Pursuant to that act, final e-prescribing standards took effect in January 2006. Although the regulations currently do not require the implementation of an e-prescribing system, those utilizing electronic prescriptions must abide by these standards when prescribing covered drugs to Medicare Part D beneficiaries. The regulations include a SCRIPT standard adopted by the National Council for Prescription Drug Programs for all prescription-related communications between providers and pharmacies. However, currently exempted from that SCRIPT standard are entities transmitting prescriptions via computer-generated faxes — faxes generated by a provider’s computer and sent directly to the pharmacy’s fax machine or vice versa. The Centers for Medicare and Medicaid Services (CMS) believed that without this exemption, providers would revert back to paper-based prescriptions instead of moving forward to computer-to-computer exchange via the SCRIPT standard. However, on July 12, 2007, CMS published in the Federal Register a proposed rule of the 2008 Medicare Physician Fee Schedule. Contained therein is a change to the e-prescribing standards. The change eliminates the exemption for computer-generated faxes by requiring all e-prescribing transactions, in any form, to be in the SCRIPT format. According to a CMS fact sheet explaining the proposed rule, “CMS expected that entities using computer-generated fax software would adopt the use of the SCRIPT standard over time, but this has not occurred to date.” The proposed rule is designed to increase the advantages of e-prescribing systems by moving all providers toward the use of the SCRIPT standard. The most notable advantage of an e-prescribing system is an improvement in patient care. Most e-prescribing systems automatically check for potential errors in prescribing, such as inconsistencies in the prescribed dosage or the existence of duplicate therapies. Many systems also warn the provider of relevant drug allergies or harmful drug interactions. Having this information available at the point of patient care allows the provider to immediately adjust the prescription accordingly without having to communicate back and forth with the pharmacy. Computer-generated faxes do not possess these capabilities. Furthermore, the legible format of electronic prescriptions reduces errors from poor handwriting, incorrect data entry and miscommunication between the provider and the pharmacy. While computer-generated faxes are in a legible format, they still require data entry into the pharmacy system, opening the door for potential error. Another major advantage of e-prescribing is the cost savings incurred once the system is fully implemented. By reducing the number of communications from the provider to the pharmacy, the provider is able to spend more time treating additional patients and generating greater revenue. It has been reported that about 900 million prescription-related phone calls occur each year, many of which could be eliminated with an e-prescribing system. However, for many providers, the savings may take several months or even years to accrue. It can take from one to three years to fully implement an e-prescribing system, including researching the systems available, installing the software and training employees. Due to their relative new nature, many e-prescribing systems require a high initial investment, and additional support equipment is often needed. However, once the system is fully implemented, many providers see a return on their investment. For example, a study conducted by the Pharmaceutical Care Management Association revealed that the federal government could save about 29 billion dollars and prevent approximately 2 million medication errors over the next 10 years with the utilization of electronic prescriptions. The proposed rule is designed to encourage providers and pharmacies to move quickly in implementing the SCRIPT standard, thereby taking advantage of all the e-prescribing benefits. Public comments on the proposed rule will be accepted by CMS until August 31, 2007. The final rule, if adopted, is expected to be published in the Federal Register this fall and could become effective as early as January 1, 2008. Until then, the exemption for computer-generated faxes set forth in the original regulations remains in effect. August 2007