E-Prescribe: Adopting Health Care Information Technology ADG associates presenting: Barbara Antuna Jessica Carpenter Patrick Esparza Brian Frazior

E-Prescribing Standards E-Prescribing Base Standards NCPDP SCRIPT 8.1/5.0 ASC X12 N 270/271 HL7 CCD NCPDP Telecommunications 5.1 NPI E-Prescribing Composite Standards NCPDP Formulary and Benefit Standard 

NCPDP SCRIPT (8.1/5.0) To provide for the communication of a prescription or prescription-related information between prescribers and dispensers, for the following: (A) Get message transaction. (B) Status response transaction. (C) Error response transaction. (D) New prescription transaction. (E) Prescription change request transaction. (F) Prescription change response transaction. (G) Refill prescription request transaction. (H) Refill prescription response transaction. (I) Verification transaction. (J) Password change transaction. (K) Cancel prescription request transaction. (L) Cancel prescription response transaction. (M) Fill status notification transaction. Source: http://www.cms.hhs.gov/EPrescribing/Downloads/E-Prescribingfinalruleonfoundationstandards.pdf

NCPDP SCRIPT SCRIPT is a standard created to facilitate the transfer of prescription data between pharmacies, prescribers, intermediaries, and payers. The current standard supports messages regarding new prescriptions, prescription changes, refill requests, prescription fill status notification, prescription cancellation, medication history, and transactions for long term care environments. Source:  http://www.ncpdp.org/pdf/Eprescribing_fact_sheet.pdf

ASC X12 N 270/271, HL7 CCD, and NCPDP Telecommunications Used for a prescriber system to request eligibility information about a patient  HL7 CCD Summarizes a consumer’s registration/medical information XML based NCPDP Telecommunications 5.1 This standard supports the flow of eligibility information and copayment amounts between plan sponsors and dispensers

National Provider ID (NPI) It is important to note that the NPI is used to identify the individual prescriber and dispenser in the electronic prescription process. The NPI was not created to be used for routing of transactions. The electronic prescribing standards are not HIPAA covered transactions and as such are not required to use the NPI. Entities covered by the Medicare Modernization Act are required to comply with the MMA, including the NPI usage.

NCPDP Formulary and Benefit Standard E-Prescribing Composite Standards The NCPDP Formulary and Benefit Standard provide patient benefits information to physicians at the point of care. These can include Formulary Status, Payer-specified Alternatives, Coverage Information, Copay Information and Drug Classifications.

Electronic Prescription Standards Workflow 8

Electronic Prescription Standards Workflow – Unidirectional Diagram 9

Medication Request Defines medication transaction requests between a prescriber and dispenser NCPDP SCRIPT 8.1 standard Types of requests NEWRX – New order request REFREQ – Refill request RXCHG – Change request CANRX – Cancel request 10

Medication Formulary and Benefits Information Provides benefits information to physicians at the point of care Includes formulary status, payer specified alternatives, coverage information, co-pay information, and drug classifications Two part process: Eligibility Checking – ASC X12N 270/271 Obtain formulary and benefit information – NCPDP Formulary and Benefit Standard 1.0 11

Medication History Provides a medication history list to a prescriber for a specific patient Sources include payers/PBMs, pharmacies, and prescribers NCPDP SCRIPT 8.1 Medical History standard HL7 CCD standard Multiple transactions: Medical history request – NCPDP RXHREQ Medical history response – NCPDP RXHRES HL7 CCD Request HL7 CCD Response 12

Fill Status Notification Notifies the Prescriber of when a prescription has been dispensed, partially dispensed, or not dispensed NCPDP SCRIPT 8.1 Fill Status Notification - RxFill Two transactions: Rx dispense message – RXFILL Acknowledgement by Prescriber 13

System Requirements – Function with EMR Must connect to the current EMR system Must provide administrative and reporting functionality Patient history, laboratory results, available medication history and allergy information.

System Requirements – Error Prevention Must be linked to error prevention software Include a notification system to flag potential medication errors Must allow the prescribing provider to override the error prevention software Prescriber documentation required to do this Must allow the integration of all pertinent clinical information

System Requirements – Medication Classification Must categorize medications into families to assist in checking of medications. Must allow for frequent upgrades and checks that will not affect the functionality of the system. Must provide information on all alternative medications, including pricing information.

System Requirements – Prescription Routing/Security Must allow for prescribers to print prescriptions or submit electronically to pharmacy. This transaction must be done through a secure interface that is HIPPA compliant and link to and from participating pharmacies.

System Requirements – Dosing and Prescriber Checks Must perform dose range checks in order to prevent excessive doses from being ordered or administer. Must allow end-users to have the ability to receive and respond to prescription renewal requests from pharmacies

System Requirements – Additional Security Measures Security must be in place to distinguish between Providers, nurses and mid-level providers and have a valid registration to route prescriptions electronically.

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