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

2. 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 

3. 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:

4. 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:  

5. 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

6. 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.

7. 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.

8. Electronic Prescription Standards Workflow8

9. Electronic Prescription Standards Workflow – Unidirectional Diagram9

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 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

16. 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.

17. 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.

18. 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

19. 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.

20. Questions?