The current system of prescribing and dispensing medications throughout the United States is marred by safety and efficiency problems that put patients’ lives at risk and contribute to the skyrocketing costs plaguing our health care system. Today’s system of prescribing medicines, in which health care providers make decisions without complete information about a patient’s medication regimen and in which prescriptions are handwritten, can be downright dangerous. Electronic prescribing, or ePrescribing, can greatly reduce prescription errors, thereby improving the quality and safety of patient care and reducing the costs associated with adverse drug events or redundant treatments. Through health information exchange, ePrescribing can reduce medication errors, increase monitoring for adverse drug reaction, maximize workflow efficiency, improve communication and streamline coordination of care between providers, pharmacists and patients.

In response to its provider members’ need for access to health information, the Northern Sierra Rural Health Network conducted a comprehensive assessment on 2006 to identify how health information technology could improve health care delivery systems across its nine-county membership area. In Phase I of the program for Promoting Rural Health Care Quality through the Effective Use of Information Technology funded by the Blue Shield of California Foundation, a survey and assessment of 14 community clinics, 6 rural hospitals, 6 public health departments and numerous private health care providers, 3 health information exchange priorities arose:

• Electronic Prescribing (ePrescribing between providers and pharmacies)
• Regional Disease Management (diabetes, chronic disease and preventive health measures)
• Remote Access to Health Information (hospital web portals to patient health information)

The resounding call for ePrescribing was clear, as is its potential value to NSRHN constituents. ePrescribing benefits to patients, providers and pharmacists include the ability to maintain a complete medication list and history for each patient; decision-support tools including alerts of patients’ chronic conditions or medications allergies; access to patient-specific formulary data; and capacity for electronic communications for prescription delivery, clarifications, and renewal request. A streamlined prescribing process may further improve patient safety and reduce costs by providing complete patient information and clinical advice at the point of care; increasing formulary compliance; and removing additional resources of human error in communication between practice, pharmacies and pharmacy benefit managers (PBMs).

Through the ePrescribing project, NSRHN hopes to improve workflow between providers and pharmacies in our region, propose solutions to curb drug seeking behavior, and reduce the number of prescription errors and adverse drug events suffered by patients in our region. Beginning in winter 2007, pilot participants will begin using the NEPSI Program and eRXNow application to improve workflow and communications between providers and pharmacies. In addition, participating sites will be provided with access to Medi-Cal medication history, formulary and eligibility data through Rx Hub. Desired outcomes include a reduction in number of prescription errors and a reduction in number of Adverse Drug Events (ADEs). Furthermore, given the large population of Medi-Cal beneficiaries in the Northern Sierra region, the program aims to demonstrate the positive impact of ePrescribing on the state’s ballooning Medicaid budget.

The Blue Shield of California Foundation awarded funding to NSRHN to implement a regional program for Promoting Rural Health Care Quality through the Effective Use of Information Technology, designed to improve the coordination and quality of care in the region. NSRHN is currently working to implement ePrescribing throughout the network by using the National EPrescribing Safety Initiative (NEPSI) model. This coalition of companies, led by Allscripts, is offering free ePrescribing license to every physician and medication prescriber in the U.S. in an effort to reduce the biggest barrier to physician adoption of ePrescribing: cost. Rather than relying on providers to finance the costs associated with ePrescribing, the NEPSI model relies on the sponsorship and donations of its member companies, which include technology vendors and health plans. In addition, the California Healthcare Foundation is contributing funding to the project, in an effort to illustrate the business case for payers to support electronic prescribing within their networks.

To complement the ePrescribing project and demonstrate the ways in which ePrescribing can make prior authorization and prescription renewal processes more efficient and cost effective, we are working to bring Medi-Cal medication history, formulary, and eligibility data to the fingertips of our participating providers. In order to spur adoption of ePrescribing by Medi-Cal providers outside of the Northern Sierra region, we are also experimenting with incentives and/or reimbursement mechanisms. If successful, these reimbursement incentives can be implemented throughout the state to drive physician adoption and use of ePrescribing.

The program for Promoting Rural Health Care Quality through the Effective Use of Information Technology is managed by NSRHN with assistance from Manatt Health Solutions and Illumisys, with funding from the Blue Shield of California Foundation. A Health Information Exchange Committee including representatives from across the region will advise the program. NSRHN is currently laying the groundwork for the ePrescribing project, planned to launch in December 2007. Initial program participants include Fairchild Medical Center, Hill Country Community Clinic, Plumas District Hospital, Siskiyou Family Healthcare, McCloud Medical Center, and Mercy Medical Center, Mt. Shasta. We hope other health care providers throughout the state will follow our lead in improving the quality and safety of patient care. Project accomplishments and future program participants will be shared with community at the NSRHN Annual Members’ Meeting in spring 2008 and 2009. For more information, contact Jan Philips Sotka, jan@nsrhn.org at 530-722-1156.