Mississippi Medicaid Program Considers Expanding E-Prescribing Program

An electronic prescribing program shown to save the State of Mississippi some $1.2 million per month in medication costs could be expanded, according to several news sources. The Mississippi Division of Medicaid is discussing expanding its successful e-prescribing program by equipping 225 doctors with handheld e-prescribing devices.

E-prescribing refers to an electronic prescription order/fulfillment route that directly connects physician workstations with mail order or retail pharmacies. Many electronic medical records (EMR) systems include an e-prescribe function, and some companies sell programs independent of an EMR.

Physicians can use the Informed Decisions devices to access patients' medication histories, avoid dangerous drug interactions and see if patients are filling and refilling their prescriptions. Doctors who use the devices write fewer prescriptions on average, and those prescriptions are likely to cost the state less, state officials say.

The state pays $35,000 per month for the program but is saving nearly $27,000 per month on hospitalizations because the physicians receive real-time alerts about the dangerous drug interactions, according to Mississippi officials.

The state Medicaid program is looking to expand the initiative because it consistently has been saving money for 18 months.

The devices also help detect fraud. Kurt Bruckmeier, a physician for about 200 Medicaid beneficiaries in Hattiesburg, Miss., said the system has "helped identify drug abusers who would very likely have gone undetected were it not for our ability to evaluate the full scope of prescriptions they were taking."

Mississippi officials said they did not know of any negative aspects to the program. Florida has launched a similar program with comparable results.

New Rules for E-Prescribing Faxes Generated by Computers?

E-prescribing - a prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point of care - is an important element in improving the quality of patient care. In an effort to encourage the adoption of e-prescribing (also known as e-rx), the U.S. Centers for Medicare & Medicaid Services (CMS) has proposed eliminating the exemption for computer-generated faxes from the e-prescribing standards by early 2009.

In the earlier rule, the U.S. government adopted e-prescribing standards for use by physicians and suppliers in connection with prescriptions under Medicare Part D. They included the SCRIPT standard for communications between physicians and pharmacies regarding prescription information, but provided that entities that transmit prescriptions via a computer-generated fax were exempt from the SCRIPT standard. SCRIPT is a data transmission standard intended to facilitate the communication of prescription information between prescribers and pharmacists.

Will Your E-Prescribing Software Pass the Test?

Many older electronic medical records (EMR) systems have a computer-generated fax function, whereby a fax is generated on a physician's computer and sent to a pharmacy's fax machine. Think of it as the halfway point between the old fashioned paper system and the "new fashioned" electronic system. CMS anticipated that physicians using computer-generated fax software would adopt the SCRIPT standard over time, but this hasn't occurred. In the words of CMS, developing e-prescribing standards "is one of the key action items in the government's plan to expedite the adoption of electronic medical records and build a national electronic health information infrastructure in the United States.

So, what's "wrong" with computer-generated faxing? In short, it retains some of the disadvantages of paper prescribing. For example, the pharmacy must key the prescription into the pharmacy system, where data entry errors could jeopardize patient safety. It's better than the old fashioned paper prescribing system, but in the minds of Medicare, it falls short of true electronic prescribing.