As BCBMA evaluates how it continues over the next decade to fulfill its corporate promise to “always put our members first” as well as fulfilling it broader mission of improving the health of its community, we recognize that the healthcare system as we know it today requires a transformation.  Addressing the challenges of improving health care quality, safety and affordability will require bold, innovative and dramatic changes far beyond the incremental tinkering that has occurred to date.  We believe that technology will play a crucial role in this transformation and, combined with strong and visionary leadership, true transformation can be accomplished.

Electronic prescribing offers a significant opportunity to enhance the quality and safety of patient care as well as to reduce medical and administrative expense. E-prescribing provides a first step toward the introduction and universal adoption of technologies that can support a transformation of health care.  Preliminary studies demonstrate a significant reduction in time spent by physicians and pharmacists in the prescription writing and dispensing processes when technology is used that provides eligibility and formulary information at the point of care.  Add to this the elimination of legibility issues, the availability of medication history and prompting for potential adverse drug-drug interactions, there is a significant opportunity to improve the quality of care. Finally, providing information about less expensive therapeutically equivalent alternatives at the point of care will have a positive impact on the pharmacy expense trend.

The ability to make this technology affordable and useable requires that it be available from multiple sources (product competition), but regardless of the source, this technology should be compatible with all the other electronic prescribing technology the market.  Establishing national standards to insure this interoperability at least around core functionality is critical to promoting successful adoption and use of the technology within the provider community as well as maximizing the benefits that patients and the health care system can derive from it.

In our view the core functionality around data exchange, which is the critical point of impact with any standards, should include the ability to:

View a patient’s full medication history (based on PBM or Health Plan claims history and retail pharmacy data)

Send prescriptions to retail (including mail order) pharmacies electronically eliminating data entry at the pharmacy

Receive refill requests electronically from pharmacies

Show member specific eligibility and formulary information

Provide plan specific messaging around therapeutic alternatives

Evaluate drug to drug interactions based on entire drug history (active drugs), as well as communicate warnings or cautions and dosage age reminders.

Transmit notification of prior authorization and requirements as well as electronic submission of prior authorization requests

Incorporate an electronic signature

Internal features such as the ability to store patient specific information about weight, lab values, allergies etc. is important (and functionality that we hope is made available by various electronic prescription technology vendors). We believe, however that this is beyond the scope of standards required to insure interoperability among and between various e-prescribing technology solutions. In addition, many of these additional features require additional input by providers or their offices (weight, allergies, etc.) that would potentially create greater adoption hurdles and would be difficult to regulate or insure compliance.  We also support the concept of  incorporating laboratory information into drug prescribing decisions, However,  again we believe that this is outside of the scope of electronic prescribing and would not suggest that it be included as a requirement for the initial set of standards.  Clearly as we move towards ubiquitous electronic medical records, this type of capability can be incorporated into the standards that will describe minimum functionality for that technology.