Digital Transformation In e-Prescribing
By Eileen Haggerty, Senior Director Enterprise Business Operations, NETSCOUT
Contemplating digital transformation in the healthcare industry typically conjures up innovations in medical imaging, diagnostic testing, gene therapies, and bio-pharmaceutical developments. These are all revolutionary advancements that are improving speed, effectiveness and quality of patient care. Another transformation on this list is electronic prescription or e-prescribing and deserves a closer look due to its criticality in optimal patient care.
As an initiative in the digital transformation, like electronic medical records, electronic prescribing is equally invaluable. It is now ten years old, having first become legal in the United States in 2007 and gained wider adoption with the advent of the Medicare Improvements for Patients & Providers Act (MIPPA) that included incentives for issuing prescriptions electronically. By 2010, with further regulatory directives for electronic prescribing of controlled substances (EPCS), implementation of guidelines, penalties and financial incentives, broader use of e-prescribing was achievable. Helped by requiring 50% of prescriptions to be electronic to achieve Meaningful Use stage 2 has influenced its growth from very small numbers of e-prescriptions in 2007 to now more than 1.6 billion annually in 2016 according to Surescripts research.
ePrescriptions for controlled substances have been legal in all 50 states since 2015; prescribing controlled substances electronically offers significant benefits – top among them increased patient safety, improved quality, higher efficiency and better total cost of care principally due to decreasing errors caused by misinterpreted handwriting. Most importantly, e-prescribing also reduces fraud and paper prescription theft, “doctor shopping”, and further helps uncover possible cases of abuse, and at a time when the opioid crisis is a top concern, this is critical.
According to recent Surescripts report in June 2017, Electronic prescribing of controlled substances in the US was up from 12.81 million prescriptions in 2015 to 45.34 million in 2016 – a 256 percent increase. This was greatly impacted by New York and Minnesota making e-prescribing of controlled substances mandatory in 2016 and will likely continue as more mandates go into effect, like Maine’s in July 2017 and Virginia’s in 2020, while still other states proceed with legislation. New York’s mandate goes so far as to require penalties, including fines and even incarceration, for doctors who refuse to create prescriptions for Schedule II controlled drugs.
The importance, adoption and dependency on e-prescribing underscores an Information Technology imperative – the availability, speed and safety of the applications and networks to send prescriptions electronically. As e-prescribing becomes more widespread and mandated, service assurance for optimal performance is going to be essential. Especially when penalties and fines are hanging in the balance – network and e-prescription application unavailability will certainly NOT be an excuse for writing paper prescriptions.
Optimizing e-prescription application service performance for this Digital Transformation (DX) initiative requires greater visibility into the data crossing healthcare and pharmacy networks, as well as a view of how to better manage the technology itself. Vendor-independent visibility is paramount due to the valuable time lost in finger pointing among various application, infrastructure, and third-party Internet providers when analysing slowdowns and outages.
For successful execution of an electronic prescription, several dependencies must be operating effectively. This includes unimpeded access to the patient’s medical record, ability to view other patient prescriptions, unobstructed issuance of the prescription, and goes to swift reception of the prescription at the pharmacy, seamless validation of insurance coverage to ultimate fulfilment and payment of the prescription. This is all electronic now, and any delay in any area of this process can impact patients, doctors and/or the business.
Patient Impact When e-Prescription Services Are Slow
Consider a large, national healthcare provider that supports millions of outpatient visits, thousands of inpatient surgeries that issues and fills millions of prescriptions annually. Their IT team is under constant pressure to ensure that the significant investment in technology infrastructure supports the highest quality healthcare services including their e-prescription and pharmacy services. As patients were arriving at the in-house pharmacies, network slowdowns were delaying prescription retrieval, insurance approvals, and prompt billing that were resulting in long lines and extended wait times. These degradations had a direct impact on patient care, experience and the provider’s bottom-line. Because patients can take prescriptions to any pharmacy of their choosing, there was an urgent business need as well to quickly find the source of network and/or application issues.
Using service assurance technology, the IT staff at the healthcare organization was able to employ dependency mapping of the e-prescription application service across the pharmacy, hospital, and data center network that included the application servers, web-front end services and supporting network infrastructure to pinpoint the root cause of the slow-downs. Quick identification of the problem to the web front-end servers used by the pharmacists at all their locations to receive the prescriptions and validate patient insurance coverage, enabled that the corrections could be made to restore high-quality e-prescription service.
Service Assurance – The Right Rx For e-Prescription Good Health
Complete visibility into complex e-prescription application services throughout the pharmacy, hospital and data center is essential to correctly diagnose the source of slowdowns or interruptions in access. Regardless of whether it is a congestion or capacity issue, a configuration or access privilege problem or a multitude of other challenges, quick analysis and problem resolution is paramount.
The dependency on digital transformation in healthcare, and with e-prescription services specifically, is significant and critical for quality patient treatment. There are many vendors involved in delivering these complex technologies for physical and virtualized infrastructure, hybrid cloud, wired or wireless connectivity, network protocols, along with all the healthcare specific applications, including e-prescriptions that must operate together flawlessly. However, when slowdowns and outages do occur; broad, complete, vendor-independent service assurance capability and visibility is essential to rapidly pinpoint and resolve issues before they become catastrophic outages and ensure e-prescription services are safely available whenever necessary.