1. Abstract #550 IRB Approval Received Category C2 Pharmacy Outreach Using the RAND e-Prescribing Toolset (PORT) Study Sokkim Lim, PharmD PGY1 Pharmacy Specialty Resident University of California, San Francisco Department of Health Care Services

2. 2 Investigators have no conflict of interest to disclose. This study was not funded. Proprietary information or results of ongoing research may be subject to different interpretations. Disclosure Statement Speakers Non-Commercialism Agreement Speakers presentation of this slide indicates agreement to abide by the non-commercialism guidelines provided on the CE Requirements page. Sokkim Lim, PharmD

3. 3 Department of Health Care Services: Medi-Cal Nations largest Medicaid program in terms of the number of people it serves: 7.3 million Second largest in terms of dollars spent: $36 billion Drug expenditures in Medi-Cal FFS program : $4.2 billion Medi-Cal FACTS AND FIGURES, September 2009 (http://www.chcf.org/publications/)

4. 4 Leader Pharmacies National network of more than 3,200 independently owned community pharmacies Contracts negotiated on a group basis in order to acquire a more competitive purchasing level –Independent pharmacies in Sacramento Valley and surrounding areas Incorporated in 1986

5. 5 Pre-Test Assessment Questions: e-Prescribing (eRx) 1.Prescriptions are received mostly in which of the following forms? a.e-Prescription b.Fax c.Phone d.Hard copy 2.Most eRx issues are related to the pharmacy management system (True/False). 3.Which problem type would include e-refill approvals that do not automatically link to the original prescription? a.Interoperability b.EMR System c.Pharmacy Management System d.eRx Network

6. 6 Background Prescribers and eRx –American Recovery and Reinvestment Act: $19 billion allocated toward adoption of health information technology –Center for Medicare and Medicaid Services released proposed regulations defining meaningful use of EMRs: e- prescribing key component –Adoption of eRx expected to increase from approx. 34% to 75% over the next five to six years Pharmacies and eRx –National: 98% chains vs. 73% independents connected –California: Independent Pharmacies (California) 50% of Medi-Cal prescription claims Largely not connected for eRx E-prescription market headed to $204.6M. April 15, 2011. http://www.healthcareitnews.com/news/e-prescription-market- headed-2046m.

7. 7 Background Northern Sierra Sacramento Francisco San Francisco Valley Silicon Valley Central Central Valley Angeles Los Angeles Inland Empire County Orange County San Diego Region # of Pharmacies Chain Pharmacies (Connected) Independent Pharmacies (Connected) Chain Pharmacies (Not connected) Independent Pharmacies (Not connected) California eRx 2009 Medi-Cal Data: Top 25 Medi-Cal Serving Pharmacies by Volume

8. 8 Study Objectives Primary –Test usability and usefulness: RAND eRx Toolset eRx support person Secondary –Identify and address eRx issues

9. 9 Methods – Participation Inclusion Criteria: –Current staff member in a Leader Pharmacy in Sacramento Valley or surrounding area Exclusion Criteria: –Not a current staff member in a Leader Pharmacy in Sacramento Valley or surrounding area Consent form for voluntary participation 9 Leader Pharmacies –7 eRx –2 non-eRx 8 week study

10. 10 Methods – Pharmacy Staff Orientation: pilot study, the toolset, and the eRx eRx support person –Resources: Existing contacts, RAND eRx Toolset, eRx support person, problems tracking sheet –Staff: documented and attempted to solve eRx related issues

11. 11 Methods – RAND eRx Toolset RAND Corp. – research in health, education, national security, environment, and other areas Toolset Chapters –1. How to use the Toolset –2. Background: What you need to know –3. Getting ready for e-prescribing –4. Optimizing workflow to take advantage of e- prescribing –5. Costs and benefits: Measuring the economic impact –6. Troubleshooting and preventing common problems with e-Prescribing –7. Future directions

12. 12 Methods – eRx Support Person Weekly Pharmacy Visits –Reported and triaged issues to eRx support person –eRx support person contacted prescribers, health IT team of medical groups, EMR vendors, pharmacy system vendors, and eRx networks as necessary Weekly Updates –Prioritized issues –Documented all troubleshooting activities

13. 13 Methods – eRx Support Person Additional Resources –Created eRx contact list –Compiled and distributed eRx costs comparison list Surveys

14. 14 Results – Demographics Non-eRx Pharmacy Participants, N=2 eRx Pharmacy Participants, N=17 –Pharmacy Role Pharmacy Manager/Owner: 29% Pharmacy Technician: 59% Pharmacy Clerk: 12% –Length of time at pharmacy <1 yr: 6% 1 to 2 yrs: 12% 3 to 6 yrs: 29% >6 yrs: 53%

15. 15 Results – Demographics eRx Pharmacy Participants, N=17

16. 16 Results – Demographics eRx Pharmacy Participants, N=17 Routes of Incoming Prescriptions Mainly eRx0% Mainly Fax23.5% Mainly Phone0% Mainly Hard Copy76.5% Preference of Route for Incoming e-Prescriptions62.5% Faxed prescriptions25.0% Phoned prescriptions0% Hard-copy prescriptions12.5%

17. 17 Results – Surveys eRx Pharmacy Participants, N=17

18. 18 Results – Surveys eRx Pharmacy Participants, N=17

19. 19 Results – Surveys eRx Pharmacy Participants, N=17

20. 20 Results – Identified eRx Issues eRx Pharmacy Participants, N=17 Total number of issues identified, N=74 Types of eRx Issues Interoperability (multi-system, formatting, matching standardization) eRx Network EMR System Pharmacy Management System Prescriber Workflow Pharmacy Workflow Cost/Benefit 12%20%27%38%41%11%8%

21. 21 Results – Identified eRx Issues Interoperability –Non-matching physician names Robert T. Smith vs. Robert T. SmithMD vs Bob SmithMD eRx Network –Duplicate eRxs

22. 22 Results – Identified eRx Issues EMR System –eRx with multiple sigs Pharmacy Management System –e-refill response does not automatically link to original

23. 23 Results – Identified eRx Issues Prescriber Workflow –Wrong quantity, responded to e-refill requests by sending new eRx Pharmacy Workflow –Inconsistency in interpreting number of refills Cost/Benefit –$600-800/month transaction fees

24. 24 Study Limitations Short timeframe Lack of control group Small sample size Categorization of some problems may be objective

25. 25 Conclusions Most participants reported benefit in eRx in their pharmacy Most participants valued the eRx support person in addressing eRx issues Most participants did not use the RAND Toolset Many different types of eRx issues were identified

26. 26 Pre-Test Assessment Questions: e-Prescribing (eRx) 1.Prescriptions are received mostly in which of the following forms? a.e-Prescription b.Fax c.Phone d.Hard copy 2.Most eRx issues are related to the pharmacy management system (True/False) 3.Which problem type would include e-refill approvals that do not automatically link to the original prescription? a.Interoperability b.EMR System c.Pharmacy Management System d.eRx Network

27. 27 Questions?

28. Sokkim Lim, Pharm.D. PGY1 Pharmacy Resident, eHealth Policy and Research UCSF, School of Pharmacy Medi-Cal, Office of Health Information Technology California Department of Health Care Services 1501 Capitol Avenue, MS 0004 P.O. Box 997413 Sacramento, CA 95899-7413 sokkim.lim@dhcs.ca.gov