1. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Electronic Prescribing and the Department of Health Central Pharmacy Christopher B. Sullivan, Ph.D. Florida Center for Health Information and Policy Analysis Agency for Health Care Administration Florida Public Health Association Medical Director’s Meeting July 29, 2008

2. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 ePrescribing Today MJJ - 2007 1. Physician Evaluates Patient & Prescribes Drug Pharmacist reviews prescription and routes it to the patient’s insurer. 2.2. Payment is collected and Medication is dispensed to the patient 5. 4.4. Script to Patient Benefit Manager for Adjudication Rx Approval Patient Benefit Manager Approves Script 3.3. 29% Cursive or P hone &or Fax (Cursive/Typed) eRx 70% 1% Manual Entry By Pharmacist vs. Typed

3. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Medicaid Wireless Handheld PDA Pilot In 2002, the Florida Legislature directed AHCA to develop a wireless handheld drug information application for prescribers to use at point of care The system was expected to provide: Continuously updated clinical pharmacology information for prescriber reference Reference to the Florida Medicaid PDL Individual Medicaid patient medication history Ongoing education and support for prescribers

4. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Value of the Wireless Handheld PDA Florida Medicaid Wireless PDA Pilot makes 100 days of a patient’s prescription drug history available to practitioners. The medication history: is available at the point of service; permits immediate utilization and compliance review; provides information about coverage and restrictions; incorporates an e-prescribing function that permits immediate transmission of prescription authorization to the patient’s pharmacy.

5. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Medicaid eMPOWERx ePrescribing

6. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Outcomes from the Wireless Handheld PDA Pilot eMPOWERx allows physician participation in prospective drug utilization review to: Minimize adverse drug reactions. Detect overuse or under use of drugs. Detect duplicate therapies. Detect potential allergic responses. Screen for appropriate dosage. Halt “doctor shopping” for medications

7. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Refill Compliance Indicator Date of Last Fill eMPOWERx Can Improve Patient Adherence

8. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Automatic Clinical Reports eMPOWERx Can Enhance Safety Supported by Clinical Content

9. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Wireless Handheld PDA Drug Interaction Alerts eMPOWERx Is integrated with a clinical information database, which includes screening tools to reduce the potential for medication errors before they occur. Employs Clinical Pharmacology and clinical report tools, empowering clinicians to screen a prescription for adverse effects. Alerts the provider to potential drug-drug or drug- allergy interactions The ePrescribing component provides Medicaid Preferred Drug List status information and Recommendations for alternative medications.

10. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Lower Drug Costs Comprehensive medication history for well informed therapeutic decisions Therapeutic duplications flagged for further review Drug Interactions

11. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 eMPOWERx E-Prescribing Features The eMPOWERx system is supported through a Web- based, real-time prescribing system: Allows providers to write prescriptions from a desktop computer or a PDA with prompts for the patient’s last pharmacy. The desktop version of eMPOWERx includes a data feed from SureScripts-RxHub. Physicians can obtain a medication history from both Medicaid and non-Medicaid sources using the desktop version. One significant barrier for the County Health Departments is the need for extra security and two factor authentication.

12. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Outcomes of the Medicaid e-Prescribing Wireless PDA Pilot Project Prescribers who used eMPOWERx write 25% fewer prescriptions than physicians not using the system. Prescribers who use eMPOWERx save Medicaid an average of $48 more per month per patient on prescription claims. Florida Medicaid reports $1.8 - $2 million in monthly savings from electronic prescribing. During 2006, eMPOWERx users received more than 5,000 drug interaction alerts each week, more than 1,000 of which were of high or very high severity.

13. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Lower Average Medicaid Prescription Claims in the Pilot Program

14. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Greater Medicaid Cost Savings per Patient in the Pilot Program

15. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Avoiding Adverse Incidents with Interaction Alerts October-December 2007

16. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Accessing Medicaid Data through Gold Standard oFlorida Medicaid Gold Standard eMPOWERx e- prescribing software is available to all Medicaid physicians at no cost. AHCA is working with Gold Standard and Medicaid to make eMPOWERx medication history available to Medicaid physicians through Florida RHIO portals. AHCA would like to work with the Department of Health to support the adoption of e-prescribing in the County Health Departments.

17. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Opportunities for eMPOWERx oDuval County Health Department is initiating a pilot project using eMPOWERx. oFlorida Medicaid is working with the Duval County Health Department to obtain extra PDAs. oThe eMPOWERx Desktop version has extra benefits with its RxHub feed, but security is an important issue that needs to be resolved. oAHCA and Medicaid would like to reach out to work with the DOH to make eMPOWERx available to all County Health Departments in Florida, either directly or through a data feed to the Central Pharmacy QS1 system.

18. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 DOH Health Maintenance System Gold Standard eMPOWERx Data Feed Through the QS1 System?

19. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Public Health Association - Medical Director’s Meeting - July 29, 2008 Christopher B. Sullivan, Ph.D. Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Office of Health Information Technology 2727 Mahan Drive Tallahassee, FL 32308