EPN - Electronic Prescribing News: EDI in the Medical Field

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February 14, 2006

EDI in the Medical Field

EDI in the Medical Field.

EDI in the Medical Field

Written by Scott Koegler
Monday, 13 February 2006

At the beginning of 2006 the practice of ePrescribing passed a milestone by transacting more than three million prescriptions through the eRx Collaborative. ePrescribing is quickly becoming one of the biggest success stories in e-Commerce, and its impact on doctors, patients, and pharmacies is showing up in ways that may not have been anticipated.

Imagine this scenario:

Dr. Thomas Sullivan, past president of the Massachusetts Medical Society takes a break during a conference he is attending in California. He answers a phone call from a long-time patient who recently moved from Boston to Florida. As he is discussing an issue with the 97 year old patient, the doctor taps on his Treo650 cell phone's display and brings up the patient's prescription history for the last 10 years.

He scrolls through the medicines he's previously prescribed for the patient and sees that a drug the patient had taken two years ago would be appropriate for his current problem. The doctor selects the medication, and it is automatically cross-checked for interactions with the patient's current medications. At the same time, the medicine's formulary is checked for available brands that are covered in the patient's healthcare plan. Dr. Sullivan checks the medicine to initiate a prescription, and advises his patient to pick it up at his local pharmacy.

"It's like night and day," says Dr. Thomas Sullivan. "I've been out of medical school for 36 years and have seen the evolution of impossible-to-get-to clinical information become accessible anywhere, anytime, and from any device." Dr. Sullivan started to use ePrescribe 3 years ago because the system offers more efficiency, better safety against potential drug interactions, and overall better patient care.

Tied together

Making this kind of instant access possible is a well integrated system of standards-compliant applications that have at their heart, EDI. Thirty years ago the HL7 (www.hl7.org) developed the ANSI X12 standards that are the root of health care document transactions. Since then, the information flowing between medical practices has grown tremendously. Today, information is transacted in both X12 and XML formats depending on the type of information being managed.

Many applications have started from that initial standard. It's typical for medical billing functions to be transacted as EDI documents. Five years ago, HL7 began the process of converting its paper based medical documents to XML documents. One significant development has been SureScripts which was developed by the NACDS (National Association of Chain Drug Stores) and NCPA (National Community Pharmacists Association). SureScripts is an industry supported organization that brings a standard document definition to transferring information about prescriptions to the pharmacies of America. Its structure is based on EDI, and connects pharmacies using an open standard.

This standardization and cooperation is what makes it possible for a doctor in California to initiate a prescription for delivery in Florida without knowing which pharmacy the patient will choose.

Front end

But the medication can't be prescribed unless the doctor has the patient's information. That's where ePrescribe and the eRx Collaborative come into the picture. One company providing the electronic connection is DrFirst (www.drfirst.com), whose Rcopia product connects the doctor to the office, the patient's history, and the pharmacy via EDI. According to DrFirst's director of marketing, Irene Froehlich, "DrFirst has been sending EDI transactions to SureScripts since its beginnings in 2000."

The Rcopia system has been seen as a way for health care agencies to lower the costs of transactions, make better selections from available comparable drugs, increase patient safety, and make doctors' offices more efficient. The online application stores patient prescription history for as long as ten years, and can recommend medications that fit with the patient's health care plan in order to lower co-payments.

The system has also been credited with reducing the workload for doctors' assistants who sometimes have to handle hundreds of faxes and phone calls from pharmacies every day. The communications are requests for refills or other questions about prescriptions that need to be sorted, researched against patient records, authorized by the doctor, and finally communicated back to the pharmacy. According to Dr. Sullivan, "Having all those requests come through the computer, with the patient history research already completed has changed the life of my office staff."

With the requests online, the doctor simply reviews a single web page to confirm the findings, then enters his authorization code. Once authorized, the responses are sent through the system to each pharmacy. "The system creates easily searchable records, which is something the paper based systems could never achieve," says Froehlich. With centrally based records, doctors can be alerted if patients that have been prescribed sensitive drugs are "shopping around" at multiple pharmacies trying to get multiple refills.

"We have a high concentration of installations along the East Coast. Many of the health plans have seen the benefits of ePrescribing and have paid the license fees for the implementations," according to Froehlich. The ePrescriptions system is a good start, but only a small subset of a full patient records system. "The cost of a fully integrated patient record system can cost $50,000 and more," according to Dr. Sullivan. "That constitutes a significant hurdle to many small practices." The implementation of an ePrescription system may be a relatively easy way to get accustomed to using a full EDI based patient record system.