Electronic Prescribing

Are you Electronic Prescribing?

Friday, May 4, 2012 by Ryan Smith

Instead of writing out prescriptions on a piece of paper, doctors will perform this function directly into their electronic medical record. The prescription travels from their computer to the pharmacy’s computer. Electronic prescriptions are sent electronically through a private, secure, and closed network – the Surescripts network.

Surescripts' e-prescribing services allow physicians to electronically send prescriptions from their offices to more than 54,000 retail pharmacies and six of the largest mail order pharmacies. In addition, Surescripts provides physicians with electronic access to their patients' prescription benefit and medication history.

Lexi-Data is the foundation of Lexicomp's clinical decision support architecture is quickly becoming the standard for when companies need an up-to-date comprehensive drug database. This product provides patient specific alerts and referential content to support sound treatment decisions in areas such as drug interaction checking (drug-drug and drug-food), drug allergy checking, therapeutic duplication checking, RxNorm Mappings, supports Surescripts Certification, Drug Classifications, dose range checking (adult and pediatric), Patient Education, and more.

Data solutions for electronic prescribing of controlled substances

Friday, March 2, 2012 by Matt Bennardo

EMRs, EHRs, and ePrescribers are poised to add controlled substances to their electronic prescribing products -- but there's a hitch. Where can these vendors get the federal and state controlled substance schedules in a ready-to-use format?

Healthcare providers that handle prescriptions in multiple states have long known that the interlocking and overlapping requirements of state and federal controlled substance schedules can be bewildering. The U.S. Drug Enforcement Administration (DEA) supplies a federal code that must be followed -- except where it is superceded by more stringent state codes. The result is that every state has different rules for prescribing narcotics and other controlled substances. Even worse, there's no single place to get information from all the states. If you want to keep up, you have to follow each one individually.

Luckily, Lexicomp can now provide both federal and state CSA codes in ready-to-use data formats that make adhering to laws much easier. The information is collected by Lexicomp's in-house staff of content experts and updated regularly. It's available as part of their integrated transactional data product, Lexi-Data, which means the data can power electronic prescribing logic from behind the scenes. Contact Lexicomp today for more information by following the links on this page!

e-Prescribing Controlled Substances

Tuesday, February 14, 2012 by Marissa Van Rooy

Electronic prescribing (e-Prescribing) is a key component to improving patient safety and reducing medication errors, because it provides real-time clinical decision support to physicians at the time of order entry. It is estimated that approximately 7,000 deaths occur each year in the United States from preventable medication errors. That is why physician adoption of e-Prescribing has been incentivized by the federal government. However, one of the biggest challenges surrounding physician’s adoption of e-Prescribing is the ability for them to electronically transmit prescriptions for controlled substances.

Prior to June 2010, all controlled substance prescriptions were required to be on paper, so instead of maintaining one process for paper-based controlled substances and another that is electronically based for noncontrolled substances; physicians were choosing to stick with a paper-based prescription process. In an effort to remove this headache and extra work that was required by physcians there was a new ruling made by the US Drug Enforcement Administration (DEA) to encourage physicians adoption. In June 2010, the DEA revised the Code of Federal Regulations to allow the electronic transmission of schedule II-V controlled substances to pharmacies. Now physicians can migrate to an electronic system and not worry about maintaining a separate paper-based system.

Lexi-Data is the foundation of Lexicomp's comprehensive clinical decision support database and it contains federal CSA codes as well as a list of state level overrides that e-Prescribing systems need to make this happen.

Lexicomp will be exhibiting at HIMSS 2012 in Las Vegas from February 20 - 24. Stop by for a visit at Booth #5134 and learn more about the preferred choice of drug information databases!

Electronic Prescribing

Tuesday, January 17, 2012 by Ryan Smith

It is estimated that approximately 7,000 deaths occur each year in the United States due to medication errors. Studies conclude that e-prescribing is the solution to improved patient safety and reducing sky-rocketing medication costs.

Lexicomp understands that for most practices, moving from paper to an electronic medical record or electronic health records can a challenge. Lexicomp has the drug information foundation which was built for healthcare IT professionals. Lexicomp provides the drug reference and data content you need to get your system certified sooner. When you choose our Lexi-Data product, you'll get superior customer service, easy implementation, and timely updates.

Electronic Prescribing

Monday, December 12, 2011 by Ryan Smith

ePrescribing is offered as a way to prevent medication errors that arise due to difficulties in reading or understanding handwritten prescriptions. ePrescribing could also reduce adverse drug events (ADEs) by making information such as drug interactions and contraindications available to prescribers at the time they are preparing a prescription.

Lexi-Data is the foundation of Lexicomp's clinical decision support architecture is quickly becoming the standard for when companies need an up-to-date comprehensive drug database. This product provides patient specific alerts and referential content to support sound treatment decisions in areas such as drug interaction checking (drug-drug and drug-food), drug allergy checking, therapeutic duplication checking, RxNorm Mappings, supports Surescripts Certification, Drug Classifications, dose range checking (adult and pediatric), Patient Education, and more.

Development slowed by your drug information database provider? 3 tips!

Sunday, November 27, 2011 by Matt Bennardo

EMR and EHR vendors are discovering that the responsiveness of their data providers can have a big impact on their ability to get certification or get to market. This is especially true in drug interaction databases, where the quality of the data can affect crucial product goals like Meaningful Use certification or SureScripts eprescribing certification.

Even beyond certification, a data provider can affect how quickly you can develop new features, respond to customer requests, or even whether you can develop new and necessary functionality at all. In many ways, a drug information vendor is one of a health IT developer's most important partners.

What if the partnership doesn't work out?
Real problems can arise if this partner is unresponsive or doesn't provide the expected level of customer service and new feature development. An EHR or EMR can literally be left treading water in situations such as these. What to do? Here are three tips.

1. "Bolt on" additional functionality: For some functionality, it's possible to lease an already-certified third-party solution that will help you meet short-term needs if your own development is stalled. The classic case for this electronic prescribing -- many EMR developers use pre-existing third-party eprescribing modules to get them to market faster while developing their own. One provider of such modules is DoseSpot.

2. Use web services to easily integrate multiple sources: Sometimes a single source just doesn't have everything you need, but maintaining multiple in-house databases can be costly and time-consuming. For specific bits of information you want to add -- for instance, patient education documents in foreign languages -- it may be easiest to access a second vendor using web services. This puts the responsibility for maintaining the data on the vendor, and leaves you with a much smaller development and maintenance task. One drug data provider, Lexicomp, now supplies much core functionality through web services, including all major Meaningful Use Stage 1 items.

3. Cut the anchor as soon as you can: Sometimes all you can do is look for another provider. The two items above can help you in some circumstances, but for core functionality you may need to cut your losses. The earlier you can identify a bad relationship, the better. One customer of Lexicomp came to us after unsuccessfully trying to work with another vendor's dataset. After a short while with the other database, they knew it wasn't right, and so they were able to painlessly replace the data with Lexicomp's. In less than a month after that, their product was live.

The moral of the story is that your drug vendor relationships are crucial to your success. If they don't feel right, then stop and look for alternatives. A slight delay upfront is better than being trapped with a vendor who makes it more difficult for you to meet your customers' needs and innovate new features.

Using Black Box Warnings to prevent adverse drug events.

Monday, October 24, 2011 by Chris Madjerich

Anyone who has been exposed to electronic order entry has experienced the dreaded "alert fatigue". If the goal of electronic prescribing is to improve patient safety and outcomes, alerting clinicians to potential drug interactions or other dosing precautions is necessary. In our current information age, there is a plethora of information available regarding medication safety and potential safety issues with the use of medications. In an attempt to help clinicians sift through all this information, the FDA has established the use of a "Black Box Warning" to call attention to the most important safety issues. A recent study published in the Archives of Internal Medicine reviewed several drug information providers comparing their ability to identify black box warnings and confirmed that Lexicomp is the leader in this area.

In an effort to incorporate this valuable information into the clinician's busy workflow, Lexcomp has recently enhanced their Lexi-Data product to include Black Box Warnings. The Black Box Warnings table allows system vendors to present critical medication safety information from these warnings within a health information system. The data is also structured in a way that will allow the system vendors to filter which alerts are presented, allowing for instance a prescriber to see warning specific to the ordering process and a pharmacist seeing warnings more relevant to the dispensing process.

Improving patient safety requires the use of "intelligent alerting", Lexi-Data has given system vendors the ability to present critical safety information in a meaningful way.

Eliminate Alert Fatigue with Customized Drug Database

Friday, October 21, 2011 by David White

Alert fatigue is related to the barrage of messages provided clinical decision support systems which can overwhelm a provider and cause them to ignore messages. The alerts, while found to be helpful in some cases, can result in a type of "fatigue" whereby the provider, after receiving too many alerts, begins to ignore and/or override the alerts. Receiving too many alerts can result in slowing the provider down rendering the alert useless.

One of the key reasons that clinicians are frustrated with decision support related to drug interaction software is the potential for this alert fatigue. Clinicans do not want to be messaged regarding dosage precautions related to an interaction which has already been recognized and addressed. It is particularly important in the era of electronic prescribing to engineer systems which can present the appropriate information to the appropriate person. Systems need to recognize whether an individual has previously addressed the issue, rather than simply blindly alerting to the presence of two medications within the medicine list. A collaborative effort between drug database providers and application vendors is needed, and discussions to improve the quality of alerts, while decreasing the quantity, are moving forward. These will greatly improve satisfaction with these tools.

Not all clinical information is structured the same!
The more detail that your medication and clinical information vendor provides about crucial alerts, the easier it is for you to implement customization for your users. If every alert looks the same (which is true of what many vendors provide!), then that means that your users will have to go through them all one by one, setting their preferences on warnings and dosage precautions by hand. Then they have to keep their settings up to date as new alerts are added. That's not user friendly design!

By contrast, Lexicomp's implementation of Black Box Warnings (also called Black Boxed Warnings) gives a great deal of flexibility to developers to allow for multi-dimensional customization. Each warning contains information about which clinician the alert is intended for, how severe the alert is, and whether the alert applies only to patients with specific conditions (e.g., pregnancy).

Win customer loyalty by automating alert customization!
This way, you can automate much of the customization without having to ask for input from every individual user. You can simply have the system hide alerts intended for nurses from pharmacists, and vice-versa. Likewise, you can make your system intelligent enough to hide alerts related to pregnancy from male patients. This is the kind of smart implementation that users are looking for to help them aviod alert fatigue and become more efficient and effective clinicians. Talk to Lexicomp today to learn more!

What are you doing about Electronic prescribing (eRx)?

Sunday, September 25, 2011 by Ryan Smith

It is estimated that each year some 530,000 adverse drug events take place among Medicare beneficiaries alone because of drugs negatively interacting with other drugs the patient is already taking, or insufficient information about the patient’s medical history. The Institute of Medicine (IOM) reported last year that more than 1.5 million Americans are injured annually by drug errors in hospitals, nursing homes and doctor’s offices. These negative drug events may require costly interventions in order to stabilize the patient, including hospitalization.

Electronic prescribing (eRx) has been recognized as an important step in moving health care from a paper-based legacy to a new electronic platform. The use of ePrescribing has been incentivized by the federal government, specifically via the Centers for Medicare and Medicaid Services (CMS).

Lexi-Data is the foundation of Lexi-Comp's clinical decision support architecture. This product provides patient specific alerts and referential content to support sound treatment decisions in areas such as drug interaction checking (drug-drug and drug-food), drug allergy checking, therapeutic duplication checking, RxNorm Mappings, Drug Classifications, dose range checking (adult and pediatric) and more.

We are committed to ensuring patient safety.

Improving EMR drug information safety with Black Box Warnings

Saturday, September 24, 2011 by Matt Bennardo

With all the focus on improving patient care with electronic medical records, it's strange that most medication and clinical data vendors don't allow developers to meaningfully use Black Box Warnings in their products. But one vendor, Lexicomp, is leading the way with detailed, customizable warnings that add value across the continuum of care.

What are Black Box Warnings and how do they help?
Black Box Warnings (also called Black Boxed Warnings) are the FDA's highest class of medication warning -- it indicates a precaution of the highest concern to patients or clinicians. They get their name from the distinctive black box that surrounds the warning on the packaged information that comes with drugs.

Not all Black Box Warnings are alike. Some are relevant at the time a drug is prescribed, others at the time the prescription is filled, and others when the drug is administered or stored. For this reason, different warnings are most likely to apply to different clinicians (or even the patient) along the continuum of care. Similarly, some warnings are only applicable to patients with special conditions (e.g., pregnancy), and some are considered by clinicians to be "obvious" warnings (e.g., only oncologists may prescribe cancer treatment regimens).

Yet, the information included in these warnings is very important -- so long as they are delivered at the right time to the right people. They can help save lives, reduce liability, and reduce the cost of care.

How do you get Black Box Warnings into your EMR system?
Until recently, there was no good way to get this information in an EMR, EHR, or HIS system. Some drug information vendors offer an indicator on their drug monographs that simply states "YES" or "NO" whether the drug has an associated Black Box Warning. It's still up to every clinician in the continuum of care -- the prescribing doctor, the fulfilling pharmacist, the administering nurse -- to look up those warnings in the drug's packaged inserts to see if they apply to them. This is an unnecessary extra step that could potentially lead to crucial missed information!

Lexicomp offers a better way. With Lexicomp, detailed information is provided about each Black Box Warning. In addition to the full text of the warning and additional context written by Lexicomp's staff of in-house experts, the warnings are all classified to make it easy to customize which ones appear for which clinicians. You can reduce alert fatigue by ensuring that only relevant warnings appear for particular clinicians or patients. Not only will your EMR be improving patient safety, but it will be making life easier for all of your users as well!

Lexicomp improves drug information database content with Black Box Warnings

Friday, August 12, 2011 by Mark Dachille

One of the most common comments I hear from users of Electronic Medical Records (EMR) systems is associated with “alert fatigue” from unwelcome drug interaction notifications. Many users tell me that they are flooded with unavoidable but unnecessary alerts that interrupt their workflow, decrease productivity, and make the important alerts harder to see. Clinicians find themselves clicking through the alerts as quickly as possible which defeats the purpose of clinical decision support.

In today's fast-paced healthcare industry, electronic health record (EHR) and other healthcare information system vendors need smart, current drug data that will enable their systems to drive patient safety and improve healthcare -- without generating a flood of annoying alerts that will only be ignored. Lexicomp has recently included new functionality that can alert users with the appropriate Black Box Warning where appropriate in the current workflow.

In the most simple terms, an FDA Black Box Warning is the strongest warning that the US Food and Drug Administration (FDA) puts on a drug. It means that you should pay close attention to the drug's usage because there are some potentially extremely harmful or dangerous threats to your health that the already FDA approved drugs could pose.

The other side of the coin, however, is that an FDA Black Box Warning means that despite the FDA's knowledge of these harmful, serious and sometimes deadly side effects that they are still leaving the FDA approved drug on the market for you to be able to take and potentially experience these harmful side effects. In theory, these FDA Black Box Warnings are designed for both the doctor who is prescribing the drug to be aware of the problems and for you as the consumer to be more aware.

The warning is placed in a prominent 'black box' on the package insert of an FDA approved drug so that people and their doctors can be more aware of it, but few doctors ever see the pill bottles and the vast majority of consumers realistically aren't going to go through the amazingly large amount of technical and medically detailed information on a package insert. This can lead to doctors note being aware of a serious alert which can have serious consequences. With Lexicomp’s inclusions of Black Box Warnings within their medication database, the warnings can be provided to the physician during the prescription process where they are most needed.

All in the presentation?

Friday, August 12, 2011 by Mark Bonfiglio

A recent JAMIA study by Bates et al. noted that the strongest factor influencing acceptance of alerts from drug interaction software is the presentation. This was found to have a stronger association than factors such as the setting or level of the alert. In an electronic prescribing environment, there is much concern about alert fatigue. Drug data vendors are often the targets of frustration of clinicians, and there is a reasonable criticism regarding the ability to have more consistency in alerting, the ability to filter to the user, and suppression of "truthful but not useful" alerts. Considering the role these alerts play in preventing adverse drug events, it would seem that at least as much attention should be paid to the way the alerts are delivered.

Clinical Decision Support and Alert Fatigue

Monday, July 25, 2011 by Mark Bonfiglio

One of the key reasons that clinicians are frustrated with decision support related to drug interaction software is the potential for alert fatigue. Clinicans do not want to be messaged regarding dosage precautions related to an interaction which has already been recognized and addressed. It is particularly important in the era of electronic prescribing to engineer systems which can present the appropriate information to the appropriate person. Systems need to recognize whether an individual has previously addressed the issue, rather than simply blindly alerting to the presence of two medications within the medicine list. A collaborative effort between drug database providers and application vendors is needed, and discussions to improve the quality of alerts, while decreasing the quantity, are moving forward. These will greatly improve satisfaction with these tools.

Does your community pharmacy have the tools to check pediatric doses?

Friday, July 8, 2011 by Chris Madjerich

Having a sick child can be a challenging and stressful time for any parent. A sick child also presents challenges for health care professionals as well as health information systems as it relates to prescribing medications. For a number of medications, pediatric dosage calculations are based on weight. Having a weight available in the community pharmacy setting is often challenging, however this is only the first step in being able to validate the correct dosage range. The second piece necessary to accurately check the validity of a pediatric prescription is having the correct information in your pharmacy system.

All too often, community pharmacy systems are not equipped with the necessary drug reference database to accurately evaluate a pediatric dose. For over 15 years, pediatric practitioners have been using Lexicomp's Pediatric Dosage Handbook and more recently, our electronic versions to prescribe and validate pediatric dosing. Now, this information has been transformed into a data set that can be integrated into pharmacy systems to allow your HIS to help you validate these critical doses. For more information about this product, visit http://www.lexi.com/businesses/ehr-vendors/.

Florida physicians maybe looking for eprescribing options

Monday, June 6, 2011 by David Wilkof

As state budgets have tightened in the last few months, and look like they will continue to do so in the medium-term future, Florida physicians may have to look elsewhere for electronic prescribing options. I have heard that the state-sponsored eprescribing program in Florida may be going by the wayside. Can someone confirm that?

My colleague, Matt Bennardo, wrote several interesting posts in this regard last week. I would suggest you link over and give them a quick read. They are quite interesting.

As part of the federal government's Meaningful Use and medical information efficiency programs, eprescribing has been receiving a lot of push in the last year or two. Many of the eprescribing systems utilize Lexi-Data drug content to review possible drug-drug and drug-allergy interactions, dose precautions, pediatric dosing and more. For those of you from Florida (and others), I would definitely give Matt's posting a quick read.

Can EHRs rely on HIEs or states for functionality?

Sunday, June 5, 2011 by Matt Bennardo

Health information exchanges (or HIEs) have long been the odd duck of the future of healthcare. Their proposed roles have varied from relatively simple (providing a mechanism for exchanging healthcare information among local providers) to complex (actually delivering some clinical decision support systems to their members). Even now there is no consensus on what HIEs should be doing, how they should be funded, and how many there should be.

The truth is that most HIEs are still funded by state and federal grants. These grants are temporary, since it's expected that some viable system of self-support will eventually assert itself. But until there's real evidence that this is happening, it's best to think of the entire HIE model as founded on the shifting sands of government whimsy. As we know all too well, many programs are "ear-marked today, gone tomorrow".

Some states also provide CDS functionality directly -- such as the eprescribing program in Florida. But again, such initiatives exist at the mercy of lawmakers, whose opinions may change without notice. For that reason, all HIS, EMR, and EHR vendors should treat such programs as temporary and not rely on them to provide functionality to their customers.

However, there are also established companies that can provide the same functionality (and have been for years). For drug information to drive clinical decision support, one such vendor is Lexicomp. They also have several partners in the electronic prescribing space that can fill that need with a less capricious solution than government programs. Contact Lexicomp today to learn more about both solutions -- use the phone number or form on this page.

Where can doctors in Florida get advice on eprescribing solutions?

Friday, June 3, 2011 by Matt Bennardo

Due to state initiatives, Florida has long been one of the national leaders in eprescribing. Physicians and other prescribers in the state are used to the convenience and improved safety of affordable electronic prescribing. Many clinicians in Florida have likely given little thought to the eprescribing sections of national Meaningful Use legislation, assuming they would easily meet requirements.

But just as Meaningful Use funding seemed to be at risk several times over the past few months, so too are many state healthcare initiatives facing potential cuts. It seems that no program, no matter how popular, is completely safe from defunding these days. What should doctors, dentists, and others in Florida do to protect themselves?

The most obvious answer is to research private eprescribing solutions that can be quickly and affordably integrated into existing systems to make an almost seamless transition and keep prescribers on track to comply with Meaningful Use in 2011 and avoid penalties. Although Lexicomp -- a leading provider of drug information -- doesn't offer an eprescribing solution itself, it does have partnerships with several.

Those in Florida looking for advice on which electronic prescribers to consider are welcome to contact Lexicomp for referrals to some of the best in the industry. Use the phone number or forms on this page to ask for advice.

Florida physicians have special need for eprescribing

Thursday, June 2, 2011 by Matt Bennardo

Because Meaningful Use penalties for eprescribing are tied to Medicare and Medicaid reimbursement, it's physicians who rely on these programs most for their revenues who will feel the pinch first. In states like Florida with large populations of older, retired Americans, the impact will be much greater if doctors fail to implement electronic prescribing in accordance with government regulations.

State programs and laws add another layer of confusion to this situation. Some states, like Minnesota, have enacted laws requiring healthcare professionals to switch to eprescribing sooner than the rest of the country -- even those, like dentists, who write relatively few prescriptions.

Meanwhile, other states are slashing programs that helped doctors use electronic prescribing more cost effectively. All of these changes are forcing some practices to scramble to fill a gap they hadn't expected. So how can doctors, dentists, and others easily find cost-effective and easy-to-use eprescribing solutions?

Lexicomp is an industry leading drug information provider. Although they don't offer their own eprescribing solution, they have several partners in this space that have been meeting the needs of clinicians quickly and affordably across the U.S. If you're confused about which eprescribing solution to use, contact Lexicomp using the phone number or form buttons on this page for advice in navigating this area.

The government prepares to trade its eprescribing carrot for a stick

Wednesday, June 1, 2011 by Matt Bennardo

So far, the government's attempts to move physicians, hospitals, and other healthcare providers to EHR systems have been positive monetary incentives. Not every provider feels that the incentives (and the reporting requirements surrounding them) are worth the headache of EHR implementation, but the government is getting ready to trade its incentive carrots for penalty sticks.

Penalties have long been a part of the legislation on this topic, but they were always eventual penalties to be levied in the future. These days, the future is fast approaching.

The penalties themselves won't be payable until 2012 and 2013, but they will be levied in part based on what happens this year -- in 2011. If docs don't use electronic prescribing at all this year, they're liable to be dinged for the next two years. And the longer they wait, the tougher the requirements get, and the harder it is to get out of the penalty box.

The upshot is that EHR vendors need to be offering their customers full-service eprescribing systems. Otherwise they're leaving money on the table and exposing their customers to possible penalties over the next several years. If you're having difficulty building your eprescribing system or getting it certified, this is the time to seriously consider a standalone module like DoseSpot that can help you get certified faster and give your customers the functionality they need and expect.

EHRs have major impact on improving pediatric care -- with the right data

Friday, May 27, 2011 by Matt Bennardo

All the buzz about Meaningful Use sometimes makes us forget what EHR implementation is really supposed to be about -- improving patient care. But this article from Practice Fusion's blog reminds us that EHR use can reduce errors, save lives, and makes it easier to serve patients better. That's what the real objective is!

The study in the article highlights the benefits of EHR use when pediatric patients are concerned. The researchers were able to link the use of electronic health records and associated clinical decision support systems to a quantifiable decrease in infant mortality -- especially among neonatal patients.

Of course, to get these kinds of results, the information in the EHR needs to be accurate, timely, complete, actionable, and specific to the patient. With respect to pediatric and neonatal patients, that last point is especially important. An EHR that is only set up to perform dose range checking and interaction checking on adults won't be nearly as helpful when it comes to children.

But luckily there are drug information vendors like Lexicomp that understand there is a vast world of difference between adults and children -- and often between older children and neonates. Lexicomp's drug information is trusted by dozens of EHR vendors to guide clinicians in prescribing, fulfilling, and administering drugs to patients of all types -- including children.

Lexicomp provides both "machine readable" transactional information (geared towards specific populations) for use in clinical decision support, as well as "human readable" reference materials for clinicians and patients. Even Lexicomp's patient education leaflets are written with either adult or pediatric patients in mind.