MODERN METHOD OF PRESCRIBING THE DRUG WITH THE HELP OF ELECTRONIC SYSTEMS AS E-PRESCRIPTION

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ABOUT AUTHORS:
Mr. Shaikh Parvej H*, Chilwant K.M., Birajdar Shivprasad M., Prof. Garad S.V.
Maharashtra College of Pharmacy,
Nilanga, dist. Latur (MS) 413521, India
*parveja2r@gmail.com

ABSTRACT
E-Prescribing is a prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care - is an important element in improving the quality of patient care. Electronic prescribing (sometimes called “eRx”),
Through e-prescribing tools, the physician has access to drug reference checking, drug-allergy interactions, and drug-drug interactions. This additional information up front ensures a safer prescription and reduces pharmacy call backs to the practice to clarify information. Also, the electronic communication is bidirectional; patients can call the pharmacy for a prescription renewal rather than the physician, and the pharmacy can then transmit an electronic message asking the physician to authorize or deny the prescription renewal.
e- Prescription has offering & cure of disease by obtaining data from the foreign expert’s clinical trials, Electronic Prescribing can save time and money. by using software skills of various software likes electronic health recordPharmacy Benefit Manager (PBM)


REFERENCE ID: PHARMATUTOR-ART-1782

INTRODUCTION:
Because of the rising costs of healthcare in the United States, there is a need for some type of healthcare reform. Many leaders view health information technology as an important tool to assist with reducing variations in quality and improving outcomes and efficiency. One of the key areas of focus and opportunity is medication therapy management. Considerable opportunity exists with medication therapy management relative to both cost and patient safety. Approximately $287 billion was spent on prescription drugs in the United States in 2007, which was about five times the amount spent in 1993.1 In addition, the World Health Organization has reported that only 50 percent of people typically take their medications as prescribed. The rates are actually lower for certain medical conditions.2 It is estimated that each year approximately 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 there is inadequate information about the patient’s medical history.3 In a 1996 report by the Institute of Medicine (IOM), it was reported that more than 1.5 million Americans are injured annually by drug errors in hospital, nursing homes, and doctors’ offices and more than 7,000 die from preventable medication errors due to illegible handwriting on prescription forms.4 These negative drug events may require costly interventions in order to stabilize the patient. Electronic prescribing is the direct computer-to-computer transmission of prescription information from physician offices to pharmacies Electronic prescribing (sometimes called “eRx”), is an electronic way for doctors to write and send your prescriptions directly to your pharmacy. This means no more prescriptions on paper and less time waiting to have your prescription filled. Physician use of electronic prescribing (e-prescribing) systems to generate legible and complete prescriptions could potentially reduce medication errors and improve physician practice and pharmacy efficiency by mitigating pharmacists’ need for clarification.


EVOLUTION OF E-PRESCRIBING:
RxHub was created in 2001 by three leading pharmacy benefit manager organizations. The purpose of a pharmacy benefit manager is to fund and administer drugs on behalf of insurance companies and employers in order to control costs. RxHub also routes patient medication histories, based on claims data, and pharmacy benefit information to providers. This helps determine if a patient is eligible to receive certain medications based on the insurance plan. SureScripts was also founded in 2001 by the National Association of Chain Drug Stores and the National Community Pharmacists Association. The purpose of the SureScripts link is to provide the electronic communication between pharmacies and physicians. In July, 2008, SureScripts and RxHub merged to form Sure- Scripts-RxHub. In 2009, Sure-Scripts-RxHub was relaunched as SureScripts®. Today, SureScripts® operates the largest electronic prescribing network and is used every day by thousands of providers across all 50 states. In addition to the creation of the technical infrastructure to allow for the communication between pharmacies and physicians, the federal government established incentives for the adoption of e-prescribing. Provisions in the Medicare prescription Drug, Improvement, and Modernization Act (MMA) of 2003 were intended to foster e-prescribing by requiring standards for interoperability and by permitting third parties to offset the implementation costs. The MMA provided prescription drug coverage starting in January, 2006.9 To further promote the adoption of e-prescribing systems, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) provided that starting in 2009, physicians would be eligible for incentive payments when they e-prescribe for Medicare patients seen in their clinics. Providers will receive a bonus equal to 2 percent of their charges billed to Medicare in 2009 and 2010 with gradual bonus decreases beginning in 2011.The Centers for Medicare and Medicaid Services (CMS) did add a fax exemption, to continue to allow computer-generated facsimile transmissions through January 1, 2012. However, in order to qualify for the e-prescribing incentive payment program, the provider cannot electronically create a prescription and fax it to the dispensing pharmacy. The prescription must be generated and transmitted electronically from the provider’s e-prescribing.

FEATURES:
1. Improved patient safety and overall quality of care.
2. Reduces or eliminates phone calls and call-backs to pharmacies.
3. Eliminates faxes to pharmacies.
4. Streamlines the refill’s requests and authorization processes.
5. Increases patient compliance.
6. Improves Formulary adherence.
7. Increases patient convenience.
8. Offers true Provider Mobility.
9. Improves reporting ability.
10. Fast way of communication between prescriber and acceptor.
11. Doctor can prescribe to patients easily.
12. Patients can retrieve prescription from anywhere by accessing site. Pharmacy can check prescription details and inform doctor easily if there is mistake.

PROCESS OF PRESCRIBING:


Fig: 1 diagram showing prescribing process.
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FUNCTIONS OF PRESCRIBER:
1. A "qualified" e-prescribing system must be capable of performing all of the following functions generating a complete active medication list incorporating electronic data received from applicable drug   plan(s) if available
2. Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks using integrated decision support systems (safety checks include: automated prompts that offer information on the drug being prescribed, potential inappropriate dose or route of administration, drug-drug interactions, allergy concerns, or warnings of caution)
3. Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any)
4. Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan
5. Review patients' current medication list and medication history information within the practice.
6. Work with an existing medication within the practice, this can involve viewing details of a medication, remove a medication from the active medication list, change dose, etc., for a medication or renew one or more medications
7. Prescribe or add new medication and select the pharmacy where the prescription will be filled.
8. The information is then sent to the Transaction Hub, where information on the patient eligibility, formulary, and medication history/fill status is sent back to the prescriber.
9. Patient-specific information capabilities (e.g., current patient medication list, access to patient historical data, patient identification)
10. System integration capabilities (e.g., connection with various databases, connection with pharmacy and pharmacy benefit manager systems)

MODEL CONSIDERED IN E-PRESCRIBING PROCESS:
The basic components of an electronic prescribing system are the:
Prescriber - typically a physician
1. Transaction hub
2. Pharmacy with implemented electronic prescribing software
3. Pharmacy Benefit Manager (PBM)

The PBM and transaction hub work closely together. The PBM works as an intermediate actor to ensure accuracy of information, although other models may not include this to streamline the communication process.

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