How ePrescribing EHR Integrations Can Mitigate Clinician Burden

Traditional forms of prescribing adds to burden

ePrescribing tools are well-positioned to support data sharing and mitigate clinician burden, according to officials from Surescripts, one of the leading vendors offering ePrescribing tools.

The traditional method of data exchange for prescriptions is via fax machines.

“In many places, fax is like a dumping ground for anything that possibly needs to be communicated with the provider office,” Andrew Mellin, MD, MBA, Surescripts chief medical officer, explained in an August interview with EHRIntelligence.

This may include a mixture of critical lab results, status updates on specialty medication, and non-clinical items such as the menu from the restaurant down the street, he noted.

Physician offices must sort the information in the fax inbox and figure out who it should be distributed to. This system is inefficient and leads to clinician burden.

Mellin also noted that faxing data is not actionable. When the document gets scanned into the EHR, the data lives as an image, he explained. A human must work on the data to plug it into the right place in the clinical workflow or associate it with the other information in the system.

This adds to enormous physician frustration, Mellin explained.

“Instead of having a button that says, ‘Yes, change this medication to what the pharmacist might recommend’ like they could do with some of the new technologies, providers are manually retyping the data and reworking it,” Mellin said. “One process can take seconds. The other one takes minutes. When you do that tens or hundreds of times a day, it adds up.”

Additionally, Mellin explained that faxes are error prone. Sometimes data is indecipherable and certain fields are incorrect, such as a patient’s gender.

Interoperable, electronic health data exchange helps to eliminate these errors, Mellin said.

Surescripts has worked to eliminate the use of faxing for pharmacy-provider communication to streamline administrative processes.

“There is a whole ecosystem of ways for physicians and pharmacists to communicate that eliminates the need for faxes and phone calls,” Mellin said.

Electronic prior authorization

One use case for ePrescribing is electronic prior authorization. Automating prior authorization could result in higher quality care by cutting back on clinician burden and providing patients with their medications in a more timely manner.

Prior authorization is a utilization management strategy that payers use to ensure patients access the most cost-effective medication available for their clinical needs.

When a drug has prior authorization requirements, providers must submit certain documents to the payer for permission to prescribe the drug. However, the traditional prior authorization process is time-consuming and can lead to delays in patient care.

A 2019 AMA survey found that 64 percent of providers have to wait a full business day to receive prior authorization feedback from payers; 29 percent reported that they had to wait at least three business days.

This delay can lead to patient care setbacks. The survey found that for 91 percent of providers, prior authorizations delayed patient care; 48 percent reported that prior authorizations often or always have this effect.

What’s more, the arduous prior authorization process places a sizable administrative workload onto clinicians. Almost nine in ten providers (86 percent) reported that the prior authorization burden was high or extremely high, averaging over 14 hours per week to complete 33 prior authorizations.

Electronic prior authorization (ePA) aims to speed up the process by sending prior authorization documents digitally instead of via phone or fax. ePA can be integrated into EHR systems to allow providers to easily request prior authorization within their clinical workflows.

To better understand how ePA might impact patients and providers, America’s Health Insurance Plans (AHIP) launched the Fast Prior Authorization Technology Highway (Fast PATH) initiative in early 2020.

Six payers participated in the project, which ran for approximately 12 months. Availity and Surescripts served as the program’s health IT partners. RTI International evaluated the results as a third party. Point-of-Care Partners acted as an advisor.

After implementing ePA, the total number of prior authorizations jumped by 34 percent. A third of these transactions took two hours or less, compared to before when 24 percent of prior authorizations took two days or longer to fulfill.

More than 60 percent (62 percent) of prior authorizations were electronic after the health IT solution was implemented, and traditional prior authorizations were cut nearly in half.

Most providers who used electronic prior authorization had positive feedback. Six in ten providers who used prior authorization regularly said that ePA made it easier to know whether they needed to request prior authorization.

Providers who used ePA for most of their patients reported less administrative work related to prior authorizations; 54 percent had fewer prior authorization-related phone calls and 58 percent had fewer faxes related to prior authorization.

Specialty Prescribing

Specialty medication dispensing also serves as a key ePrescribing use case.

When providers send prescriptions for traditional medications to the local pharmacy, the prescription is typically processed and dispensed within hours. But for a specialty medication, the fill process is much more complex.

“When we look at specialty medications, what sets them apart is just the overall amount of clinical information that's needed to dispense them,” Cecelia Byers, PharmD, specialty pharmacy clinical product manager at Surescripts, told EHRIntelligence in an interview earlier this month.

The first hurdle to specialty medication dispensing is getting the prescription to the right pharmacy, Beyers noted. Physicians sometimes send the prescription to the local retail pharmacy before it is forwarded to a specialty pharmacy.

Once the specialty prescription gets to the correct place, pharmacists require specific clinical information to be able to dispense the medication to the patient depending on what the prescription is.

“If it's weight-based medication, they need the patient’s weight,” Byers explained. “Sometimes they need clinical information about the status of the condition that the patient has, along with general information about the patient to make sure that therapy is correct.”

Byers explained that because specialty prescriptions require so much clinical information, only 50 percent of those prescriptions are currently sent electronically. Providers and pharmacists often use fax machines and phone calls to share clinical information related to specialty medications, which Byers pointed out is an error prone process.

“When providers are sending prescriptions to pharmacies, if clinical information is not sent along, it requires that pharmacy to pick up the phone and call to get that information,” Byers explained. “Oftentimes, pharmacists and technicians are calling and leaving voicemails for the provider's office to try to make sure they understand the request, so there's a lot of back-and-forth phone calls.”

Many specialty pharmacies have enrollment forms online that providers can fill out and send in via fax for the pharmacy staff to review and enter into their system. While this aims to eliminate the issue of phone-tag, there are a lot of opportunities for pharmacists to make mistakes in enrollment documentation due to manual data entry.

Surescripts’ specialty patient enrollment tool aims to mitigate clinician burden and speed up time to treatment by automatically sending clinical information for specialty medications.

The product, which is embedded within contracted EHRs, grabs the clinical information needed to fill the specialty medication and sends it to the pharmacy via FHIR resources along with the electronic prescription. The pharmacy can then take that message apart and put the information into the correct areas of their dispensing system.

This eliminates the need for fax communication. However, Byers noted that the vendor meets pharmacies where they are at, as not all pharmacies are able to do a full product integration.

“We generate a fax for some of those pharmacies, but in a full integrated fashion, we'd be able to deliver that electronically so that they're able to digest that clinical information,” Byers said. “That's really the ideal situation that we want our data to be presented in, because that's coming straight from the source where that prescription was written.”

Byers said that this ePrescribing tool is helping address clinician burden and boost clinical efficiencies.

“In terms of the overall workflow for the pharmacy, they're not having to call as often,” she noted. “Decreasing those calls creates more efficiencies within the pharmacy because they're not having to pick up that phone or send another fax out to that prescriber as they're trying to get the medication filled for the patient.”

As the healthcare industry looks to cut down on administrative burdens, ePrescribing tools may be one key way to streamline efficiencies so providers can spend more time with the patient and not in front of the fax machine.