# Presentation: 351259

## ePrescribing In Long Term CareChallenges and Opportunities

- How Electronic Medication Management Systems Can Improve Medication Safety and Reduce Cost

## What is ePrescribing

**The fully automated, electronic transmission of prescriptions from the prescriber to the pharmacy**
**Benefits include:**
-  Eliminates paper at facility and pharmacy
- Not email
- Not eFax
- No re-entry of information
-  Bi-directional – allows three way communication
- Prescriber
- Facility
- Pharmacy
-  Formulary Information presented at the beginning of the process
-  DUR and Allergy Information presented at the order entry

## ePrescribing in Long Term Care

**Challenges**
-  Universal adoption requires standards for information sharing
-  LTC requirements have historically been ignored
-  Existing standards did not allow type of information unique to LTC to be included
- Census only transactions
- Facility specific information
-  Lack of appropriate standards drive development of proprietary applications
-  Proprietary applications increase cost and reduce adoption

## What is Unique About Long Term Care

**Characteristics of Retail Electronic Prescribing**** **
** **One Way
-  Many to Many
-  Unpredictable
-  Requires significant adoption to realize benefits
-  Heavily dependent on physician adoption

## What is Unique About Long Term Care

**Characteristics of Electronic Prescribing in Long Term Care**
-  Involves three-way communication
- Prescriber
- Facility
- Pharmacy
-  Requires two way information flow
-  Volumes are much more predictable
-  Pharmacy has greater role in medication decisions, higher level of accountability

## What is Unique About Long Term Care

**Characteristics of Electronic Prescribing in Long Term Care**
-  Close One to one relationship Between Facility and Pharmacy
-  Different roles in Long Term Care
- Consultant Pharmacist
-  Physician adoption desired but not required
- Use of Nurse Practioners and Physicians Assistants
- Nurse as an agent
-  Small number of pharmacy software vendors compared to the retail market

## ePrescribing in Long Term Care

**Advantages**
-  Close relationship between facility and pharmacy enable realization of benefits quickly
-  Smaller number of systems allows broad access in a very short time frame
-  Potential for impacting adverse drug events (ADEs) and Medication errors is significant
- Although the size of the population is small compared to the ambulatory market the number of medications per resident is far greater, an average of 10 per resident and acuity levels are far higher
- In July 2006 the Institute of Medicine’s report on “Preventing Medication Errors” states 800,000 preventable ADEs each year in LTC setting alone
- Source:_http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf_

## ePrescribing in Long Term Care

**Advantages**
-  Opportunity to reduce cost and improve care are much greater due to the percentage of medication dollars spent on this population
- High percentage of medication dollars are spent in by Seniors
*According to the 2003 report released by Families USA, a Washington based consumer health organization, seniors represent 13 % of the total population and yet they account for about 34 % of all prescriptions dispensed and 42% of all prescription drug spending.* *
- Due to high acuity levels of typical residents many of the medications are more costly than the average ambulatory patient
- Residents often do not participate in medication administration so responsibility of physician, facility and pharmacy is much greater
- Reducing time spent in the prescribing process and the opportunity for errors can significantly increase overall quality of care
- *Source: Compiled by PRIME Institute, University of Minn., for Families USA

## ePrescribing in Long Term Care

**Conclusion**
-  Although there are definite challenges to implementing electronic prescribing in Long Term Care the ability is real
- The results from the CMS pilot has proven that the standards can and do work in an LTC setting
- Subsequent Pilots have enabled the expansion and refinement of the standards to include even more relevant information
- Industry leaders have demonstrated a willingness to work together to enable the technology
- Real benefits have been proven in
- Cost and productivity savings
- Safety improvements
- The opportunity for impact is immense

## ePrescribing in Long Term Care

**What Needs To Be Done**
-  Standards must continue to include Long Term Care
-  Long Term Care must not be exempted from requirements
-  All participants must continue to be a part of the standards creation and adoption
-  Facilities
- Pharmacies
- Software Vendors
-  States must not be allowed to create complex and expensive regulations that deter or delay the implementation of this functionality

## Questions?