The Impact of e-Prescribing

In 2007, we went live with integrated e-Prescribing within our enterprise electronic health record via the MA-Share rxGateway, our statewide health information exchange collaboration of payers and providers. We had to redefine workflows, cleanup old prescription data and refine the our existing applications to adapt to the new features of e-Prescribing (eligibility checking, formulary enforcement, medication history display and prescription routing). The following is a summary of the impact of e-prescribing on our General Internal Medicine practice in the first year:

Time and Resource Impact:
1. Prior to full implementation of e-prescribing, Medical Assistant call-in of prescriptions averaged 350 prescriptions per day. We've reduced this to 80/day and we'll further reduce this to 30/day by next month when all residents go live with e-Prescribing.

2. Each call-in averages 4 minutes per prescription and this equals 23 hours or 3 FTE worth of work per day, approximately $96,000.00 of salary. This has been reduced to 0.66 FTE of Medical Assistant work per day or $21,000.00 salary.

3. The Medical Assistant staff are now available to more consistently perform the core work required to support the patients, providers, and practice. In the past, the lack of control over the daily volume of prescriptions resulted in unpredictable exam room support.

4. We experienced significant improvement in efficiency and patient satisfaction in the time for prescriptions to reach the pharmacy. With e-prescribing, prescriptions travel quickly to pharmacies versus up to 2 days for the rx to be called to the pharmacy.

5. We have also seen a decrease in medication errors, in terms of wrong patient, wrong medication, wrong dose since e-prescribing has decreased the potential for "communication errors"

6. We are able to track prescriptions more efficiently. With the paper call-in system, rxs were being called in by many people. Now we can look in our EMR and quickly determine where a prescription is in the process (i.e. in queue, transmitted successfully, transmission failed, etc)

By redirecting our Medical Assistance staff from prescription refills to other tasks we have:

* Piloted a standardized patient visit check out process that is going well
* Provided consistent documentation of vital signs for all patients.
* Helped with fee ticket entry improving the timeliness of charge capture
* Improved examination room turn around time, resulting in decreased waiting room stays

All of these workflow and efficiency improvements have reduced nurse stress level substantially. In addition, nurses are very happy about the decreased opportunity for error and the rework this caused with errors in prescription call ins.

e-Prescribing has been a win/win/win for providers, payers and patients. Massachusetts is now the number #1 e-Prescriber in the country and the MA-Share rxGateway enables payers and providers to collaboratively implement e-Prescribing quickly. It's now live at BIDMC and Partners. It will soon be live at Children's and we've offered it to all other hospitals in the state.