With the adoption of the E-Prescribing standards this year (2008) the healthcare team is taking a close look at how to implement this technology. Provider, payors and pharmacies alike face many challenges if they transmit prescriptions electronically. This article calls out many of those challenges, including: financial cost, workflow changes, and hardware/software selection. In 2006, CMS funded a pilot study to look at the feasibility of implementation in the US. You can review the materials at the CMS E-Prescribing Portal. The final rule called for the adoption of three standards by April 2009:

Formulary and benefit transactions: gives prescribers information about which drugs are covered by a Medicare beneficiary's prescription drug benefit plan.
Medication history transactions: provides prescribers with information about medications a beneficiary is already taking, including those prescribed by other providers, to help reduce the number of adverse drug events.
Fill Status notifications: allows prescribers to receive an electronic notice from the pharmacy telling them that a patient's prescription has been picked up, not picked up, or has been partially filled, to help monitor medication adherence in patients with chronic conditions.

One of the major criticisms by the pharmacy community has been lack of inclusion in the pilot study. Pharmacies were not extensively used in any of the healthcare sector tests, yet play a major role in implementation and compliance with the rule. Although CMS is targeting Providers with this rule, we know E-Prescribing has at least 2 parties involved: a sender and a receiver. In many cases, the Pharmacy will be on either end of that transmission, requiring compliance.
However, there are a few respites from the rule. If your healthcare system transmits prescriptions from orderer to pharmacy over a closed, protected network (such as HL7), you do not have to comply. In addition, prescriptions issued to Long Term Care facilities that are then forwarded to a pharmacy for fulfillment need not worry. The final exemption originally included computer-generated faxes, currently commonplace for transmission of refill requests from pharmacy to provider. Unfortunately CMS rescinded this exemption, putting the burden on pharmacies to be compliant with E-Prescribing if they generate facsimiles via computer applications.

A few observations are worth mentioning. First, the overall intent of the legislation is to improve patient safety and push a very divergent patient care sector in healthcare to standardization. E-Prescribing will help bring together the almost 100 prescription order entry and management computer applications in the US. It forces vendors to conform to said standards, whereby helping create universal electronic communication of health information.
While it is a worthwhile endeavor, implementation will be challenging and costly for many entities.

As stated by the Washington Post, the nations two largest vendors for E-Prescribing solutions in the public sector are merging. This could help standardization of information between the hundreds of currently available pharmacy and provider systems on the market. Less than a week after the July 1st enforcement date, we see this important announcement.

http://www.washingtonpost.com/wp-dyn/content/article/2008/06/30/AR200806...

If anyone missed the recent teleconference presentation on E-Prescribing, I have attached the handout for your enjoyment. You will need Acrobat to review.