National Progress Report On E Prescribing Year 2011

THE naTional progrEss rEporT
on e-prescribing and interoperable HealtH care
Year 2011
neutrality transparency physician and patient choice open standards collaboration privacy
the evolution of e-prescribing
2012 2011
90,000or36%ofoffice-basedphysiciansnow 1 e-prescribe. urescriptsannouncesnetworkexpansionto S allowclinicianstoexchangealltypesofclinical messageswiththeirpeers. heU.S.DrugEnforcementAdministrationallows T theoptionofissuingprescriptionsforcontrolled medicationselectronically. atientProtectionandAffordableCareActpasses. P
8percent(317,000)ofalloffice-based 5 physiciansactivelye-prescribe. PCSstate-by-stateapproval E advancing.
2010 2009 2008 2007

2006
mericanRecoveryandReinvestmentAct A provided$19billiontowardsadoptionofhealth informationtechnology. MSreleasesproposedregulationsdefining C meaningfuluseofEMRs.E-prescribingisakey component. edicarelaunchesMIPPAe-prescribingincentive M program. hodeIslandannounces100percentofitspharR maciesareenabledfore-prescribing. ureScripts-RxHubisrelaunchedasSurescripts. S
MSissuesMedicarePartDe-prescribing C incentiveregulations. EAproposesruletoallowe-prescribing D forcontrolledsubstances. edicareImprovementsforPatientsand M ProvidersAct(MIPPA)passesincludes e-prescribingincentives. xHubandSureScriptsmergetoform R SureScripts-RxHub.
enterforImprovingMedicationManagement C launched. -prescribingbecomeslegalinall50statesandD.C. E ationalE-PrescribingSafetyInitiativelaunched. N ureScripts,RxHub,InformedDecisionsandthe S AMAlaunchICERx.orgtoassistvictimsofnatural disasters.
irstproposedfoundationstandards F releasedforMedicarePartDe-prescribing. HSissuesStarkexemptionsandFraud& H Abusesafeharbors. ureScripts,RxHubhelplaunch S www.katrinahealth.orgtosupport victimsofHurricaneKatrina.
2005 2004 2003 2002 2001
MSpilot-testsproposedMedicarePartD C e-prescribingstandards. irstannualSafe-RxAwardsrecognizetop F e-prescribingstates. nstituteofMedicinereleasespivotal I PreventingMedicationErrorsreport.
nstituteofMedicineendorsesNational I HealthInformationInfrastructure. edicareModernizationActprovides M incentivesfore-prescribingadoption. ureScriptsbeginsnetworkoperations. S
pproximately2,500,or4%ofofficebased A physicians,e-prescribe. fficeoftheNationalCoordinatorforHealth O InformationTechnology(ONC)established. ureScriptslaunchese-prescribingcommuS nityadoptionprograms.
RxHubbeginsnetworkoperations.
RxHubfounded. SureScriptsfounded.
introduction
a letter from the president and CEo

Bytheendof2011,58percentofoffice-basedphysiciansintheUnited StateshadadoptedelectronicprescribingontheSurescriptsnetwork. Alittlemorethanthreeyearsago,thisfigurewaslessthan10percent. Thisincreaseisacriticalmilestoneinthenationwideefforttoadopt e-prescribing and achieve meaningful use of health information technology.
Thisremarkablegrowthinadoptionandusehastransformedoneofthemostcommontransactionsinhealthcareintoa mainstream electronic health care tool. Electronic routing of prescriptions on the Surescripts network accounted for more than one in three prescriptions that were picked up by patients at community pharmacies. As states implement e-prescribingforcontrolledsubstances(EPCS),thesenewtypesoftransactionswilldriveadditionaluseofe-prescribing. Thissurgeinadoptionanduseunderscoresthevalueofe-prescribing.In2011,Surescriptscollaboratedwithpharmacies andpharmacybenefitmanagersonastudytoquantifythebenefitsofe-prescribing.weexaminedde-identifieddatasets representingover40millionprescriptionrecordsandcomparedelectronicprescriptionswithpaper,phonedandfaxed prescriptionstomeasuretheimpactonfirstfillmedicationadherence. Thisfirst-of-its-kinddataanalysisconsistentlyshowedthatwhenaphysicianadoptse-prescribingthereisa10percent increaseinher/hispatientsfirstfillmedicationadherence.Thestudyalsodemonstratedthattheimprovementinpatient firstfillmedicationadherencecanproduceanestimatedsavings,over10years,between$140billionto$240billionin healthcarecostsavingsandimprovedhealthoutcomes. AnotherSurescriptsstudyshowsthatthemajorityofe-prescribingadoptersfrom2008arealreadymeetingthestage1 meaningfulusee-prescribingmeasure.Manyarealsopositionedtomeettheproposedstage2measure. Surescriptsiscommittedtofacilitatingthebroadershifttowardcollaborativecareandexpandingournetworktoestablish moreefficient,meaningfulandpowerfulwaystocommunicateandshareclinicaldataelectronically.weareleveraging ourcorecapabilities,andourleadershipandexperiencetopromoteelectronichealthinformationsharingamongproviders acrossthecarecontinuum.webelievethatdoingsowillpromoteadditionalmeaningfuluse,whilehelpingtolowercosts andimprovequalityforphysicians,pharmacies,patientsandallhealthcareconstituencies. Regards,
Harry totonis PresidentandCEO,Surescripts
WWW.SURESCRIPTS.COM
tHe national progress report on e-prescribing and interoperable HealtH care Year 2011
contents
introduction TheEvolutionofE-Prescribing........................................ 1 AletterfromthePresidentandCEO................................... 2 ExecutiveSummary .................................................. 4 E-PrescribergrowthintheU.S.20082011 .............................. 6 part 1: electronic prescribing use TheThreeComponentsofE-Prescribing ................................ 8 ImpactofE-Prescribing:MedicationAdherence .......................... 9 PrescriptionBenefitInformation .......................................10 ThevalueofPrescriptionBenefitInformation............................11 MedicationHistory ...................................................12 PrescriptionRouting .................................................13 HowtoImproveUseofPrescriptionRenewals...........................14 EHRvs.StandaloneE-PrescribingSoftware .............................15 CollaborationDrivesQualityImprovements.............................16 FutureofE-Prescribing..............................................17 part 2: electronic prescribing adoption TheClassof2008:TrackingthegrowthofMeaningfulUse.................18 Prescribers........................................................ 20 E-PrescribingPhysiciansbySpecialty..................................21 E-PrescribingPhysiciansbyPracticeSize .............................. 22 PharmaciesCommunityandMailOrder.............................. 23 Payers............................................................ 24 part 3: about surescripts AboutSurescripts................................................. ibc Acknowledgments................................................. ibc
introduction
Executive summary
national progress report Year 2011 at-a-glance Thisreportprovideshealthcareindustrystakeholderswithauniqueviewofe-prescribingintheUnitedStates.The reportgoesbeyondtheremarkablesustainedgrowthseenin2011totellacompellingstory,throughgraphicsand analyticaldataaboutthestillgreatpotentialofe-prescribingandcollaborativecareforpharmacies,prescribers, pharmacybenefitmanagers(PBMs)andotherhealthcarestakeholders.
more than one in two office-based physicians e-prescribed in 2011, up from one in ten in 2008 E-Prescribing entered the mainstream of health care technologyintheUnitedStateswith317,000office-based physicians, or 58 percent, now actively e-prescribing (Figure 1).Bytheendof2011,morethanoneintwoofficebased physicians used e-prescribing, versus one in ten threeyearsago.
Figure 1: 2011Office-basedPhysicianswhoE-Prescribe (Thedarkerthearea,thegreaternumberofactivee-prescribers)
75%
NewPrescriptions PrescriptionRenewalResponses
96 million 474 million
570 million prescriptions were routed electronically By the end of 2011, an estimated 36 percent of prescriptions dispensed were routed electronically, up from 22 percent at the end of 2010. More than 570 million were routed electronically in 2011, versus 326 million in 2010. This represents a 75 percent increase in just one years time(Figure 2).
2010
Figure 2: PrescriptionRoutingUse20102011
74,000 80 76% 156,000 134 Before e-prescribing 234,000 196
2011
390,000 304 91%
With e-prescribing
Numberpickedupoutof100 writtenprescriptions
Numberpickedupoutof100 85% 91% writtenprescriptions
Abandoned
10%
INCREASE
Abandoned
69.5 Rx 69.5 Rx Picked Up Picked Up
Pickedup
Abandoned
e-prescribing is Helping to improve First Fill medication adherence. savings are estimated up to $240 billion over 10 Years Surescripts collaborated with pharmacies and pharmacy benefit managers on a study comparing electronic prescriptions with paper, phoned and faxed prescriptions. The data showed a consistent 10 percent increase in patient first fill medication adherence among physicians who adopted e-prescribing technology (Figure 3). One findingwasthattheimprovedmedicationadherencefrom e-prescriptions can lead to 10-year estimated savings of between $140 billion to $240 billion, measured in health carecostsavingsandimprovedhealthoutcomes.
Figure 3: E-PrescribingIncreasesFirstFillMedicationAdherence
WWW.SURESCRIPTS.COM
ESTIMATED MEANINGFUL USE ACHIEVEMENT AS OF Q4 2011

number of prescribers in 2008 percent of prescribers meeting meaningful use for e-prescribing measure (stage 1)* 54 to 60%
Total High and lowest meaningful use estimates by specialty (Highest) Family practitioner (lowest) ophthalmologist eHr vs. standalone e-prescribing eHr standalone e-prescribing
39,893
12,416 1,082
69%to74% 27%to27%
close to 60 percent of physicians who started e-prescribing in 2008 meet the stage 1 meaningful use e-prescribing measure. 38 percent would meet the proposed stage 2 e-prescribing measure Surescripts analysis of 39,893 prescribers who began e-prescribingin2008showsanestimated54to60percent of active early e-prescribers would have satisfied the stage1meaningfulusemeasurefore-prescribingbythe end of 2011. The second finding from this data set indicatesthat38percentoftheseearlyuserswouldmeetthe proposedstage2meaningfulusee-prescribingmeasure.* This analysis also showed that physicians use of e-prescribingincreasesovertime. Eightypercentofphysicianswhoadoptede-prescribingin 2008 used an integrated electronic health record (EHR). The data showed that prescribers using EHRs had significantly higher utilization levels (+53 percent) than prescribersusingstandalonee-prescribingsystems.
31,902 6,976
60%to67% 44%to50%
Figure 4: MeaningfulUsebySpecialty,Classof2008
Internist
Internist
Internist
Internist
* eferencestomeetingthestage1meaningfulusee-prescribingmeasureorthestage2meaningfulusee-prescribingmeasure,asproposedbutnotcurrentlyineffect, R alsoassumethattheusermettherequirementforparticipatingasaneligibleprovider.
e-prescribinge-prescribing
45% 45%
81% 81%
E-Prescribing Adoption Rates Register Significant Growth by Physician Specialty and Practice Size
Family Practice Family Practice Family Practice Family Practice
Solo Solo Solo Solo
47% 47% in 2011, approximately two-thirds of internists, 75% 75%

Internist
Internist Internist Internist Family practice physicians and cardiovascular disease physicians were e-prescribers
Solo
the three smallest practice sizes led 31% 31% e-prescribinge-prescribing e-prescribing adoption in 2011 Solo Solo Solo
46% 46% 46% 46%

2011
45% 45%
2010
81% 81%
2011
specialty Internist
Internist Gastroenterology Gastroenterology
Year Internist Internist to Year

Gastroenterology Gastroenterology
practice size Solo

2 to 5
Solo 2 to 5
31% 31%
2010
Year to Year Solo

2 to 5
Solo 2 to 5
internist
Family Practice Family Practice
e-prescribinge-prescribing e-prescribinge-prescribing
45% 45% 38% 38% 47% 47%
+80%
81% 81% 76% 76% 75% 75%
solo practitioner
2 to 5 2 to 5
31% 31% 42% 42% 42% 42% 42% 42% 44% 44% 44% 44% 44% 44%
+48%
2 to 5 2 to 5
46% 46% 53% 53% 53% 53% 53% 53% 55% 55% 55% 55% 55% 55% 46% 46% 46% 46%
FamilY practice
Family Practice Family Practice Cardiovascular Cardiovascular
+59%
2 to 5
2 to 5 6 to 10 2 to 5 6 to 10
+26%
2 to 5 6 to 10
2 to 5 6 to 10
cardioVascular disease
47% 47% 49% 49%
+55%
75% 75% 76% 76%
6 to 10
6 to 10 6 to 10
+25%
6 to 10 6 to 10 11 to 25
6 to 10
Figure 5: E-PrescribingAdoptionbySpecialty*
38% 38%
76% 76%
Figure 6: 2011E-PrescribingAdoptionbyPracticegroupSize**
6 to 10 11 to 25 6 to 10 11 to 25
6 to 10 11 to 25
e-prescribinge-prescribing *Samplesizeis314,616,whichrepresents99%ofallactiveoffice-basedphysicians. 34% 34% e-prescribinge-prescribing **Estimatedbasedonsampleanalysisof292,658or92%ofallactiveoffice-basedphysiciansovertheSurescriptsnetworkasofDecember2011. to 25 38% 38% 76% 76% 11 to 25 11 to 25 11
11 to 25
Cardiovascular Cardiovascular
Cardiovascular Cardiovascular
49% 49%
76% 76%
11 to 25 26 to 100
11 to 25 26 to 100
34% 34%
11 to 25 26 to 100
11 to 25 26 to 100
introduction
E-prescriber growth in the U.s. 20082011
2008
2009
2010
physicians e-prescribe
1 in 10
1 in 4
1 in 3
2008
he Centers for Medicare and Medicaid T Services (CMS) issues Medicare Part D e-prescribingincentiveregulations. he Drug Enforcement Administration T (DEA)proposesruleallowinge-prescribing forcontrolledsubstances. edicare Improvements for Patients and M Providers Act (MIPPA) passes; includes e-prescribingincentives. xHub and Surescripts merge to form R Surescripts-RxHub.
2009
mericanRecoveryandReinvestmentAct A provides$19billiontopromotetheadoptionofhealthinformationtechnology. MS releases proposed regulations C defining meaningful use of electronic health records (EHRs). E-prescribing is a keycomponent. edicare launches MIPPA e-prescribing M incentiveprogram. hodeIslandannounces100percentofits R pharmaciesareenabledfore-prescribing. urescripts-RxHub is re-launched as S Surescripts.
2010
90,000or 36%of office-based physi1 cianse-prescribe. urescriptsannouncesnetworkexpansion S toallowclinicianstoexchangealltypesof clinicalmessageswiththeirpeers. heDEAallowstheoptionofissuingpreT scriptions for controlled medications electronically. atient Protection and Affordable Care P Actpasses.
WWW.SURESCRIPTS.COM
in 2011, 58 percent of office-Based physicians Used E-prescribing

2011
more than 1 in 2
2011
urescriptsannounces58%ofalloffice-basedphysicianse-prescribe. S 6,900+pharmaciesnowconnectedtotheSurescriptsnetwork. 5 fficeoftheNationalCoordinator(ONC)announcesproposedcriteriaforMeaningfulUseStage2. O NCannounces123,921EligibleProfessionalshaveregisteredforEHRincentives. O
part 1: ElECTroniC prEsCriBing UsE
The Three Components of E-prescribing

Prescriptionbenefitinformation,medicationhistoryandelectronicroutingreducecosts, addefficiency,andprovidecontinuityofcare.
E-prescribing is built around three key components that allow pharmacists, prescribers and pharmacy benefit managers(PBMs)toobtainmaximumefficiency,significantcostsavingsandvalue: 1. prescription benefit and formulary informationincreasescomplianceandprovideslower-costchoices. 2. medication historyutilizationleadstoamoreclinicallyappropriateprescription. 3. electronic routingmeansallprescriptionsaresenttoandreceivedbyapharmacy,encouragingmore firstfilladherence. Part One of the 2011 National Progress report examines the growing evidence supporting the advantages of e-prescribing,beginningwithSurescriptsMedicationAdherenceStudyandfollowedbykeyinsightspertaining to benefit information, medication history, and electronic routing. It ends with a review of current trends and futuredevelopments.
medication HistorY
Ambulatory&Acute
beneFit inFormation
PrescriptionBenefitforAmbulatory; EligibilityServicesforPharmacy andMedicaid
electronic routing
ProcessNewPrescriptions andRenewals
Healthcareprovidersandprescriberscanaccessallthreecomponentsofe-prescribing throughvendorcertifiedsoftwareontheSurescriptsnetwork.
8
WWW.SURESCRIPTS.COM
The impact of E-prescribing on Medication adherence

In2011,SurescriptspartneredwithPBMsandretailpharmaciestocomparetheeffectivenessofe-prescriptions andpaperprescriptionsonfirstfillmedicationadherence.Aspartofthestudy,weanalyzedde-identifieddatasets representingover40millionprescriptionrecords. e-prescribing improves First Fill adherence 10 percent when compared to paper prescriptions Thedatashowedaconsistent10percentincreaseinpatientfirstfillmedicationadherence(i.e.,newprescriptions thatwerepickedupbythepatient)amongphysicianswhoadoptede-prescribingtechnology. e-prescribing can produce significant Health care savings Theanalysissuggeststhattheincreaseinfirstfillmedicationadherencecombinedwithothere-prescribingbenefits could,overthenext10years,leadtobetween$140billionand$240billioninhealthcarecostsavingsandimproved healthoutcomes.*
Without e-prescribing
Numberpickedupoutof100writtenprescriptions
With e-prescribing
Numberpickedupoutof100writtenprescriptions
Abandoned
10%
INCREASE
Abandoned
Pickedup
Abandoned
E-Prescribing should be considered a powerful tool in the health care systems efforts to address medication adherenceandimprovepatientoutcomes. Ken majkowski, pharmd,
vicePresidentofStrategyandInnovation Surescripts
$140$240B
william H. shrank, md, msHs
SpecialistinMedicationAdherence HarvardMedicalSchool
Inhealthcaresavingsoverthenext 10yearsduetoe-prescribing
The Surescripts research is an important contribution...In a huge study, they have shown a clear link between e-prescribingandfirstfillmedicationadherence.
* 2011 study found that every dollar spent on improving patient adherence to medication can result in three to ten dollars of savings from reduced downstream medical costs for A certaindiseases. 9

prescription beneFit inFormation
E-prescribing is realizing its potential to empower prescribers and pharmacists to deliver higher quality care, better medication therapy management and improved workflowefficiencies. At the same time, it is enabling them to significantly reduce prescription costs. Eligibility can be quickly checked electronically at the time of prescribing to help prescribers choose medications that are on formulary andcoveredbyapatientsdrugbenefit.
opporTUniTY For prEsCriBErs To UsE BEnEFiT inForMaTion inCrEasED 87 pErCEnT
KeY statistics lectronicresponsesforprescriptionbenefitinformaE tiongrew87percentin2011. n average, the response rate to requests for preO scriptionbenefit(therateatwhichinformationforthe patientcanbereturnedtotheprescriber)wasapprox pproximately 62 percent* of patient visits involved A imately80percentin2011,upfrom69percentin2010. oneormoreoftheseresponsesin2011.
Prescription Benet Responses

87%
789 million
125%
422 million
248%
2008
Contributing Factors:
Active Prescribers (pg. 20) Number of E-Prescribing Applications Certified for this Service (pg. 15) 74,000 43 156,000 78 234,000 137 390,000 157
2009
2010
2011
10
* ccordingtotheAugust2010NationalAmbulatoryMedicalCareSummary,anestimated1.037billionvisitsweremadetooffice-basedphysiciansin2010(datarelated2011). A
WWW.SURESCRIPTS.COM
The Value of prescription Benefit information

Prescription benefit information is an important component of e-prescribing. Surescripts works with the nations pharmacy benefitmanagers(PBMs)andpayerstoofferprescribersaccesstotheirpatientsprescriptionbenefitinformationinrealtime duringanofficevisit.ThePrescriptionBenefitserviceputseligibility,benefitsandformularyinformationataprescribersfingertipsatthetimeofprescribing.Thisenablesprescriberstoselectmedicationsthatareonformularyandarecoveredbythe patientsdrugbenefit.Italsoinformsthemoflower-costalternativessuchasgenericdrugs. Pharmacies save time and resources when they receive an appropriate electronic prescription that eliminates unnecessary phonecallsfrompharmacystafftophysicianpracticesrelatedtodrugcoverage. Benefitinformationisbrokenintotwocomponents:eligibilityandformulary.Eligibilitydetermineswhatinsurancecoverage forprescriptionsisavailableforaspecificpatient.Aformularylistisapre-approvedlistofpreferredgenericorbrandname prescriptionsthatiscoveredunderahealthcareplan.Thelistisdeterminedbytheinsurancecompanyandchangesfrequently.
nt infor mation s ent to p aye
patient encounter
q re
t ue s
o sp
for
n
p atie
o se t
est f requ
or inf or mation
r&
s ent
pha
hy s
rm
to p
ac
re
ici
an
1 2
pHYsician
DrugTherapyDecisionMade ReviewsBenefitandSelectsTherapy E-Prescriptiongenerated
pbm/paYer
provides patient:
PrescriptionBenefit PrescriptionHistory
4
pHarmacY
processes: NewPrescription PrescriptionRenewal
6
pre
pre s
cr ip tion
r o u te d to p h a r
mac
s cr ip
tion ren
ew al and reque s t r
e spo
nse
benefit information enables: Accurateprescriptionsforeligibledrugtherapies Improvedpatientsafety Potentiallylowerco-paysforpatientsresultinginimprovedadherence IncreasedefficienciesforPBMs,pharmaciesandprescribers Improveddrugspendmanagementforpayers Nearly253millioncovered-livesareconnectedthroughPBMs,payersandstateMedicaidagenciesontheSurescriptsnetwork whichisopentoallpharmacies,payersandhealthcareparticipants.Patientscanhavemultipleprescriptioncoverage. Therewere789millioneligibilityresponsesin2011ontheSurescriptsnetwork.Thesebehindthesceneselectronicconnections toprescriptionbenefitinformationadduptoamorecomprehensivelevelofcarefromprescribertopharmacy.PBMsandpayers gain from the strong compliance generated when benefit information is used. Benefit information also helps create positive outcomesanddecreasehealthcarecosts.Thatshowe-prescribingcandrivedownthecostcurve.
11

medication HistorY
whenapatientconsentstosharetheirmedicationhistory, prescribers can securely request and receive this information, which allows them to better treat the patient. Medicationhistoriesaregeneratedsecurelyusingcertified vendor software under all applicable laws pertaining to securityandprivacy.*
MEDiCaTion HisTorY Was aVailaBlE For onE in THrEE oFFiCE VisiTs in 2011
KeY statistics I lectronic medication history deliveries increased 72 n 2011, more than 15 million medication histories E were delivered to clinicians working in acute care percentin2011. environmentstosupporttransitionsincare. pproximately 31 percent of patient visits generated A anelectronicallydeliveredmedicationhistoryin2011.
Medication Histories Delivered
600
72%
500 400 300 200 100
395 million
184%
230 million
395%
81 million
0
2009
156,000 76
16 million
2008
Active Prescribers (pg. 20) Number of E-Prescribing Applications Certified for this Service (pg. 15) 74,000 42
2010
234,000 133
2011
390,000 154
* orinformationonSurescriptshandlingofpersonalhealthinformation,pleasereviewourPrivacyPolicyonhttp://www.surescripts.com/about-us/commitment-to-privacy.aspx. F 12
WWW.SURESCRIPTS.COM
prescription routing
Prescribers are e-prescribing in record numbers. In 2011, e-prescription routing on the Surescripts network increased75percentto570million.Morephysiciansare exchanging prescription information electronically and bi-directionally with pharmacies using vendor software certifiedbySurescripts.
MorE THan 570 Million prEsCripTions WErE ElECTroniCallY roUTED in 2011, a 75 pErCEnT inCrEasE oVEr 2010
KeY statistics y the end of 2011, an estimated 36 percent* of pre- orethan570millionprescriptionswereroutedelecB M scriptions dispensed were routed electronically, up tronicallyin2011versus326millionin2010,a75perfrom22percentattheendof2010. centincrease.** fthese,approximately24millionelectronicprescripO tionswereroutedtomailorderpharmaciesin2011,a three-foldincreaseover2010.
Prescription Routing Transactions

NEW PRESCRIPTIONS PRESCRIPTION RENEWAL RESPONSES
75%
57 million 269 million 35 million 156 million 13 million 55 million 2008

Active Prescribers (pg. 20) Number of E-Prescribing Applications Certified for this Service (pg. 15) Connected Community Pharmacies (pg. 23) 74,000 80 76% 156,000 134 85% 234,000 196 91% 390,000 304 91%
2009
2010
2011
* alculationbasedon52millione-prescriptionsdispensedasapercentageof144milliontotalprescriptionsdispensed.TotalprescriptionsisbasedonnewandrenewalprescripC tionsdispensedinDecember2011.Thesefiguresexcludeprescriptionsforcontrolledsubstances. ** equestsforprescriptionrenewalsarenotrepresentedinthissection,asprescriptionrenewalrequestsdonotleaddirectlytotheissuingofprescriptionorders. R
13
How to improve the Use of prescription renewals

As e-prescribing routing statistics demonstrate, electronic routing of prescriptions is currently the most used component of e-prescribing compared to medication history and prescription benefit information. Electronic renewalsaloneaccountedfor95millionresponsesontheSurescriptsnetworkin2011. Prescribersandpharmaciescanhelpincreaseefficiencyandreduceinterruptionstoprescriberandpharmacyworkflows.
prescribers
take advantage of the efficiency of electronic prescription renewal requests. Efficiency is a key benefit of e-prescribing connectivity, which significantly reduces the number of faxes and phone calls pharmacies needtomake. respond to electronic renewal authorization requests promptly. Prescribersshouldrespondtorenewalrequests within 24 hours. In an emergency, a follow-up call in the event of a delayed response is appropriate.
pHarmacies
report issues with electronic renewals or e-prescriptions to your pharmacy software vendor. Provide the following details when reporting errors: transaction date, name of prescriber, messageID,prescriberSPI,pharmacyNCPDPID. ensure that information in your pharmacy system about local prescribers is up-to-date.
Pharmacy software vendor should keep prescriber files up-to-date as new prescribers become activated for e-prescribing. Store-bystore data updates in each store should be consistent.
14
WWW.SURESCRIPTS.COM
eHr Vs. standalone e-prescribing soFtware

Prescribers e-prescribe using either electronic health record(EHR)softwareorstandalonee-prescribingsoftware. Standalone e-prescribing software performs only thee-prescribingfunction.Bycomparison,e-prescribing is one of many functions such as documentation and chargecapturethatareintegratedinEHRsoftware.
EigHTY-TWo pErCEnT oF aCTiVE prEsCriBErs UsE EHr To E-prEsCriBE
KeY statistics ighty-twopercentofactiveprescribersusedEHRsfor ome standalone e-prescribing software vendors E S e-prescribingin2011,comparedto79percentin2010. license the use of their products to companies that provide EHRs. At the end of 2011, 228 EHRs used or t y-seven percent of cer tified and deployed F embedded standalone e-prescribing software that EHR software was used for all three ambulatory was certified for connection to the Surescripts nete-prescribing servicesprescription benefit inforwork,comparedto148EHRsin2010. mation, medication history and electronic routing attheendof2011.*
Vendor Software Certified and Deployed for E-Prescribing

EHR STANDALONE
40 264
35 22 28
0
22 27 110
20 40
161 25
60
132
135
20 127
80 100
105
95
2010
2011
2010
2011
2010
2011
2010
2011
Medication History
Prescription Benefit
Prescription Routing
All Three Services
Percentage of Active Prescribers Using EHR vs. Standalone E-Prescribing Software

2008 2009 2010 2011 63% EHR 70% EHR 79% EHR 82% EHR
* ertificationforallthreee-prescribingservicesiscomprehensiveofcertificationforprescriptionbenefitinformation,medicationhistoryandelectronicroutingservices.Routing C servicesincludeconnectivitytoretailandmailorderpharmaciesandtheabilitytomanageprescriptionrenewalselectronically. 15
industry Collaboration Drives Continuous improvement in Electronic prescription Quality

Surescripts is focused on continuous improvements in the quality of the millions of e-prescriptions and health information transactions that are transmitted daily over its network and on utilizing industry standards that emphasize the need for all healthcaretechnologyprovidersanduserstobepartofthequalityeffort.Astheindustryleaderine-prescribing,ourgoalhas beenambitiousfromthestart:toachieve100percentreliabilityofe-prescribingtransactionsfromthetimeaprescriptionis preparedbyaprescribertothetimethemedicationisdispensedbythepharmacy. Byactivelymanagingqualitythroughcollaborationandcommunicationwithprescribertechnologyvendors,pharmacies,pharmacy benefitmanagers(PBMs)andregulators;andbycreating,implementingandenforcingqualityimprovements,theend-to-end qualityofe-prescribingisrealizingcontinuousimprovements. Constantmonitoringoftransactionshelpstodefineandmeasurethesafety,accuracyandcompletenessofthee-prescriptions thatflowthroughtheSurescriptsnetwork.Continuousimprovementisachievedbyworkingwithparticipants,identifyingthe rootcauses,andputtingpermanentandmeaningfulchangesinplacethatreduceanyincidentsofnon-conformancewithour guidelines.Clinicalimprovementsresultingfromthissystemicapproachtoqualityhaveproduceduptoa25percentreduction inthenumberofissuesidentifiedviathenetwork. Progressisbeingmadethrougheducation,trainingandrecommendedimprovementstoprescribersoftware.Belowarethree examplesofhowSurescriptsiscollaboratingwiththeindustrytocontinuouslyimprovequalityandthee-prescribingexperience forprescribers,pharmacistsandpatients. QualitY tip 1: to avoid confusion and reduce pharmacy call backs for clarification, prescribers should not split directions between sig and notes Fields. issue:SplittingdirectionsbetweentheSIgandNotesfieldscancause uncertaintyorleadtoerrorsatthepharmacy.Supplementaryorconflicting Sig information often results in workflow disruption at the pharmacyandbyextensionattheprescribers.Apharmacycallback forclarificationpurposescould,inaworse-casescenario,resultina potentialpatientsafetyincident. Examplesofimproperuse: Sig field1 po dailY, Notes fieldtake one tablet twice a day.
QualitY tip 2: most drug descriptions should typically include the complete drug name, strength, strength units and dosage form (if applicable). In the United States, lovastatin is commercially available in three strengths.Prescribersshouldidentifytheproperstrength. e.g.:lovastatin40mgtablet
10
20
40
QualitY tip 3: Quantity qualifiers must be correctly associated with drug descriptions. where possible, quantity along with the quantity qualifier should reflect the actual metric quantity. example of improper use: Amoxicillin 250mg/5ml, 1 EA. In this case,thepharmacistdoesnotknowwhetherprescribermeant1fluid ounce or 1 bottle. Even if the prescriber meant a bottle, sending a nonmetricqualifiermightstillresultinconfusionbecauseAmoxicillin 250mg/5mloralsuspensioncomesinthreebottlesizes:80,100and 150ml.UseinsteadAmoxicillin250mg/5ml,150ml. ThecorrectQuantityQualifiermakesitclearthat the prescriber wants the pharmacy to dispense 150mlbottle: use amoxicillin 250mg/5ml, 150 ml
Surescripts clinical quality program team of pharmacists, pharmacy technicians, prescribers, technologists, and Six Sigma BlackBelts(TrainedQualityleaders)arefullyengagedinqualityimprovementsthatincludeincreasingefficiency,valueand theuserexperience.
For more information about surescripts efforts to raise industry quality, contact the surescripts Quality office (quality@surescripts.com) and visit our blog at www.surescripts.com/eprescribingquality.
16
WWW.SURESCRIPTS.COM
Future of E-prescribing
E-PrescribinggrowthDrivesIndustryCollaborationonNewStandardsandCapabilities
Surescriptshasbeencollaboratingwiththenationspharmacies,PBMs,prescriberandpharmacytechnologyvendors, andgroupsinvolvedincreatingindustrystandardsonimprovementsandinnovationsthatwilldrivethefutureofe-prescribing.wearecommittedtoexpandingsupportforandenablingelectronicexchangeofalltypesofclinicalinformation.
epcs: electronic prescriptions for controlled substances
InSeptember2011,SurescriptsbegantheinitialdeploymentofEPCSinstateswhereEPCSislegal.Progresswillbedrivenby anindustry-widecollaborationbetweenpharmacies,technologyvendors,pharmacybenefitmanagers,Surescriptsandother networkstoplanandimplementsupportforU.S.DrugEnforcementAdministrationandstatepharmacyboardrules. TosupportthedeploymentofEPCS,networkparticipantsmustadheretomajorDEArequirements: prescribers must: Useane-prescribingapplicationthatisauditedandcertifiedforthispurpose. Completeacompliantidentity-proofingprocess. Useasecure,two-factorauthenticationprocesstosigne-prescriptionsforcontrolledsubstances. software vendors and pharmacies that have developed their own software systems must: ompleteSurescriptscertificationandDEA-requiredthird-partyauditsbeforeconnectingtotheSurescriptsnetworkforEPCS. C pharmacies must: ApplyupdatestotheirsoftwaresystemstoensureDEAandSurescriptsNCPDPSCRIPTadherenceforEPCS.
electronic prior authorization for prescription drugs
Electronic prior authorization (ePA) is viewed as a way to address the need for prescribers to obtain approval for prescriptions that are subject to closed formulary, step-therapy regimen, off-label use or other plan benefit parameters and eliminate the inefficiencies of paper-based prior authorization processes (PA) that create significant administrative burdens forprescribersandpharmacies. In October 2011 the National Council for Prescription Drug Programs (NCPDP) reactivated its Prior Authorization workflow-to-Transactions Task group. In addition, industry pilots were initiatedandcollaborationthroughNCPDPcontinues to date. Humana, Agadia, CvS/Caremark, Surescripts, CoverMyMeds, McKesson and Ibeza are reviewing draft standards, collaborating on enhancements, and should soon produceanePAstandardthatwillbeusefultoall.
Collaboration on Standardized Procedures and Proper Use of ePA Needed for all Stakeholders
Provider
Standardizedproceduresforrequesting PA.Implementation areneeded.
Pharmacy
Standardizedinformationandimplementationguidelinesare neededforconsistent communications.
Payers
ModifiedPA processing;Minimize frequencyof unnecessaryPA.
alignment on standards will Help move clinical interoperability Forward
Theabilitytocommunicateelectronicallytootherhealthcareprovidersbetween(orwithout)EHRs,andacrossregionalnetworks and health systems means that health care providers can exchange clinical information more quickly and efficiently whileimprovingpatientcare.Clinicalinteroperabilitysolutionshelpbyallowingphysiciansandotherhealthcareprovidersto securelysendandreceiveclinicalinformationelectronicallywithpeerslocally,regionallyandnationally.Surescriptsandmany otherorganizationshavecollaboratedwiththefederalgovernmenttocreatethestandardprotocolsneededtomakethistype ofelectronicclinicalcommunicationpossible.TheSurescriptsnetworksupportsallfederalandstatepoliciesandstandards forhealthinformationexchange,includingprivacyandsecuritystandards(suchasHIPAAandstatelaw),technologyinteroperabilitystandards(suchasDirect)andmessagetypes(suchasHl7).
17
part 2: E-prEsCriBing aDopTion
The Class of 2008: Tracking the growth of Meaningful Use

As much as 60 Percent of Physicians who Started E-Prescribing in 2008 Meet Stage 1 Meaningful Use E-PrescribingMeasure;38PercentofThisgroupwouldMeettheProposedStage2E-PrescribingMeasure*
2008 e-prescribing adoption bY Quarter
Q1 2008 Q2 2008 Q3 2008 Q4 2008 total
5,626 7,074 10,092 17,006 39,798
summarY Arecentanalysisofacohortofphysicianswhoadoptedandbeganusinge-prescribingin2008producedfourfindings.Summaryoffindings:1)Estimatesshow thatthemajority,asmuchas60%,ofthoseprescribershavesuccessfullymetthe stage 1 meaningful use e-prescribing measure*; 2) 38 percent of these early userswouldmeettheproposedstage2meaningfulusee-prescribingmeasure* if it were now in effect; 3) physicians use of e-prescribing increases over time (see Figure 2) 4) that e-prescribing was utilized at a higher rate by prescribers whousedEHRsoftwarecomparedtostandalonesoftwareusers. bacKground Inordertospurwidespreadadoptionofcertifiedelectronichealthrecord(EHR) technology,thefederalgovernmentthroughtheHealthInformationTechnology for Economic and Clinical Health Act (HITECH)is providing up to $30 billion in incentives for prescriber adoption and meaningful use of certified EHR technology. The Centers for Medicare and Medicaid Services (CMS) is responsible for administering the EHR incentive program and developing objectives and measurementcriteriathateligibleprovidersmustmeetinordertoqualifyforanEHR incentivepayment(s). E-Prescribingisoneofthecoreobjectivesforstage1ofmeaningfuluse,which requiresmorethan40percentofaneligibleprovidersprescriptionstoberouted electronically. Todate,CMShasmadecloseto$4billioninpaymentstoeligibleprovidersand hospitalsthathavemetthemeaningfulusemeasureofcertifiedEHRtechnology. CMSisprovidingreportinginatransparentmanneronpaymentsmade,towhom, andwhichEHRvendorstheyuse. metHods SurescriptsanalyzedprescriberadoptionandutilizationdatafromtheSurescripts network.PrescriberdemographicdatawasmatchedtoSK&Aprescriberdatain order to segment by specialty and practice size. we used aggregate IMS Health data about prescriber volume to create models of estimated average total prescriptionvolumeperprescriberbyspecialtyandmatchedthattoourlistofprescribers.Thedatashowedacountof48,993prescriberswhoadoptedandbegan using e-prescribing between January 1, 2008 and December 31, 2008. The data was further segmented by e-prescribing system (EHR versus standalone) and specialtytypefor39,798activee-prescribers(Figure1).Prescriberspracticedin 50statesandninedistrictsandU.S.territories.Modelsweredevelopedtoanalyzeactivee-prescribersuseandthenumberofearlye-prescriberswhowould havemetthestage1meaningfulusee-prescribingmeasureandproposedstage 2measure(notineffect)byfourthquarter2011. results ByDecember2008,Surescriptsestimatesthatbetween6,927and8,129prescribers (17.4 percent to 20.4 percent of active e-prescribers) met the more than 40
Figure 1: AdoptionandUseofE-Prescribing byQuarterQ1thruQ42008
e-prescriptions per actiVe e-prescriber

(aVerage per montH)
Q1 2008 Q2 2008 Q3 2008 Q4 2008 Q1 2009 Q2 2009 Q3 2009 Q4 2009 Q1 2010 Q2 2010 Q3 2010 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011
49 78 82 94 125 132 139 153 160 160 163 178 198 197 200 213
Figure 2: UseofE-PrescribingperActive E-PrescriberperQuarter2008-2011
18
WWW.SURESCRIPTS.COM
ESTIMATED PERCENT OF EARLY USERS OF E-PRESCRIBING BY PHYSICIAN SPECIALTY WHO HAVE SUCCESSFULLY MET THE STAGE 1 MEANINGFUL USE E-PRESCRIBING MEASURE
specialty Family practitioner internist pediatrician general practitioner cardiovascular disease obstetrician/gynecologist ophthalmologist psychiatrist gastroenterologist obstetrician/gynecologist other eHr vs. standalone e-prescribing eHr standalone e-prescribing 31,902 6,976 222 144 60%to67% 44%to50% number of prescribers 12,416 6,474 2,627 2,293 1,994 1,453 1,082 822 771 762 9,104 average utilization
(monthly)
percent of prescribers meeting meaningful use

(stage 1)
316 303 157 139 135 91 62 114 88 83 95
69%to74% 67%to72% 55%to67% 33%to43% 58%to70% 59%to70% 27%to27% 38%to45% 38%to54% 51%to59% 33%to36%
Figure 3: EstimatedStage1MeaningfulUseE-PrescribingMeasureMetbyEarlyUsersfrom2008*
percent stage 1 meaningful use program measure. By December 2011, these numbers increased to 21,392 to 23,877prescribers(53.8percentto60.0percentofactivee-prescribers),Figure3.Themodelsalsosuggestthat 15,146prescribers(38.1percent)wouldhavealreadymettheproposed65percentthresholdintheproposedstage 2meaningfulusemeasure(notcurrentlyineffect). Theresultsalsofoundthate-prescriptionsperactivee-prescriberincreasedovertime.Infirstquarter2008,they wereanaverageof49permonth.Byfourthquarter2011,theyhadreachedanaverageof213permonth. Familypractitionersdemonstratedthehighestindividualutilizationlevelswith316e-prescriptionspermonth.They alsoappearedtohavethehighestlevelofsuccessfullymeetingthestage1meaningfulusee-prescribingmeasure ofanyspecialtywithanestimatedspecialtyutilizationrateof69percentto74percent.Theywerefollowedbyinternistsat303e-prescriptionspermonthandaspecialtyutilizationrateof67percentto72percent(Figure3). Themajorityofprescribers(80.2percent)whoadoptedandbeganusinge-prescribingin2008didsousinganintegratedEHRsoftwaresystem.ThedataindicatesthatphysiciansusingEHRsoftwarehadsignificantlyhighere-prescriptionutilizationlevels(+53percent)thanprescribersusingstandalonee-prescribingsystems.Upto67percent ofthee-prescribingphysiciansusinganEHRweremorelikelytomeetthestage1meaningfulusee-prescribing measureversusanestimated44percentto50percentofe-prescribersusingstandalonee-prescribingsystems. discussion Therequirementsforstage1meaningfulusee-prescribingmeasurehavebeenwidelycommentedonanddebated by healthcare stakeholders, as they have significant implications in terms of provider adoption, use, and reimbursement.TheEHRincentiveprogramisaprimarymechanismthegovernmentisusingtoinfluencetheuseof healthinformationtechnologytoimprovehealthcareoutcomesandlowercosts. Thisanalysisofadoptionandusedatasuggeststhatamajorityofproviders*whobegane-prescribingin2008(54 percentto60percent)areinapositiontomeetthestage1meaningfulusee-prescribingmeasurewhile38percent ofthisgroupwouldmeetproposedstage2meaningfulusee-prescribingmeasure.
* eferencestomeetingstage1meaningfulusee-prescribingmeasureorstage2meaningfulusee-prescribingmeasure,asproposedbutnotcurrentlyineffect,alsoassumethatthe R usermettherequirementforparticipatingasaneligibleprovider. 19

prescribers
In 2011, 390,000 physicians, nurse practitioners and physician assistantsthe majority of prescribers made e-prescribing a mainstream health care information technology in the United States. Prescribers use eitherstandalonee-prescribingsoftwareoranelectronic health record (EHR) to e-prescribe. All prescribers describedinthissectionoftheReportusedprescription routing services. A portion of these prescribers also used prescription benefit information and medication historyservices.
FiFTY-EigHT pErCEnT oF oFFiCE-BasED pHYsiCians E-prEsCriBE
KeY statistics y the end of 2011, 390,000 prescribers routed pre- fthese390,000prescribers,317,000werephysicians. B O scriptionselectronically,upfrom234,000attheendof urescripts estimates that approximately 58 percent S 2010. This represents about 54 percent of all officeof active office-based doctors nationwide are basedprescribers.* e-prescribing.
Prescribers Routing Prescriptions

67%
390,000
50%
234,000
109%
156,000 74,000
2008
% of Active Prescribers Using EHR (pg. 15) 63%
2009
70%
2010
79%
2011
82%
* ased on total count of 718,193 office-based prescribers, per SK&A data. Surescripts counts of active e-prescribers represent those that used ambulatory prescription routing B serviceswithinthelast30daysof2011.Asmallproportionoftheseprescribershavebeenregisteredbyhospitalsandotherorganizationsthatdobothambulatoryandacutecare. 20
WWW.SURESCRIPTS.COM
e-prescribing pHYsicians bY specialtY*

top three specialty groups have e-prescribing47% 47% adoption and use rates at or above 75 percent. 75% 75%
Internists, family practitioners and cardiovascular disease specialists have adopted e-prescribing at the highest Internist Internist Internist Internist ratesin2011.Elevendifferentspecialtieshaveachievedadoptionratesof60percentormore. specialties with Highest rates of e-prescribing adoption e-prescribinge-prescribing
specialty
Internist Internist Gastroenterology Gastroenterology
45% 45%
2010
81% 81%
2011
Year-to-Year Internist Internist

internist
45% 45% 38% 38% 47% 47%
+80%
81% 81% 76% 76% 75% 75%
FamilY practice
+59%
cardioVascular disease
47% 47% 49% 49%
+55%
75% 75% 76% 76%
Specialty Group
dentist/oral surgeon dermatologist endocrinology & metabolism Gastroenterology Gastroenterology gastroenterology general practitioner general surgeon nephrologist neurologist Cardiovascular Cardiovascular non-alleo/osteopaths obstetrician/gynecologist oncologist/Hematologist optometrist/ophthalmologist orthopedic surgeon other pediatrics Cardiovascular Cardiovascular other specialty other surgery otolaryngologist pediatrician podiatrist psychiatrist psychologist urologist
38% 38%
% E-Prescribing in 2011
44 62 78 Gastroenterology Gastroenterology 69 43 36 67 57 Cardiovascular Cardiovascular 39 52 58 67 43 43 Cardiovascular Cardiovascular 34 31 61 59 55 35 68 68
76% 76%
38% 38% 49% 49%
76% 76% 76% 76%
49% 49%
76% 76%
* stimatedbasedonsampleanalysisof314,616or99%ofallactiveoffice-basedphysicians. E 21
Solo 2 to 5
Solo 2 to 5
31% 31%
Solo 2 to 5
Solo 2 to 5
46% 46% 46% 46% 53% 53% 46% 46% 53% 53% 46% 46% 2011 53% 53% 55% 55% 46% 46% 53% 53% 55% 55% 53% 53% 55% 55% 46% 46% 53% 53% 55% 55% 46% 46% 55% 55% 46% 46% 35% 35% 55% 55% 46% 46% 35% 35% 46% 46% 35% 35% 27% 27% 46% 46% 35% 35% 27% 27% 35% 35% 27% 27% 35% 35% 27% 27%
part 2: E-prEsCriBing aDopTion 31% 31%

Solo Solo
e-prescribing pHYsicians bY practice siZe* 2 to 5 2 to 5

three smallest practice sizes lead e-prescribing adoption in 2011.
42% 42% 31% 31% 42% 42% 31% 31% 2010 42% 42% 44% 44% 31% 31% 42% 42% 44% 44% 42% 42% 44% 44% 34% 34% 42% 42% 44% 44% 34% 34% 44% 44% 34% 34% 31% 31% 44% 44% 34% 34% 31% 31% 34% 34% 31% 31% 22% 22% 34% 34% 31% 31% 22% 22% 31% 31% 22% 22% 31% 31% 22% 22%
Solo 2 to 5
Solo 2 to 5
e-prescribinge-prescribing e-prescribinge-prescribing Physicianpracticegroupsthatrangefromsolopractitionersuptoofficeswith11to25physiciansaretheleaders Solo Solo Solo Solo intheadoptionanduseofe-prescribing.Solopractitionersincreasedtheiradoptionby48percentin2011.Practices e-prescribinge-prescribing e-prescribinge-prescribing 2 to 5 2 to 5 2 to 5 2 to 5 with26to100physiciansincreasedadoptionby13percentin2011.
6 to 10
6 to 10 Solo 2 to 5 6 to 10
6 to 10
6 to 10 Solo 2 to 5 6 to 10
practice size
Solo 2 to 5
e-prescribinge-prescribing e-prescribinge-prescribing e-prescribinge-prescribing
Year-to-Year Solo
2 to 5
solo practitioner
6 to 10
2 to 5 6 to 10
2 to 5 6 to 10 11 to 25 2 to 5 6 to 10 11 to 25
+48%
2 to 5 6 to 10
6 to 10
2 to 5 6 to 10 11 to 25 2 to 5 6 to 10 11 to 25
2 to 5
11 to 25 2 to 5 6 to 10 11 to 25
+26%
2 to 5 6 to 10 11 to 25
11 to 25
e-prescribinge-prescribing e-prescribinge-prescribing e-prescribinge-prescribing e-prescribinge-prescribing
6 to 10
6 to 10 11 to 25 26 to 100 6 to 10 11 to 25 26 to 100 6 to 10 11 to 25 26 to 100
+25%
6 to 10 11 to 25 26 to 100
6 to 10 11 to 25 26 to 100 6 to 10 11 to 25 26 to 100
11 to 25
6 to 10 11 to 25 26 to 100
+35%
6 to 10 11 to 25 26 to 100
26 to 100
11 to 25 26 to 100 100+ 11 to 25
11 to 25 26 to 100 100+ 11 to 25 26 to 100 100+
+13%
26 to 100 100+ 11 to 25
11 to 25
11 to 25 26 to 100 100+ 11 to 25 26 to 100 100+
100+
26 to 100 100+
+23%
100+ 26 to 100 100+
26 to 100
26 to 100 100+
26 to 100 100+
26 to 100 100+
26 to 100 100+
26 to 100 100+
26 to 100 100+
26 to 100 100+
* stimatedbasedonsampleanalysisof292,658prescribers(or92%ofallactivee-prescribersovertheSurescriptsnetworkasofDecember2011). E e-prescribinge-prescribing 22
100+
100+
100+
100+
WWW.SURESCRIPTS.COM
pHarmaciescommunitY and mail order

Surescripts works with community pharmacies in the United States. Community pharmacies include chain pharmacies and independently owned pharmacies. In addition,PBMsandsomechainpharmaciesoperatemail orderpharmacies. Prescription routing connectivity gives prescribers the ability to send new prescriptions electronically to the computersystematthepharmacyofthepatientschoice. Pharmaciesgaintheabilitytosendprescriptionrenewal requests to the practices e-prescribing software for reviewandanelectronicrenewalresponse,whichprovides efficiencytotheprescriberandpharmacy,andconvenience tothepatient.
ninETY-onE pErCEnT oF THE naTions CoMMUniTY pHarMaCiEs aCCEpT E-prEsCripTions
KeY statistics T inety-one percent of community pharmacies in the hereare62,461communitypharmaciesintheUnited N States represented by both chain and independently UnitedStateswereconnectedforprescriptionrouting owned pharmacies.** Of these, about 64 percent are in2011.* chain pharmacies and 36 percent are independently orethan98percentofchainpharmaciesand79perM owned(includingthosethatarepartofbuyinggroups). centofindependentpharmacieswereconnectedtothe Surescriptsnetworkforprescriptionroutingin2011. S ixofthelargestmailorderpharmacieswereableto receiveprescriptionselectronically.***
Community Pharmacies Connected for Precription Routing

CHAINS INDEPENDENTS
14,000 10,000 39,000
16,000
17,600
39,600
39,300
36,000
2008
Community Pharmacies Connected Independent Pharmacies Connected 76% 46%
2009
85% 62%
2010
91% 73%
2011
91% 79%
* nadditiontoretailandmailorderpharmacies,SurescriptsalsoconnectssomepharmaciesassociatedwithfederalandstategovernmentsandwithmedicaldevicemanufacturI ers.Foralistofe-prescribingpharmacies,gotowww.Surescripts.com/connected-pharmacies.html. ** asedonNCPDPdataanalysis. B *** vSCaremark,ExpressScripts(wellPoint,NextRx),MedcoHealthServices,PrescriptionSolutions,PrimeTherapeutics(PrimeMail)andwalgreensMailService. C 23

paYers
Private payers and their associated pharmacy benefit managers (PBMs) provide important prescription benefit andmedicationhistoryinformationtoprescribersthrough vendorsoftwareconnectedtotheSurescriptsnetwork. The availability of prescription benefit information and medicalhistoryallowprescriberstotreatpatientsmore effectively. Asmoreprescribersenablemedicationhistoryandprescriptionbenefitinformation,drugformularycompliance andpatientsafetywillimproveonastate-by-stateaswell asanationalbasis.
ForalistofpayersandPBMsthatareconnectedtoSurescripts,please visithttp://www.Surescripts.com/about-us/connected-payers.aspx.
TWEnTY-FoUr sTaTEs sHoWED inCrEasEs in aCCEss To prEsCripTion inForMaTion in 2011 WHEn sElECTing MEDiCaTion THErapY
KeY statistics ore than 66 percent of patients in the United States M nearly 253 million member records (patient-lives) attheendof2011wereprovidedaccesstoprescription fromparticipatinghealthplans.** benefit and medication history information (on behalf n 2011, Surescripts provided access to more than I ofpayersandpharmacies).* 30,000 formulary files, including formulary status, y the end of 2011, par ticipation by payers in B coverage, co-pay and alternative medication lists e-prescribingallowedprescriberstolocateandaccess maintainedbyparticipatinghealthplans.
percentage oF patients For wHom paYers can proVide prescription beneFit and medication HistorY inFormation
91100% 8190% 71 80% 6170% 5160% NV 4150% 31-40% 21-30% CA OK AZ NM AR SC MS TX LA AL GA UT CO KS MO OR SD ID WY NE IA IL IN OH WV KY TN VA NC DC PA NJ DE MD
WA
MT
ND MN WI
MI
VT
NH ME
NY
MA RI CT
AK HI FL PR
24
* alculatedbytakingthenumberofrecords,less19percentforpatientswhohavemorethanonesourceofprescriptionbenefitcoverage,anddividingitbytheU.S.populationof309 C million.FiguresincludetheDistrictofColumbia,PuertoRicoandU.S.territories.U.S.populationfiguresarefromAnnualEstimatesoftheResidentPopulationfortheUnitedStates andPuertoRico,PopulationDivision,U.S.CensusBureauRelease,July1,2010.Surescriptssuggeststhatpayerscanprovideamedicationhistoryforanestimated95percentofthe patientsforwhomitcanprovideprescriptionbenefitinformation.Thisisbecausesomepharmacybenefits,whenofferedasacarve-out,arenotassociatedwithaclaims-based medicationhistory. ** hisfigureisinclusiveofrecordsfromall50U.S.statesandtheDistrictofColumbia. T
WWW.SURESCRIPTS.COM
part 3: aBoUT sUrEsCripTs
about surescripts
The Surescripts network supports the most comprehensive network of health care organizations in the United States. Pharmacies, payers, pharmacy benefit managers (PBMs), physicians, hospitals, health information exchanges and health technology firms rely on Surescripts to securely share health information across the healthcarecontinuum. guidedbytheprinciplesofprivacy,security,neutrality,choice,transparency,collaborationandquality,Surescripts operatesthenationslargesthealthinformationnetwork.Byprovidingpatientmedicationinformationforroutine, recurring and emergency care, Surescripts is committed to saving lives, improving efficiency and reducing the costofhealthcare. Formoreinformation,gotowww.Surescripts.comandfollowusattwitter.com/Surescripts.
the surescripts electronic prescribing network

Surescriptsconnectsprescribersinall50statesthroughtheirchoiceofcertifiede-prescribingsoftwaretothe nationsleadingpayers,chainpharmaciesandindependentpharmacies. Any e-prescribing software providerincluding those offering standalone e-prescribing solutions and those that integrate e-prescribing capabilities into electronic health record systemsmay connect their customers to Surescriptssecurenationwidee-prescriptionnetwork,aslongastheyhavesuccessfullycompletedSurescripts implementation and certification process. This process validates that the certified software is able to send and receiveelectronicmessagesinaccordancewithindustrystandards. Surescriptscertifiessoftwareusedbyprescribers,pharmacies,andpayers/PBMsforthreemainservicecapabilities:prescriptionbenefitinformation,medicationhistoryandprescriptionrouting.
acknowledgements
SurescriptswouldliketothankCircleSquareInc.,theNationalAssociationofChainDrugStoresEconomicsDepartmentandSK&Afortheirexpertiseandsignificantcontributionstothe2011ProgressReportonE-Prescribing. For more information about surescripts, visit www.surescripts.com and follow us at twitter.com/surescripts.
Designed by Curran & Connors, Inc. / www.curran-connors.com
2800CRySTAlDRIvE ARlINgTON,vIRgINIA22202 T:866.797.3239|F:703.921.2191
9202NDAvENUESOUTH MINNEAPOlIS,MN55402 T:866.797.3239|F:651.855.3001
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National Progress Report On E Prescribing Year 2011

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National Progress Report On E Prescribing Year 2011

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THE naTional progrEss rEporT

on e-prescribing and interoperable HealtH care

the evolution of e-prescribing

8percent(317,000)ofalloffice-based 5 physiciansactivelye-prescribe. PCSstate-by-stateapproval E advancing.

2010 2009 2008 2007

MSissuesMedicarePartDe-prescribing C incentiveregulations. EAproposesruletoallowe-prescribing D forcontrolledsubstances. edicareImprovementsforPatientsand M ProvidersAct(MIPPA)passesincludes e-prescribingincentives. xHubandSureScriptsmergetoform R SureScripts-RxHub.

enterforImprovingMedicationManagement C launched. -prescribingbecomeslegalinall50statesandD.C. E ationalE-PrescribingSafetyInitiativelaunched. N ureScripts,RxHub,InformedDecisionsandthe S AMAlaunchICERx.orgtoassistvictimsofnatural disasters.

irstproposedfoundationstandards F releasedforMedicarePartDe-prescribing. HSissuesStarkexemptionsandFraud& H Abusesafeharbors. ureScripts,RxHubhelplaunch S www.katrinahealth.orgtosupport victimsofHurricaneKatrina.

2005 2004 2003 2002 2001

MSpilot-testsproposedMedicarePartD C e-prescribingstandards. irstannualSafe-RxAwardsrecognizetop F e-prescribingstates. nstituteofMedicinereleasespivotal I PreventingMedicationErrorsreport.

nstituteofMedicineendorsesNational I HealthInformationInfrastructure. edicareModernizationActprovides M incentivesfore-prescribingadoption. ureScriptsbeginsnetworkoperations. S

pproximately2,500,or4%ofofficebased A physicians,e-prescribe. fficeoftheNationalCoordinatorforHealth O InformationTechnology(ONC)established. ureScriptslaunchese-prescribingcommuS nityadoptionprograms.

a letter from the president and CEo

Harry totonis PresidentandCEO,Surescripts

Figure 1: 2011Office-basedPhysicianswhoE-Prescribe (Thedarkerthearea,thegreaternumberofactivee-prescribers)

96 million 474 million

57 million 269 million

390,000 304 91%

Numberpickedupoutof100 85% 91% writtenprescriptions

69.5 Rx 69.5 Rx Picked Up Picked Up

76.5 Rx 76.5 Rx Picked Up Picked Up

ESTIMATED MEANINGFUL USE ACHIEVEMENT AS OF Q4 2011

47% 47% in 2011, approximately two-thirds of internists, 75% 75%

46% 46% 46% 46%

Internist Gastroenterology Gastroenterology

Year Internist Internist to Year

practice size Solo

Year to Year Solo

45% 45% 38% 38% 47% 47%

81% 81% 76% 76% 75% 75%

47% 47% 49% 49%

75% 75% 76% 76%

E-prescriber growth in the U.s. 20082011

in 2011, 58 percent of office-Based physicians Used E-prescribing

part 1: ElECTroniC prEsCriBing UsE

The Three Components of E-prescribing

The impact of E-prescribing on Medication adherence

69.5 Rx 69.5 Rx Picked Up Picked Up

76.5 Rx 76.5 Rx Picked Up Picked Up

part 1: ElECTroniC prEsCriBing UsE

opporTUniTY For prEsCriBErs To UsE BEnEFiT inForMaTion inCrEasED 87 pErCEnT

Prescription Benet Responses

The Value of prescription Benefit information

processes: NewPrescription PrescriptionRenewal

part 1: ElECTroniC prEsCriBing UsE

Medication Histories Delivered

Prescription Routing Transactions

57 million 269 million 35 million 156 million 13 million 55 million 2008

part 1: ElECTroniC prEsCriBing UsE

How to improve the Use of prescription renewals

eHr Vs. standalone e-prescribing soFtware

EigHTY-TWo pErCEnT oF aCTiVE prEsCriBErs UsE EHr To E-prEsCriBE

Vendor Software Certified and Deployed for E-Prescribing

All Three Services

Percentage of Active Prescribers Using EHR vs. Standalone E-Prescribing Software

part 1: ElECTroniC prEsCriBing UsE

industry Collaboration Drives Continuous improvement in Electronic prescription Quality

epcs: electronic prescriptions for controlled substances

electronic prior authorization for prescription drugs

alignment on standards will Help move clinical interoperability Forward

part 2: E-prEsCriBing aDopTion

The Class of 2008: Tracking the growth of Meaningful Use