From the October 2003 Issue

Serious Business

Scrip for Success

Converting Interim HIPAA Fixes Into Long-Term Strategies

Taking It to the Next Level: What Works

Paper-Plagued to Paperless: What Works

Scrip for Success

Kentucky family practice uses electronic prescriptions to improve efficiency, revenue and customer service.

By Susan R. Miller, R.N., B.H.S., C.M.P.E.

Unlike hospitals that have larger budgets, physician practices often must choose diverse best-of-breed IT solutions that offer greater efficiency at a significantly lower cost. Making such systems work together optimally, however, is the key to getting the most bang for the buck.

Family Practice Associates of Lexington has two locations in the Lexington, Ky., area and 10 providers: eight physicians and two mid-level providers. In late 1998, we started searching for a computerized solution to help us track our patient care and, ultimately, to eliminate our paper medical records. After looking at many systems, we decided that an electronic medical record (EMR) system did not match our budgetary means or our physicians’ needs. In September 1999, we purchased Advanced Imaging Concepts’ IMPACT.MD, a medical document management system that uses high-speed scanning to digitize paper-based patient documentation and store it in a computerized patient record.

We began using the imaging system within a month, and for the next several months, our providers accessed it from centrally located PCs in the treatment blocks. Soon, we wanted to be able to access the system while in the exam room, so in August 2000, we put a PC in every exam room. We decided not to use handheld devices for accessing the system because our providers had become comfortable with PCs, and the small screens of handhelds did not adequately display document images.

However, our providers still wrote prescriptions by hand. They also manually completed an office visit checklist to document all medications prescribed for each patient that was later scanned and shredded. But they wanted an electronic system that would eliminate the need for writing prescriptions by hand. An added benefit of electronic prescriptions was the greater legibility and increased accuracy compared to handwritten prescriptions. Since we already had a PC in every exam room, the stage was set for a change.

Finding a Remedy

We considered several electronic prescription systems before choosing the TouchWorks Rx+ module from Allscripts Healthcare Solutions Inc., Libertyville, Ill., in January 2001. The module is a medication management and prescription communication tool featuring drug and allergy interaction checking and plan-specific formularies.

Allscripts worked with AIC to write a real-time interface that allows our patient demographic information to populate the system as a provider writes a prescription, so that we do not have to enter patient information more than once. The interface automatically sends prescription information back to the patient’s electronic chart once a provider finishes. If a patient receives a prescription during an office visit and later calls our office with a question about it, the staff member who accesses the patient’s chart has immediate access to the prescription information.

We began using Rx+ in March 2001, and we now write about 7,000 prescriptions per month. While the provider enters the prescription, the module checks the patient’s formulary to see if that medication is covered and displays the drug’s status. If the drug isn’t on the patient’s insurance plan formulary, the provider can prescribe a covered alternative. Occasionally, the provider will recommend a noncovered medication for a specific medical reason or the patient may ask for an alternative medication.

Beneficial Side Effect

Allscripts had something else that interested us: its FirstFill service, which allows us to purchase prepackaged, bar coded pharmaceuticals and fill prescriptions in our medical offices without employing an on-site pharmacist. We had used the service for several years until 1996, when our practice moved to a building that included a pharmacy. Once we switched to the document imaging system, we no longer needed staff to pull paper charts; we could use them in our prescription fulfillment station, which we reinstated when we began using Rx+.

After the provider enters the prescription into the system, the patient goes to our fulfillment station at checkout. If the medication is in stock, we offer to dispense it and check the co-pay amount by electronically contacting the patient’s insurance provider. If the patient asks us to fill the prescription, we collect the co-pay.

With this system, the staff member dispensing the medication knows immediately if she is holding the wrong drug, because she must match the medication’s bar code to the prescription using a scanner before dispensing to the patient. If the medication’s bar code is correct, a label with the patient’s name and instructions is printed; if it is incorrect, a blank label is printed. Our practice fills about 6 percent of all prescriptions issued, and the electronic prescription system can be set up to automatically reorder dispensed pharmaceuticals.

If we cannot fill the prescription, or the patient does not want us to fill it, we offer to print the prescription or fax it to the patient’s pharmacy. If we fax it, the order is usually ready and waiting when the patient arrives at the pharmacy. For a controlled drug, which in Kentucky requires a handwritten signature, we print the prescription, the physician signs it and we give it to the patient to take to the pharmacy.

A Healthy Prognosis

Our estimate shows that we broke even on the software and prepackaged pharmaceuticals within 10 months. By the second year of operation, we netted approximately $20,000 in extra income for a service we implemented to save time and to help our patients.

Although prepackaged pharmaceuticals are a source of extra income for us—Allscripts credits us with the difference in cost between the drug price and the patient’s co-pay for each prescription—we offer them primarily as a convenience to our patients. We have never wanted to compete with pharmacies or become a pharmacy. Although FirstFill provides the opportunity for us to stock more drugs than we carry, it was our choice to offer only drugs, such as antibiotics, that treat acute episodic illnesses, and not maintenance drugs. We do this because our core mission in supplying medication is to help the sick walk-in patient by giving him one less stop on the way home.

When we digitized our patient records, we kept all but two filing clerks on payroll even though we increased efficiency. Some staff members’ workload decreased at first, but the electronic prescription system has allowed us to shift responsibilities so that everyone is busy again. Instead of filing paper records, these staff members participate directly in patient care by supplying patients with their medications at the time of service—both a staff morale booster and a step toward improving patients’ adherence to their plans of care.

Electronically faxing prescriptions versus phoning them in has cut our time usage from an estimated six minutes per call to less than one minute per fax. This is dramatic when one considers an entire year. We estimate that we receive 200 phone calls a day requesting prescription refills. With approximately 240 business days in a year, this means about 48,000 phone calls per year. Saving even five minutes per phone call saves us the equivalent of 4,000 hours per year. At $12 per hour, this represents an annual savings of $48,000 just for the decrease in staff time spent refilling prescriptions by phone.

The savings that we enjoy with TouchWorks Rx+ are part of a larger, overall return on investment that we have experienced since digitizing our patient documentation. We have saved more than $80,000 per year by eliminating paper charts, outsourced transcription and reduced staffing levels. Combining this saving with our streamlined prescribing process has improved our efficiency even more significantly.

For more information about the TouchWorks Rx+ module and FirstFill, www.rsleads.com/310ht-201

© 2003 Nelson Publishing, Inc