Friday, September 14, 2007

ePrescribing in Mississippi

You don't really think of Mississippi as being an early adopter of technology, but this article on, states otherwise. My comments are below.

E-prescribing PDAs save millions for Mississippi Medicaid BY Nancy Ferris

Mississippi’s Medicaid program is saving about $1.2 million per month in prescription costs as a result of equipping 225 doctors with handheld e-prescribing devices.

State officials say the system not only reduces medication costs, it also increases the quality of care for patients. That's because doctors have access to patients’ recent medication histories and can avoid prescribing medicines that would interact with ones they are already taking.

In addition, doctors can find out whether patients are filling and refilling their prescriptions. This allows them to detect when patients’ continued poor health is due to noncompliance with the doctors’ treatment plans.

Prescribers who use the handheld devices write fewer prescriptions on average, state officials said, and those prescriptions are likely to cost the state less.

After 18 months of steady savings, the Mississippi Division of Medicaid is negotiating with its contractor to expand the e-prescribing program, officials said.

Besides cutting drug costs, the state is saving nearly $27,000 a month on hospitalizations avoided because the doctors are getting real-time alerts about drug interactions, they said.

The program costs the state about $35,000 per month, so the hospitalization savings come close to covering the cost of the handheld devices from Informed Decisions, based in Tampa, Fla.

Florida has launched a similar program, with comparable results.

Asked whether there was any negative aspect to the program, Mississippi officials said they knew of none.

“I can see which medications patients are taking regardless of who prescribed them. As a result, we are now able to keep comprehensive, up-to-date medication lists for all our patients,” said Dr. Kurt Bruckmeier, who cares for about 200 Medicaid beneficiaries through Pacific Physicians Services in Hattiesburg, Miss. “It has also helped identify drug abusers who would very likely have gone undetected were it not for our ability to evaluate the full scope of prescriptions they were taking.”

I think this is a fantastic program that will pay for itself over a very short time. ePrescribing and medication adherence go hand in hand - especially when it comes to refills. I am not familiar with pharmacy policy, but do they tell the MD when you do not refill a script? I don't think so. With all scripts and patient information linked up via these PDAs or hand tablets, MDs have all the info at their fingertips - as well as drug-drug interaction information to reduce ADRs.

The problems arise however when the technology fails and the MDs have no idea what is going on with the patient. I'm sure there are back-ups and colocation servers, but in Ol' Miss there could be flooding, hurricanes, fires, etc.... Also, as we have seen with Pfizer of the last couple of weeks, what happens when someone hacks into the system? Not that medical records of the elderly have that much value (no offense) but it is protected information that anyone can blast out over the internet or use to for blackmail (that might not happen but it could!).

This works into the EHRs that many tech companies, MDs and healthcare providers are trying to adopt. I like the idea, and use one on Revolution Health but at the same time I am wary about that information out there. Not that I have anything to hide, but I do not know who is looking at that information. Some techie who is performing a system analysis? They also capture what you are interested in, what medications you are on, etc.... which they can then use to market your "eyes" to advertisers.

Also health social networking sites which encourage you to sign up for chat groups and the like - all that information goes somewhere and is monetized somehow. Sorry for that little rant. These are all opt-in websites and have strict privacy policies and terms of use.

This of course would not happen with the proper EHRs and ePrescribing tools since they are covered under HIPPA and would be gross misconduct if that information was shared. So I encourage the technological advances - if you are heli-skiing in Canada and break your leg, the mountain MD with a handheld internet browser can see what meds you are on and your history of broken bones, your allergies, etc... And this makes for safe practices. Scuba diving in the Maldives and black-out from NO2 poisoning - same thing. When all medical records are computerized and on servers, it will be safer to get into an accident /life threatening situation!

Go forth Ol' Miss and show us the benefits of ePrescribing and adopt that new technology!

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