At a press conference featuring healthcare leaders from throughout the state, Governor Donald L. Carcieri announced that Rhode Island was launching a new system for tracking swine flu. Unprecedented in its approach, the system makes use of prescribing data provided by pharmacies throughout the state via a secure electronic link. It is enabled by the state’s success with e-prescribing and the digital healthcare infrastructure available through its partnership with Surescripts, The Nation’s E-Prescription Network. “Since 2003 Rhode Island has consistently led the way on e-prescribing, and we have been continually recognized as one of the top 10 states in the nation for our success in implementing this initiative,” said Governor Carcieri. “I am proud of all that we have been able to accomplish through a very effective public-private partnership.”
“E-prescribing has been a priority of my administration because of its potential to improve patient safety, increase quality of care, and reduce healthcare costs. It has tremendous value for monitoring and protecting public health, and for increasing efficiencies in our health care system,” Governor Carcieri continued. “The growth of e-prescribing has been an important component of our overall effort to promote the electronic exchange of health information.”
The First Statewide System for Tracking Disease Using Prescription Data In a healthcare first for Rhode Island and the nation, Surescripts and the state's pharmacies are now providing epidemiologists at the Rhode Island Department of Health with weekly updates of prescription data from pharmacies throughout the state. Participating pharmacies include CVS/pharmacy, Rite Aid, Stop & Shop, and Walgreens. The epidemiologists can use the data – which has been de-identified to exclude personal information – to see where there may be spikes in prescriptions of TAMIFLU or other antiviral medications.
“Rhode Island is the first state in the nation to work with Surescripts to use prescription data in the aggregate for disease surveillance, specifically monitoring and tracking the use of antiviral data during this H1N1 pandemic,” said Director of Health David R. Gifford, MD MPH. “This provides another important tool for the state’s public health officials to look at trends related to the course, severity and treatment of the H1N1 pandemic.”
The new capability allows state health officials to do three things: · Use the data as a valuable proxy for detecting a potential outbreak of swine flu, including its location and affected age group. · Offer a more far-reaching and granular view of potential flu activity when compared to the state's "Sentinel" system -- 25 physician practices around the state which report flu outbreaks to the state DOH. · Help detect discrepancies between disease outbreaks reported by the Sentinel system and outbreaks identified based on flu prescriptions. These discrepancies may suggest a number of possibilities: prescribing in the absence of flu; that supplies of an important drug are running low; additional outbreak areas that were not detected by the Sentinel system; the need for additional education to assure the appropriate use of antiviral medications.
Rhode Island’s electronic tracking of antiviral data represents the second prominent use of prescription data for reasons of public health. In 2005, an effort formed in the wake of Hurricane Katrina allowed physicians and pharmacists throughout the country who were caring for displaced residents of New Orleans and surrounding regions to go to KatrinaHealth.org to access the prescription history of an evacuee for whom they were providing care, but had no medical records. Katrina Health and its successor effort – ICERx.org – were forerunners to the Rhode Island system launched today.
First State to Reach 100 Percent of Pharmacies E-Prescribing Rhode Island’s new system for tracking swine flu is built upon its success in driving the adoption and use of e-prescribing. In yet another first for the state and the nation, Rhode Island today announced that it has now connected 100 percent of its retail pharmacies for e-prescribing. By connecting all of the state’s pharmacies to the Surescripts network, Rhode Island is not only further supporting the growth of e-prescribing and improvements in the cost, quality and safety of prescriptions processed in the state, it is creating new opportunities for meaningful use of the state’s rapidly expanding digital healthcare infrastructure.
"This is a very significant milestone in our efforts to leverage health information technology to improve the quality, safety and value of health care in Rhode Island,” said Laura Adams, President and CEO of the Rhode Island Quality Institute (RIQI). “When a misplaced decimal point can cost a life, the value of eliminating hand-transcribed prescriptions cannot be overstated.”
Pharmacists are realizing significant benefits from e-prescribing. Dave Feeney, R.Ph., owner of Oxnard Pharmacy in Warwick turned to e-prescribing as a way to create more efficiencies and economies for his pharmacy.
“E-prescribing allows you more time with patients, improves prescriber relationships and improves patient relationships,” said Feeney. “For example, we have a lot of diabetes patients that we are now able to spend more pharmacist-patient time with to counsel them on diabetes education. Also, patients no longer have to wait for their prescriptions when they arrive at the pharmacy and they have to make fewer return trips to the pharmacy for refill requests.”
“All CVS/pharmacy stores have been enabled to receive electronic prescriptions since 2004 and we are delighted that our home state is the first in the nation to achieve this 100% milestone,” said Papatya Tankut, R.Ph, Vice President of Pharmacy Professional Services at CVS/pharmacy. “E-prescribing is a more efficient way for physicians to provide prescription information to pharmacies. It provides physicians with more information about their patients’ prescription profile at point-of-care, eliminates legibility issues which enhances safety at the pharmacy, and provides greater convenience for patients. Tracking prescription patterns to help identify H1N1 flu outbreaks is just one more reason CVS will continue to support efforts to increase the adoption of e-prescribing technology in our health care system.”
“Stop & Shop applauds the achievements in Rhode Island and strongly supports e-prescribing technology,” said Jim Wonderly, Vice President of Pharmacy. “We’re focused on doing all we can to monitor and control the H1N1 flu outbreak including distributing free Tamiflu to qualified customers as part of a Rhode Island state program. We are on board to do all we can to improve efficiencies for our customers, physicians and pharmacists.”
Physicians also benefit from e-prescribing, according to David Gorelick, an internist with Aquidneck Medical Associates in Newport.
"I see approximately 500 patients per month. I prescribe and manage thousands of medications for my patients," said David Gorelick, an internist with Aquidneck Medical Associates in Newport. "Refilling medications with paper records could take up to 10 minutes by the time the chart was located and brought to my desk for review. With e-prescribing, refills can be done in seconds. This is a huge time savings for my practice that allows us to focus more of our attention on direct patient care. E-prescribing also greatly improves patient safety as I now have a computer system to check prescriptions against the patient's allergies and potential interactions between all of their current medications and over-the-counter products."
Rhode Island Establishes Model for Digital Healthcare The engine behind all of this success in converting from paper to digital healthcare in Rhode Island has been a collaborative effort of involving healthcare leaders from across the state. It began with The Rhode Island Quality Institute (RIQI), founded by U.S. Senator Sheldon Whitehouse in 2001. A few years later, the RIQI Statewide e-Prescribing Committee was created. Chaired by Dr. Gifford, the e-Prescribing Committee includes lead officials from the state department of health, the state's major health system, the state's pharmacies and other key players.
“Rhode Island’s unique collaborative model is leveraging the power of the Surescripts network to produce meaningful improvements across the state’s healthcare system,” said Harry Totonis, president and CEO of Surescripts. “Instead of theorizing about how to drive health IT adoption, the Rhode Island e-Prescribing Committee pulls out spread sheets, analyzes real data, sets goals, identifies barriers to health IT adoption and use and acts swiftly to remove them. You need only attend one of their conference calls to understand why Rhode Island is in the leadership position it’s in.”
Through the end of September 2009, Rhode Island had achieved the following level of e-prescribing adoption and use: · Retail Pharmacies Connected For E-Prescription Routing = 100% · Prescribers Using E-Prescriptions = 63% · Prescribers using an Electronic Health Record for E-Prescribing = 56% · Prescriptions Routed Electronically = 31%
Senator Sheldon Whitehouse is part of a bipartisan group of U.S. Senators working to change the federal rule that currently prevents doctors from e-prescribing controlled substances. Current federal rules require that doctors write paper prescriptions for controlled pharmaceuticals, such as pain medications, antidepressants and some drugs used to treat asthma in children. A change in this rule would provide greater incentive for providers to participate in e-prescribing by eliminating the need for maintaining a separate paper-based prescribing system for controlled substances.
“Today’s announcement is another impressive milestone in a long line of health care innovations in Rhode Island,” said Whitehouse. “Electronic prescribing is a necessity for improved quality and safety in health care delivery, and I’m thankful for all the hard work put in by the Rhode Island Quality Institute and participating pharmacies to adopt this technology. The next step in this effort is for the DEA to issue final regulations allowing providers to prescribe controlled drugs electronically, and I will continue working in the Senate to make that goal a reality.”