By Annette M. Boyle
FALLS CHURCH, VA – A recent expansion of e-prescribing at all military treatment facility (MTF) pharmacies brings them in line with their civilian counterparts by allowing them to accept electronic prescriptions from providers located off-base.
“This is something our pharmacy community has wanted for several years,” said Henry Gibbs, branch chief of the Defense Health Agency’s Pharmacy Informatics Integration.
Patients and providers have embraced the change, as well. As of Feb. 7, physicians had electronically submitted more than 140,000 prescriptions to MTF pharmacies, nearly twice the number filled as of mid-January. Gibbs said he expects the week-over-week numbers to grow substantially as pharmacies communicate the new option to community providers.
“We expect to see these numbers continually rise as the program matures at each site,” Gibbs told U.S. Medicine. Some sites have been active for several months; others only a few weeks. He projected that MTFs would receive about 20,000 e-prescriptions during the last week of February.
For many providers, federal incentives and electronic health record systems have made e-prescribing a part of the normal workflow. Including base pharmacies takes little additional effort. Providers simply scroll through the list of pharmacies in the e-prescribing database or network and select the local military pharmacy.
“E-prescribing makes military pharmacies a more attractive and convenient option for doctors and patients, and it aligns the Military Health System with current best pharmacy practices,” said George Jones, PharmD, chief of the Defense Health Agency (DHA) Pharmacy Operation Division.
According to the DHA website, the electronic prescribing initiative additionally “brings the Military Health System into alignment with the e-Prescribing Meaningful Use Requirements and also addresses the growing number of civilian providers who utilize electronic prescribing as their only means of generating a prescription.”
While on-base providers have been able to send prescriptions to military pharmacies electronically for years, the off-base option was first piloted in March 2014 at Naval Hospital Bremerton in Bremerton, WA. Following extensive testing, the rollout began in September and ended in February 2015 with 161 pharmacies participating in the United States, including Guam and Puerto Rico.
Pulling prescriptions from external systems into the military pharmacies required some changes in the software and processes at the base pharmacies, Gibbs noted. “We got a lot of feedback as we worked interactively with the staff at Bremerton and knew some changes in workflow had to occur,” he said.
The beta-testing at Bremerton identified 55 issues that were corrected before the nationwide rollout. “We not only tested the software for issues, we also forged the way the new software is operationalized and integrated into our daily workflow,” Cmdr. David W. Hardy, Clinical Support Services director at Naval Hospital Bremerton, said in a Navy press release. Staff at the naval hospital also worked with the project design team to develop implementation and user guides and assisted with implementation training in other locations. Now about 44% of the naval hospital pharmacy’s network prescriptions come in electronically.
E-prescribing eliminates the front-end order-entry process that technicians have to do when prescriptions are faxed by physician’s offices or delivered by hand by patients. “Now the prescriptions come in electronically and go into the Composite Health Care System (CHCS), where they are held for verification of patient identity, drug and prescriber,” Gibbs explained. While the pharmacies receive much more information in the e-prescription than they got in the faxed of hard-copy versions, the verification process and use of the holding queue required some adjustments to previous processing systems.
Even so, pharmacies report increased efficiency as a result of the expanding e-prescription program. “Pharmacists have been very positive,” said Gibbs. “Getting the information electronically enhances patient safety and reduces the chance of transcription errors. Overall, this is making the prescription process much more streamlined and easier to do.”
Patients have seen benefits, as well, as they no longer have to carry the prescription to the pharmacy and wait for it to be filled. “As soon as the provider hits the ‘send’ key, the pharmacy has the prescription and with no order entry required. The electronic system potentially improves the wait times for patients,” he said. Generally, pharmacists can resolve any questions about a prescription or verification issues before a patient arrives for pick-up.
E-prescriptions cannot be used for all drugs, however. Prescriptions for controlled substances such as narcotics and stimulants still must be faxed or handwritten and delivered personally to the pharmacies.
The DEA has permitted e-prescriptions for Schedule 1-5 drugs since 2010, but the system requirements are substantially more involved than for other medications. In the Release Notes documentation provided to pharmacies, the Defense Health Administration (DHA) noted that “the CHCS does not meet the Drug Enforcement Agency (DEA) regulation for the e-prescribing of controlled substances.”
Now that pharmacies at military hospitals and clinics have begun accepting e-prescriptions, the DHA will start monitoring utilization and soliciting feedback on how the system works for them. “We couldn’t expect the rollout to go better than it has,” said Gibbs. “Now that it’s working as expected, we’ll be looking to see how we can improve the process in the future.”