E-prescribing allows doctors to electronically transmit new prescriptions and refill requests to a patient's pharmacy of choice. The process involves an electronic medical record system integrated with an e-prescribing technology provider that serves as a clearinghouse, transmitting prescriptions and refill requests between doctors, pharmacies, and benefits providers. This streamlines prescribing and refilling for both doctors and patients compared to traditional paper prescriptions.

1. WHAT IS
E-Prescribing?

2. What is E-Prescribing?
• To the patients, e-prescribing is simply the
electronic version of a paper prescription order.
• This is true, but the supporting technology also
covers the entire process of order creation,
tracking, fulfillment of prescriptions, as well as
the database maintenance of the prescribing
physicians, clinic locations, pharmacies, and
benefits checking

3. What is E-Prescribing?
Let's start from the beginning, and then
break down the components and entities
as we go…

4. Ordering a Prescription
When a patient visits the doctor and is
prescribed medications, a physician who e-prescribes
will have already been set up with
1) an Electronic Medical Record (EMR) system
that supports e-prescribing, and
2) an account with an e-prescribing technology
provider which serves as a data clearinghouse for
electronic prescriptions

5. Ordering a Prescription
• Before writing the prescription, the doctor will
ask the patient where they want to pick up
their prescriptions
• The patient's preferred pharmacy is verified in
the EMR and the prescription is written
• An electronic transaction goes to the patient's
preferred pharmacy immediately.

6. Ordering a Prescription
• The patient then visits the pharmacy to pick
up the prescription
• To the patient, everything is seamless, and the
prescription is delivered just like any other,
except that they don't have to drop off a
paper prescription at the pharmacy, then
either wait or come back later

7. Here’s what it looks like:
Image © from LearnHealthTech.com

8. Yes, except for…
• Electronic prescribing of narcotics has taken a
lot longer to get off the ground for many
organizations. Almost all states allow it, but
there are additional security steps that must
be taken to support the process such as
biometric verification of the prescribing
physician using fingerprint scanning

9. E-Prescribing Refills
• E-prescribing is also able to support medication refill
requests. The patient can initiate the medication refill
request several ways:
– By calling the pharmacy, who then sends an electronic
refill request to the doctor, who then either approves or
denies it. The pharmacy or the doctor's office may
communicate the status of the prescription to the patient
– By using a web-based patient portal that sends a refill
request message to the doctor, who then either approves
or denies it, then sends a message to the patient's
pharmacy
– By calling the doctor's office, who then either approves or
denies it, then sends a refill authorization to the patient's
pharmacy

10. The Technical Components
The main technical setup is done by:
1. The IT staff who support the physician offices
who will perform e-prescribing: This group will
set up the e-prescribing configuration on the
EMR software, including maintaining the list of
prescribing doctors for the organization
2. The EMR software vendor: Assists with the set
up of e-prescribing on their system

11. The Technical Components
The main technical setup is done by:
3. The pharmacies who will fill the
prescriptions: They will have their own
configuration to process prescriptions
4. The vendor who supplies the e-prescribing
solution: They provide the technical
infrastructure to process prescriptions, verify
licenses of prescribing doctors, and maintain and
publish the list of participating pharmacies.

12. E-Prescribing Function
Note that the e-prescribing
provider does
not physically handle
medications. They are just
a data exchange.
Sweet deal, huh?

13. Affected Data Structure in EMRs
Some of the databases or database tables that
come into play are:
1. Medications table, which are usually
downloaded as a "formulary" from third-party
provider.
2. User or Provider table, depending on what
the given EMR calls them
3. Department table, listing all the clinic and
hospital locations in a Healthcare enterprise

14. Medication Eligibility Checking
• In addition to fulfilling prescription orders, e-prescribing
services can also provide real-time
checking of patients' eligibility for medications
on their own insurance plans
• When the prescribing doctor writes a
prescription electronically, an e-prescribing
message is sent back to the EMR advising on
suggested alternatives to certain medications.

15. The Complete Picture

16. Who are the E-Prescribing Providers?
• In reality, the question should probably be
“who is the e-prescribing vendor?”
• This part won't please people who don't like
monopolies, because far and away the largest
e-prescribing provider is Surescripts, based in
Arlington, VA

17. Surescripts
• Their payment model has them getting most
of their revenue from pharmacies and
pharmacy vendors
• There are a few other e-prescribing vendors,
but they face a huge uphill battle with most
pharmacies and physicians already being live
with Surescripts. Here are their numbers:

18. See the complete article at
www.learnhealthtech.com/what-is-e-prescribing
and for much more about Healthcare IT, visit
www.LearnHealthTech.com