HIStalk Healthcare IT News and Opinion. G. Cameron Cam Deemer is president of Dr. First of Rockville, MD. Tell me about yourself and the company. Im president of Dr. First. Ive been with the company for about 1. Dr. First originally began as a standalone e prescribing vendor about 1. Since then, weve migrated into a technology platform vendor serving over 3. EMRs. We have a large chunk of the hospital market, which typically uses our medication history services and our discharge prescribing. Were now migrating also into the patient facing application space. What challenges remain for e prescribing now that adoption is nearly universal At this point, most of the physicians who are ready to adopt have access to e prescribing. Theres a couple of pockets that we found that are still issues. Issuu is a digital publishing platform that makes it simple to publish magazines, catalogs, newspapers, books, and more online. Easily share your publications and get. A lot of this came up when New York implemented the I STOP program and suddenly we found pockets of physicians all over the state who had not yet adopted e prescribing for one reason or another. For instance, think about surgeons who typically write a very limited number of scripts. They dont really see the need for an EMR. Theyre not going to see the patients on a repeated basis, things like that. There were still those pockets out there where they still had a use for standalone e prescribing because theyre not strongly committed to EMR use yet. The other one is physicians after hours and away from the EMR who are still writing scripts on paper or calling it into the pharmacy because they dont have a good mobile solution. Thats a problem were trying to solve right now. InformationWeek. com News, analysis and research for business technology professionals, plus peertopeer knowledge sharing. Engage with our community. What is the role of technology in addressing the opioid issue Theres an interesting transition happening literally right now. For the first time, state PDMP data the controlled substance registries are being made available in the workflow for physicians through a few vendors. I would say its experimental right now, trying to figure out what works best for the physicians. Its the first time they havent been asked to go to a separate portal, log in, enter patient information, and go through all that, which they were reluctant to do. Instead, in the process of writing a prescription, youre able to see all the fills the patient has had for opioids. From a physician perspective, our experience has been they love that. It just becomes part of their workflow. They dont have to do anything special to consume it. What I believe will happen over time is that as physicians become more aware of patient behavior, the problem will shift back to illegal drugs. States must have some strategy there to nail down that side of the issue as well. I think we can get the legitimate drug prescribing side well under control as we move this into the workflow. The market has shown strong interest in tools for price transparency, electronic pre authorization, specialty drug prescribing, and especially the electronic monitoring of drug adherence. How do you see that layer of intelligence thats built on top of e prescribing moving to the next level One of the most exciting things right now is price transparency. If you look at surveys, usually the number one complaint of patients is, I have no idea how much this is going to cost. Regularly you see that pricing issues and affordability are the top reasons for patient non compliance. If were going to deal with outcomes, we need to get price transparency under control. Weve done quite a lot of work around that in the last couple of years. Humana rolled a program out nationally with us and we gained experience in how physicians respond. Since then, it brought several additional payers into that space to contribute their information. Payers have tried to do that to some degree, but they are reluctant to share their actual drug costs with prescribers, they dont necessarily have access to insurance specific charges, and they struggle to account for differences in dose forms such as a tablet vs. You really nailed the problem. Until now, e prescribing vendors and EMR vendors have had access to basic formulary and benefit information as a result of participating in the e prescribing networks. That gave us a general understanding of how drugs are covered, but without patient specific or employer specific information. It varies dramatically among pharmacy benefit managers, PBMs, even with the same formulary. Certainly it does not include pricing information. We knew we had to get better than that. How do you get the real information, down to the penny, of what the patient is going to payThe only way to do that was to do an actual adjudication of the prescription before it is sent to the pharmacy. Let the physician know that this is the exact impact, specifically for this patient under whatever part of the patients coverage plan they happen to be in at the moment and considering everything thats happened before with that patient. The PBM is the only one that knows that, so you must do an adjudication. The real challenge for us and for the PBMs was, how do you do that Its different. Theyre used to adjudicating pharmacy claims using the data that comes from a pharmacy. Theyre used to receiving certain fields and responding with certain fields in a certain way. Theyve been doing that for years. Now youre moving upstream to the physician. Physicians dont prescribe the same way the pharmacies dispense. For instance, a physician isnt concerned with a specific NDC code as a pharmacy would be, but its a representative NDC. They just pick one that represents that drug name and thats typically what we send to the pharmacy. The PBM is going to need something more specific than that to adjudicate it properly in their system. There also can frequently be mismatches, where the EMR may not have kept its drug database up to date. The PBMs generally do, but they may not sync with what the EMR is using. There might be a difference in drug compendia, where the EMR is using one set of drug databases while the PBM uses one from a different company. Nobodys done the work to sync that up or make sure they even know which compendium is being used. The other challenge is about how physicians write quantities in prescriptions. The physician may have a way of describing the quantity of a drug that the pharmacist understands, but that is not what the PBM requires to adjudicate a prescription rather than a claim. Even after a couple of years, the industry is still experimenting with that, to be able to make sure that the results get closer and closer to working every time rather than erroring out because something wasnt understood. Its getting much better as we allow people to experiment. The other thing, how are they going to adjudicate that claim The PBM industry has for years had the concept of a dummy claim. A pharmacy system vendor or a pharmacy could send a dummy claim just to make sure things were adjudicating correctly. Theoretically, you could run a physicians prescription through that same process. Once youve cleaned up the prescription enough that it will process through that function, how do you connect to that functionIts usually a different connection than what we would use out of an EMR or an e prescribing system. Its an NCPDP claims connection. The response may not come back fast enough since it could be a slow system. If it does come back fast enough, you still only have one answer and you need several. You need to know not just that drug, but other drugs the physician could choose from that might have more favorable pricing for the patient if they want to see alternatives. The dummy claim system isnt made for that. Its not made to hit it over and over and over and over with transactions. Its made for occasional transactions. Theres some cost on the PBM side of building their system slightly differently to allowing a transaction to process multiple times for multiple drugs that are all related, but are more preferred than the drug that was submitted. Its a more complex logic involving systems that have a higher requirement on them. They still need to return their response very fast before the physician loses interest and moves on. Is there opportunity in connecting technically sophisticated pharmacy chains like CVS and Walgreens back to prescriber systemsThats an interesting question. With what weve just been discussing about price transparency, that doesnt quite apply in the same way, but there is a connection there. What weve been discussing so far was getting plan information from the PBM.
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