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My youngest son came down with what he said was “the worst illness of my life” a few months ago. (He’s 10 and prone to exaggeration.) I felt sorry for him, as any parent would. He had chills, fever, and an awful sore throat. Stomach issues. I’ll spare you the details.
Maybe he wasn’t exaggerating, after all.
It turned out to be strep—the ubiquitous bacteria known as Streptococcus—which is what we hoped for when we went to the clinic. Not some unidentifiable virus that my son would have to ride out until who knew when, but an illness quickly vanquished with the help of antibiotics.
And what got antibiotics into our hands that same afternoon? An electronic prescription, which flashed from the clinic to the pharmacy with a few clicks of the mouse. As patients, we take this for granted.
But there’s more to an e-prescription than a few clicks.
This is the journey of an e-prescription as seen through the eyes of a patient at the opposite end of my son’s age: a centenarian, who just got his driver’s license renewed, drives a cherry red Cadillac coupe, and flew P-51 Mustang fighter planes during the Second World War.
Let's track this patient* and his experience from one waypoint to the next.
The centenarian has been self-medicating. There’s Nyquil cold and flu medicine (the kind that makes you drowsy) and melatonin gummies in the plastic bag he takes with him to the clinic. He can’t sleep, he tells his long-time doctor. Sometimes he’s awake all night.
His doctor diagnoses insomnia, and for this, the centenarian will need a prescription.
“Prescriptions are all about patient safety,” says Surescripts Principal Segment Marketing Manager Sarah Malakoff.
A prescription is the specification of a therapy sent from the person who decides what the therapy is (the prescriber) to the person who dispenses it (the pharmacist). E-Prescribing sets the standard for safe, clear prescriptions with technology that enables high data quality and efficient communication between the prescriber and pharmacist.
At Surescripts, our partnership with the National Council for Prescription Drug Programs (NCPDP) to develop standards led to the tried-and-true transactions to initiate a new prescription (NewRx), refill a prescription (RefillRx), change one to another (RxChange), or cancel the prescription altogether (CancelRx).
The bag of Nyquil and melatonin gummies doesn’t really hold up as proof of the centenarian’s current medication regimen. One of his medications isn’t in the bag. Without more information, the doctor is prescribing blind. He’d have to rely on the bag of medications and the centenarian’s memory.
Fortunately, the e-prescribing process includes tools that help to deliver the full story on the centenarian’s medication regimen. His doctor sees that he has been prescribed a medication by his urologist, but this medication would not cause an adverse drug event when used alongside the medication for insomnia.
“Pharmacotherapy for insomnia is an area of great caution, especially for a centenarian,” explains Surescripts Chief Medical Information Officer and hospitalist Andrew Mellin, “with risk of side effects, falls and injuries.”
Medication History makes it simpler to avoid adverse drug events and readmissions with a cleaner, more complete picture of dispensed medications.
“There’s something we can try,” the doctor says. It’s a newer, brand-name medication for insomnia. “But it’s not on formulary. It might not be covered. It might be expensive. Do you still want to try it?”
At this point, the sleep-deprived centenarian will try just about anything. “Yes,” he says. “I want to sleep.”
In the quest to get medication quickly—and affordably—it’s necessary to be able to see patient-specific benefit and cost information at the point of care.
Eligibility & Formulary allows prescribers to confirm insurance coverage at the plan level. Real-Time Prescription Benefit takes it a step further: to the patient-specific level, with out-of-pocket costs, the potential availability of more affordable alternatives, and flags for prior authorization.
“This entire process takes just two seconds on average,” says Surescripts Product Manager Nicholas Chambers, referring to the time it takes to run a real-time benefit check.
The doctor initiates an e-prescription for insomnia medication using electronic health record (EHR) software, and with a few clicks, the NewRx transaction reaches the pharmacy within minutes, if not seconds.
Over one million prescribers—and virtually all U.S. pharmacies—used E-Prescribing to fill 2.34 billion e-prescriptions in 2022.
The centenarian drives to the pharmacy, and by the time he arrives, his doctor’s e-prescription has already reached the screen of a pharmacy technician, whose job (working from a top-down queue) is to match the e-prescription with the centenarian, and then tie the e-prescription to the centenarian’s existing file.
After patient matching comes data entry and insurance verification. Then comes selecting the right drug and the correct dose. Then comes how much to dispense at a time and determining the number of refills.
Above all, it’s correctly interpreting the directions to ensure that everyone is on the same page, from the doctor to the pharmacist to the centenarian, and confirming the medication is clinically appropriate and won’t cause an adverse interaction with the centenarian’s other medications.
From a patient’s perspective, it can look like not much is happening. But that couldn’t be further from reality.
“There’s a ton of activity, from the second the prescription hits the pharmacist’s screen, to the moment the medication gets dispensed to the patient,” Surescripts Director of Product Safety and Performance Larry King tells me.
Fortunately, with E-Prescribing and standardization, pharmacists have less guesswork. This reduces the possibility of errors.
“$400!” the centenarian shouts at the pharmacy counter, incredulous. His doctor did tell him that this new, brand-name medication for insomnia would be expensive. But still, $400 is quite a lot for out-of-pocket costs.
“Or it needs prior authorization,” the pharmacist says. Unfortunately, the centenarian’s doctor uses one of the few EHRs that aren’t configured to automatically start the prior authorization process. “In which case you’ll need to call your doctor, who will need to fax the health plan and request prior authorization.” There’s a pause. “Which can take up to a week.”
But the centenarian wants to sleep now, not later.
As Surescripts Manager of Product Innovation Emelie Jensen explains, a flag may appear during a real-time benefit check, and this flag would indicate prior authorization is required for the medication. At this point, Electronic Prior Authorization kickstarts the process automatically, before the patient has even left the clinic (assuming the EHR is configured for this).
And it all happens in real time, at the point of care, through a fully integrated solution.
Good news: Rather than wait a week for prior authorization—or pay $400 out of pocket—the centenarian decides to follow the pharmacist’s suggestion to try an in-stock, lower-cost alternative, and one that doesn’t require prior authorization.
The pharmacist sends an RxChange request to the centenarian’s doctor, who approves the request, and the pharmacist fills the alternative medication right there at the pharmacy. The centenarian heads home with his medication in hand.
It’s time to get some sleep.
The future of e-prescriptions—and of the prescribing and fulfillment and care experience as a whole—is more and more healthcare professionals using technology to improve their day-to-day workflows.
“The technology is there,” Surescripts Principal Product Marketing Manager Caitlin Sunde tells me. “It’s proved its value. We can provide a holistic picture of the patient—all behind the scenes—from medication history to prescription coverage information. So, patients can focus on their health. And providers can focus on their patients.”
As we follow through on our vision to help healthcare heal itself by simplifying how health intelligence is shared, we will improve the lives of patients, from 10-year-olds with strep to centenarians with insomnia.
Learn more about how E-Prescribing sets the standard for safe, clear prescriptions.
*Patient scenario and all related patient information are fictional and intended for illustrative purposes only.
Dean Riggott Photography
Surescripts
