Dr. Waldren identified the following predictors of a successful transition:
▸ Commitment to the technology. “Everyone has to be on board with [the transition],” Dr. Waldren stressed. “You don't want a dual system where some doctors are still using a prescription pad and others use a computer. There needs to be a blanket adoption.”
▸ Vision of a paperless prescribing process. “If you dabble in the technology, or do it only some of the time,” the transition will be more difficult, he said.
▸ Good intraoffice communication.
▸ Strong leadership and management in the practice.
▸ Proactive outreach to pharmacies and patients.
When planning the switch to e-prescribing, it's important to set realistic, measurable goals, said Dr. Waldren.
“Maybe you want the 2% bonus from Medicare, or maybe it's reducing the number of phone calls from pharmacists by 75%, or getting by with one less front desk person.” Whatever goal you adopt, he said, “stay focused [on it].”
Next, evaluate your practice's long-term goals and short-term needs in order to identify the e-prescribing system that will best meet both, said Dr. Waldren.
One of the first considerations when shopping for a system is deciding whether to purchase stand-alone software, which can be acquired for, on average, $2000–$3000 per physician, or a full-function electronic health record (EHR) system with an e-prescribing component, which can cost up to $50,000.
“Each has its pros and cons,” said Dr. Waldren. Stand-alone systems are relatively inexpensive and easier to implement than a full EHR, “but you're still stuck with paper charts,” he said. “EHRs automate your entire practice,” but they're relatively expensive.
Because full-blown EHRs will likely be a requirement down the line, “if you're looking at a stand-alone system, think of it as one of the first modules to deploy in an electronic health record,” said Dr. Waldren. For this reason, system interoperability should top the list of requisite features, he said.
Other considerations with respect to system selection include making sure the solutions being considered meet the Medicare definition of e-prescribing and that they connect to the pharmacy industry's SureScripts RxHub, Dr. Waldren advised.
Additionally, evaluate the user friendliness of the various systems, and try to visit other practices that have implemented the systems you're interested in “to see the products in real-world action,” he said. “A salesman's demo is not enough.”
After selecting a system and negotiating pricing with the vendor, create a team within the practice to lead and manage the transition and develop a reasonable “go-live” strategy that clearly specifies the nature and timing the transition, advised Dr. David Allard, physician director of the Henry Ford Health System's Royal Oak (Mich.) Medical Center.
Training needs and expectations should also be well defined, he said. “In our practice, [software] trainers remained on site for 3–5 days and training was done in groups organized by function [doctors, nurses, front desk].”
Hands-on training should take place close to the “go-live” date to keep the information fresh, Dr. Allard said.
Also, “training should be revisited a few weeks later to address advanced functionality and address any issues that have come up,” he advised.
Finally, in anticipation of the transition, “contact local pharmacies and notify them that you are moving toward e-prescribing,” said Dr. Waldren.
Additionally, inform patients that the prescribing and renewal processes will be changing and let them know how it will affect them, he said.