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Having had the pleasure the past few years of helping practices transition to electronic health records (including prescribing systems), I was excited to see that New York State was making ePrescribing (eRX) mandatory for both medical and dental providers beginning March 27, 2015.
After interviewing a number of eRX companies and dental software vendors, it is apparent that they are preparing for the explosion of eRX use in both New York and other states that will inevitably follow New York's lead.
So, if you are a dentist in New York, you're probably scrambling to find a suitable eRX system for your practice or group. You have to, or you won't be able to prescribe medications beginning March 27. But I'd also like to address dentists that don't have the mandate breathing down on them, but still have the choice to decide whether or not to adopt eRX – or continue their "old school" medication management ways. I have been evangelizing the benefits of eRX for the past few years. It boils down to a couple of basic questions you need to ask yourself when it comes to your medication management:
1) Would you like to reduce your potential for error and liability?
2) Would you like to improve patient care when it comes to their medication management?
To answer the questions of how eRX can help reduce your liability and improve your patient care, we must first look at how eRX works at the core of its functionality.
Sending prescriptions electronically
When I asked dentists to describe eRX, those that have heard of it seem to focus solely on the ability to electronically select medications and send them directly to the pharmacy, thus bypassing the traditional manual processes of faxing, phone calls and handing paper to the patient. Obviously this eRX is less error-prone and more efficient.
However, having conducted eRX seminars for dentists, as well as consulted with dental practices, I commonly hear, "I only prescribe a few medications, so I question if I should take on the implementation and expense of ePrescribing.”
To that I point out that the ability to send prescriptions electronically is only a part of the whole picture and there are a number of additional features that reduce liability and improve patient care.
Up-to-date medication lists at your fingertips
Think about that patient in your chair that has numerous medical problems and can't remember all the medications they're on. With electronic prescribing, it's very easy to push a button and have a list of all medications prescribed from different sources that they are presently taking.
Drug-to-drug and allergy interactions
These powerful features are full of checks and balances to make sure that the drugs you prescribe don't have any adverse interactions with each other or with the patient's up-to-date medication list obtained through the electronic prescription clearinghouse. They also check for interactions with the patient's allergies and health conditions. Being alerted if any of your patient’s medications will have adverse interactions with the anesthetic you're about to administer is a key benefit.
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Dental specific information and decision support
Some eRX systems have the capability to go one step further. There is functionality within some eRX systems known as "dental specific" decision-support. With this "next generation" feature, you are alerted to a specific drug’s potential effects, including various complications that can occur. Knowing if certain medications cause bleeding, dry mouth or other side effects ahead of time can be incredibly helpful. Additionally, it can present various treatment alternatives that don't have the adverse effects. A major dental content vendor that provides this type of content to eRX vendors is Lexicomp.
Real time formulary checking
A big advantage of eRX is that it has become standard to automatically check a patient's formulary when writing your electronic prescriptions. This gives you the opportunity to have a conversation with a patient regarding whether the medications will be covered and, if not, what the alternatives might be.
The Holy Grail: Patient compliance reporting
The final frontier for prescribing is incorporating the ability to receive status updates on when the patient picks up their medications at the pharmacy. This allows the provider to electronically keep track of a fully accurate medication list based on patient compliance. Some vendors have this capability
What about controlled substances?
On October 6, 2014, the DEA changed the classification of drugs that contain hydrocodone combinations from schedule III to schedule II. Most of the eRX vendors were ready for this change using EPCS (electronic prescriptions for controlled substances). From a workflow standpoint, there are a few more hoops you need to jump through regarding the checks and balances on this. However, the good news is that controlled substances are now part of electronic prescribing.
Because providing all the features and functionality described above is so complex – and the need for continual adherence to state and federal regulations – there is a blossoming industry of third party vendors that specifically provide eRX functionality, either directly to a provider or through an interface with the provider’s dental software. Presently, “pure” eRX vendors you should know that provide services to the dental industry are: Dr. First, Dosespot, Allscripts, MDToolbox and New Crop.
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Dental software vendors that provide ePrescribing functionality
A number of forward-thinking dental software vendors have worked with the eRX vendors and developed interfaces to allow you to prescribe from within the dental software. This technology is getting more sophisticated all the time. Dental software vendors that presently incorporate eRX functionality into their software are Henry Schein, Patterson, MacPractice, Planet DDS, Open Dental, Dentimax, XLDent and Dovetail. QSI is due to release their eRX solution in Spring 2015.
You can find ePrescribing podcasts and more info at www.dentalsoftwareadvisor.com/dental-eprescribing
Your options as a dentist
Today the ability to prescribe is offered to you in two ways:
1) Stand alone
With a stand-alone version, you are logging directly into the eRX vendor’s system and using their screens and functionality directly. The benefit of this approach is that you don't necessarily need dental software that interfaces with a prescribing system. The downside of a stand-alone system is that you now have to go back and forth between your dental software system and the eRX system and you have to reenter a patient's demographic information. This is not very smooth from a workflow standpoint.
With an integrated system, your dental software will typically have an eRX button on one of its screens that will bring up the eRX vendor screen. The benefits of this approach are that the patient information is automatically passed through the eRX software and fits into your normal workflow. There are really no issues with this approach except that you need dental software that integrates with one of the eRX vendors.
Here is a list of dental software vendors and the company they partner with:
Planet DDS Dosespot
MacPractice New Crop
open Dental New Crop
Dentimax Dr. First
No turning back
The bottom line is that, whether your state will be mandating electronic prescribing in the near future or you just want to adopt eRX because it reduces your liability and improves your patient care, it is critical that you begin looking at this technology now. Many providers have commented, "I'll just wait until I'm forced to do it" or "I'll wait until everybody else is doing it ". This is a bit myopic. Having been through many EHR and associated eRX implementations over the years with practices and groups, I can tell you with certainty that adopting this technology doesn't happen overnight. It takes time to find the right vendor and successfully implement it within your practice workflow. So, the best advice I can give regarding eRX is to begin evaluating the technology and associated vendors sooner rather than later, so that you are prepared to be part of the changing patient care landscape.
About the author
Mike Uretz is a nationally-recognized dental software and Electronic Health Records (EHR) expert. He is the founder of DentalSoftwareAdvisor.com, as well as the Dental EHR Editor for Dental Products Report.
As an industry consultant and educator, Uretz has helped individual practices and multi-clinic groups properly evaluate and select software vendors and solutions, structure and negotiate pricing and contracts , provide implementation oversight and vendor management.
As a speaker and educator, Uretz has published numerous dental software focused columns and articles for a number of dental industry publications and websites and conducted next generation dental software and electronic health records workshops and seminars for associations, dental societies, and universities around the country.