May 23

Creating 21st Century Solutions in Healthcare

by Wayne W. Oliver, Vice President, Center for Health Transformation
Originally published by the Atlanta Journal Constitution on November 4, 2011

At the Center for Health Transformation, we are working hard to create a 21st Century Intelligent Health System that can save lives and saves money for all Americans. However, it seems like every time we make a little progress, we must overcome a new challenge.

Take electronic prescribing and electronic medical records (EHRs). Both rely on cutting-edge technology to provide better healthcare for patients.

We know that e-prescribing and EHR systems are safer and more cost effective than paper prescriptions and paper health records. The state and federal governments are even creating incentives for doctors and hospitals to move away from traditional paper.

And, it is working. We are seeing more and more physicians making significant investments of time and resources as they embrace electronic systems. According to Surescripts which provides the infrastructure for e-prescribing, by the end of this year, more than half of the prescriptions issued in our nation will be issued electronically.

But just like the old saying, “One step forward, two steps back,” we are seeing challenges surface that seriously threaten the on-going movement toward electronic medicine.

One example of a barrier to e-prescribing is referred to as “prior authorization” or “prior approval” for prescription medications. Sometimes health plans require prior authorization of a drug for a clinical reason. But usually, health plans require prior authorization because of the high cost of the drug (and to steer patients toward generics) and the desire to ensure that the medication is medically necessary.
Virtually every prior authorization program is paper based. So, before a patient can receive a medication which requires a prior authorization, a physician must fill out a paper form by hand, fax it off to some health plan bureaucrat who either approves or rejects the request. Then, the physician and possibly the pharmacy are notified 2 to 4 days later. It is a laborious process that causes needless delay in prescription medication therapy.

Prior authorization programs are not new. They have been around for more than two decades. But prior authorization programs were conceived before e-prescribing and EHR solutions were created to help cut down on medical errors.

There are electronic solutions available. The National Council of Prescription Drug Programs (NCPDP) has created an industry-wide standard for an electronic prior authorization process. However, with new ObamaCare requirements bearing down on health plans and more and more regulations coming down every day from Washington, most health plans are focusing on other priorities. But they should abandon 20th Century prior authorization programs and adopt 21st Century electronic solutions.

As a nation, we have encouraged physicians, pharmacists and hospitals to migrate to electronic platforms, obviously something that moves us into the 21st Century. It’s now time to remove some of the barriers, hassles and challenges to a fully-integrated, electronic health system. It’s time for health plans nationwide to embrace 21st Century solutions such as electronic prior authorization programs so we can all get on with the business of saving lives and saving money.

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