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Prescription Benefits’ Information Silos Provide Feedstock for RxEOB

Posted on June 7, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

In health care, silos between industries prevent synergies like in the travel industry, where you can order your hotel, flight, rental car, and tourist sights all in one place. Interoperability–the Holy Grail of much health care policy, throughout the Meaningful Use and MACRA eras–is just one sliver of the information hoarding problem. There is much more to integrated care, and prescriptions illustrate the data exchange problems in spades. Pharmacist Robert Oscar recognized the business possibilities inherent in breaking through the walls, and formed RxEOB 15 years ago to address them.

RxEOB helps patients and their physicians make better decisions about medications, taking costs and other interests into account. Sold to health insurance plans and benefits managers, it’s an information management platform and a communication platform, viewing patients, health plans, physicians, pharmacists, and family members as team members.

It’s instructive to look at the various players in the prescription space, what data each gives to RxEOB, and what RxEOB provides to each in return.

Payers

These organizations have lots of data that’s useful in the RxEOB ecosystem: costs, formularies, and coverage information. What payers often lack is information such as price, benefit status, and tier for drugs “similar to” one that is being prescribed.

The “similar to” concept is central to the pharmaceutical field, from the decision made by drug companies to pursue research, through FDA approval (they want proof that a new medication is substantially better than ones it is similar to), to physician choices and payer coverage. There may be good reasons to prescribe a medication that costs more than ones to which it is similar: the patient may not be responding to other drugs, or may be suffering from debilitating side effects. Still, everyone should know what the alternatives are.

Physicians

One of RxEOB’s earliest services was simply to inform doctors about the details of the health care coverage their patients had. This is gradually becoming an industry function, but is still an issue. Nowadays, thanks to electronic health records, most physicians theoretically have access to all the information they need to prescribe thoughtfully. But the information they want may be buried in databases or unstructured documents, jumbled together with irrelevant details. RxEOB can extract and combine information on available drugs, formularies, authorization requirements, coverage information, and details such as patient drug histories to help the doctor make a quick, accurate decision.

Pharmacies

These can use RxEOB’s information on the benefits and cost coverage offered by health insurance for the patients they serve.

Benefits managers

These staff know a lot about patients’ benefits, which they provide to RxEOB. In return, RxEOB can help them set up portals and use text messaging or mobile apps to communicate to patients.

Consumers

Finally we come to the much-abused patients, who have the greatest stake in the whole system and are the least informed. The consumer would like to know everything that the rest of the system knows about pricing, alternatives, and coverage. And the consumer wants to know more: why they should take the drug in the first place, for instance, how to deal with side effects. RxEOB provides communication channels between the patient and all the other players. Thus, the company contributes to medication adherence.

RxEOB is a member of the National Council of Prescription Drug Programs (NCPDP) which works on standards for such things as prior authorizations and communications. Thus, while carving out a successful niche in a dysfunctional industry, it is helping to move the industry to a better place in data sharing.

Dymo Prescription Printer – DYMO LabelWriter 4XL

Posted on November 9, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I always love when people talk about the paperless medical office. It’s as if they believe that after implementing an EMR they will no longer have to have paper in the office. Turns out, EMR software can print out a lot of paper if you’re not careful.

While ePrescribing is on the horizon in many places, the harsh reality is that many still have to print out prescriptions. Add in the requirements around prescribing controlled substances and in almost every state doctors using an EMR are still having to print out prescriptions.

In my clinic, it always felt wrong to print out an entire sheet of paper for one prescription. Eventually we got our vendor to support printing out multiple prescriptions on one sheet of paper. That helped, but many patients only need one prescription so that’s a lot of wasted paper. Beyond the green movement, wasted paper = wasted money.

With this background, that’s why I was intrigued by the DYMO Prescription Printer that I saw at MGMA. I’d worked with DYMO label printers before since the lab I worked with printed off lab labels directly from our EMR software. It makes sense that they could use a little bit larger printer and do the same thing with prescriptions.

It’s pretty obvious to see the paper saving benefits of using a DYMO printer like this, but I think the other advantage to this printer is its size. The printer has such a small footprint that you could easily put it a lot of places that a standard printer just won’t fit.

I admit that I haven’t done a full analysis of the savings using this printer compared with a standard printer. However, the nice thing about the DYMO printers is that they’re thermal printers which means that you’ll never have to spend money on ink or toner to print prescriptions. That’s pretty nice.

I’d love to have some of my readers try out the DYMO Prescription Printer to let me know what they think and whether they think I should add it to my list of EMR related technology products. Maybe I should see if DYMO will give one away to one of my readers to try out and report back.

I always love when small adjustments to current technology can make a huge difference. Or in other words, did I just write a post about a label printer? Sometimes the best innovations are subtle changes.

EMR Security Problem

Posted on November 11, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

On EMR Update a user posted an interesting security problem with their EMR software:

I was on our user’s forum reading about a security flaw in our EMR. There were some discussions about the ability to circumnavigate prescription privileges and have your staff write themselves narcotics. We couldn’t figure out if anyone had done anything like this in our office, so I had our IT guy spend some time in the system. He was able to determine that one of our staff members had in fact been printing out an old script that had been written in the past and manually faxing it to pharmacies around town. The problem with the software is that it lets you print out a script from a locked note, and it prints out with the present date so it can be filled!

Has anyone else had staff in their EMR get away with writing bogus prescriptions? If you don’t know, you may want to check your system. Obviously this is an intolerable situation. We are hoping our vendor will take this seriously for once and get it fixed quickly. Otherwise, we will be forced to look elsewhere for a replacement EMR that doesn’t have this issue.

I love this story, because it highlights a number of interesting things.

1. The challenge of creating a secure, usable, and effective EMR. It’s NOT easy.

2. How responsive will your EMR vendor be to end user requests?

3. What would it take for you to switch EMR software? Can you imagine?