GT: The purpose of the National ePrescribing Patient Safety Initiative, or NEPSI, is to provide electronic prescribing tools free to every physician in America. The objective of doing that is to address the 1.5 million injuries and over 7,000 deaths each year that were identified by the Institute of Medicine as preventable medication errors. The definition of preventable is, if the physician or caregiver had used a basic electronic prescribing system which eliminates handwriting errors and which reduces drug interactions and the like, they could have been prevented.

NEPSI was officially launched in January in Washington, D.C. The idea behind NEPSI started about three months earlier, and about three to four months after the Institute of Medicine published their report on injuries and deaths from medication prescribing errors. The genesis of the initiative came from a simple thought: we have a national problem. The number of deaths is the equivalent of a plane crashing every week, once a week, all year long. We know we can do better and we have the tools to do better. We’ve had thousands of physicians so far register on the site.

GT: Supporters have played different roles and all have contributed, in one or another, financially. There are two national partners, Allscripts and Dell. There are a number of technology company supporters, including Cisco, Fujitsu, Microsoft and Sprint. We have a connectivity partner – SureScripts, and a search partner – Google. Our information content partner is Wolters Kluwer Health. We also went to major managed care players in the country and we are in discussions with several other insurers. We started the program with Aetna, Horizon Blue Cross Blue Shield of New Jersey, and WellPoint. The focus was to say that, not only did we make the product free for physicians and easy to learn, but we also made sure that there were incentives to encourage both the adoption and the utilization of the product. The managed care players have all stepped up with various programs. They benefit when physicians are actually using this technology. It not only reduces errors but it increases compliance with formularies. Consequently, they’re willing to share some of those savings, and we’ve seen adoption incentives ranging anywhere from one percent of the revenues that a physician would receive from a managed care player, all the way up to 10 percent. So not only is there a win because it’s free, because it’s easy and because it’s better health care for patients but there are also financial incentives for adopting the NEPSI eRx NOW product.

We wanted to build a broad-based consortium of key stakeholders in health care. In the past there have been initiatives that gave software away free but they didn’t address hardware. Some software was too hard to use. And others didn’t address the physician incentive piece or the local training piece. We have sponsorship for the software, so it’s free. There is no additional hardware to purchase. You can learn it in less than an hour. And there are incentives for adoption and utilization. But we also wanted to make sure that there were local and regional centers where physicians could go for help – where they could ask questions, where they could see other physicians using the technology. So we went out to some of the most prestigious academic medical centers and industry leaders, whether they be multi-specialty groups or integrated delivery networks, in key states. They serve as regional sponsors to help with training and to assist in demonstrating for smaller physician groups how to do this. Some are even stepping up and sponsoring practice management interfaces, and the like. That really varies by region. In New Jersey, Horizon Blue Cross Blue Shield has stepped up not only as a managed care sponsor, but also as a regional sponsor. They’ve said they’re going to use some of their teams of people to help deploy this.

You’ll notice that I did not list any pharmaceutical companies as sponsors of the initiative. We did that to prevent any confusion relative to why this is being sponsored. This is all about patient safety. This is all about eliminating the medication errors and death that come from paper handwriting errors and the like. Under no circumstances do we ever interrupt the physician’s prescribing pattern to do any kind of advertising or suggestion of a particular sponsor, drug, or anything like that. While there have been systems out there that I’ve heard about and read about doing that, the NEPSI sponsored system was very careful about insuring that that was not the case.

GT: The national sponsors, as large employers, have tens of thousands of employees who are being subjected to these medical errors which in some cases are driving up our health care cost. We, along with every other employer, will benefit from safer and more efficient health care and a reduction in medical errors. Second, we believe that the move to electronic systems will encourage eventual use of more systems. If people decide, because electronic prescribing is so good, that they want to go to a full electronic health record and buy Dell equipment or Fujitsu equipment, or if they use more Microsoft software, all of that’s a good thing because we think electronic health care is safer more efficient health care. With that said, none of those organizations will benefit in a direct manner because it’s not necessary, for example, to buy new equipment to use this initiative. Allsripts receives no direct financial payment for the software. We’ve made it very clear it’s free. Down the road if someone wants to change to another system, we’re happy to provide them all the data at no cost. So we were very careful to make sure that there was no influence from that perspective.

GT: The NEPSI initiative is powered by a product called eRx NOW, which is based on the engine that comes from the Allscripts electronic prescribing system. It’s a web-based Application Service Provider (ASP) product, so you can access it from virtually any computer. Sprint is giving away over a thousand free phones to people who go to the website and sign up. Those phones are enabled to write electronic prescriptions. It will be very easy to access this system from anywhere and to write prescriptions and route them electronically.

To acquire the system, physicians would go to the national eRx website <www.nationalerx.com> to register. They need to give some license information, some DEA information and the like. That is validated and then they are enabled to use the software. This software fits into their workflow. For example, if they’re using a wireless tablet and walking around the office, or in some cases they may be using that cellphone/PDA – just like they would pull out a prescription pad, they would pull out the PDA and they would write a prescription. Similarly, they could go to any desktop. They might be at home and get a call from a patient who needs a renewal. The physician could go to any desktop, log on, enter their various passwords and write a prescription. Very simple to use, very easy to train on.

We have exceeded all of the privacy, confidentiality and security requirements specified by the government and the major safety organizations. Along those lines, we have the data stored in a secure site and it is backed up at multiple sites.

GT: This is an electronic prescribing system that will do standard drug utilization and drug interaction checking. In addition to the safety features, the system also provides prior history, eligibility where available, and then allows for electronic routing of prescriptions. Once a prescription is written, the physician can ask the patient if he or she would like it printed out. The patient gets a legible, formulary-compliant, drug interaction-checked prescription. Or, the patient can have the prescription sent to the pharmacy of their choice on their electronic system or by fax – that’s through our partner SureScripts. Health insurer formulary information is included for most patients – between 80 and 90 percent coverage across the country – as we continue to add various payers, various PBMs and the like.

GT: Because the system is interactive, when the patient’s information is put in, the system queries either the PBM or the payer and uses that information to pull down to check for drug interactions and prior history of other written prescriptions, subject to confidentiality – in each case a patient would have to give permission to have that information shared. Such checking helps prevent fraud, as well as preventing duplicate prescribing and drug interactions. We do that in association with the large PBMs and payers.

GT: There are two tie-ins that you would want in an electronic prescribing system. The first and most important is an interface to the practice management system, because that includes the health care information as well as various information that you donwant to duplicate, like the patient’s name, address, drug allergies and the like. We provide free interfaces to all of our practice management electronic health record products. A number of other organizations have stepped up and have provided either free or very low-cost interfaces for physicians to their existing practice management systems. Second, if a physician already has an electronic health record, in most cases that will include electronic prescribing, so that physician may not want to use our product. If they do, we will interface to it. But in most cases, for workflow reasons, if they already have an electronic health record they wouldn’t necessarily be using eRx as well.

GT: At Allscripts all of our systems are interoperable. We’ll connect to any system. That said, there are thousands of different kinds of systems out there and hundreds of practice management systems. As we see new practice management systems we’re absolutely willing and intent on building interfaces to each of those systems. We currently support dozens of PMS vendor interfaces, including all of the more common ones. Some of them, of course, are quite archaic and not even in business any longer.