New rules will ease health IT adoption

Medicare Program; E-Prescribing and the Prescription Drug Program

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Editor's Note: A previous version of this story incorrectly stated that e-prescribing foundation standards include Version 6.0 of the National Council for Prescription Drug Programs Script standard. They actually include Version 5.0. The correction is reflected in the story below.

The Department of Health and Human Services will issue rules this week to make it easier for doctors, hospitals, health insurers and pharmacies to adopt health information technology tools.

The rules set forth initial standards for e-prescribing and proposed exceptions to physician self-referral prohibitions. In the latter case, the proposed rules would allow hospitals and other health care organizations to give clinical IT systems and services to physicians.

“These actions represent a unified effort” to advance the use of health IT, which will cut medical costs and improve the quality of care, HHS Secretary Mike Leavitt said at a press conference at George Washington University Hospital in Washington, D.C.

“Every day we delay, lives are unnecessarily lost,” he added. Leavitt said e-prescribing can reduce errors by 70 percent compared with handwritten prescriptions.

The new rules, issued by HHS’ Centers for Medicare and Medicaid Services (CMS) and the department’s Office of the Inspector General, will appear in the Federal Register.

E-prescribing foundation standards are the final rule, issued after CMS published a draft in February and the public had an opportunity to comment on it. They comprise Version 5.0 of the National Council for Prescription Drug Programs Script standard, developed for transmitting prescriptions from physicians to pharmacies; ASC X12N 270/271 Version 4010, for checking eligibility for benefits; and the council’s Telecommunications Standard Version 5.1, for transmissions.

Those standards will be mandatory for prescription drug plans participating in the new Medicare drug benefit but optional for physicians and pharmacies, CMS Deputy Administrator Leslie Norwalk said at the press conference.

She said many of those who commented on the proposed e-prescribing rules asked for more standards, and some of those will be forthcoming. She mentioned standards for exchanging information on patients’ medication histories and benefit plan formularies and levels. “They are fairly broadly used now,” Norwalk said.

CMS will dispense $6 million to finance pilot programs for e-prescribing programs that use the new standards, she added. It will issue a notice inviting applications later this month.

Also, CMS has made a grant to Medco Health Solutions to evaluate the impact of the Southeast Michigan e-Prescribing Initiative, one of the country’s largest such programs.

As for the new rules on donated systems and services, they will create exceptions to the Stark and anti-kickback laws that prevent health care institutions from giving gifts to doctors who send patients to those institutions. The rules apply to hospitals, managed care companies, group practices and drug plans, Leavitt said.

Dr. David Brailer, the national coordinator for health IT, said doctors who practice in small offices are least likely to adopt health IT because they cannot afford it and lack technical know-how. He said the Stark and anti-kickback exceptions will allow hospitals to donate systems and support services to physicians who practice at the hospitals.

The rules “do speak to the two barriers” and will reduce what HHS officials call the adoption gap, he said.

“This is not the only step” to foster health IT, Leavitt said, “but it’s an important step.” One effect could be to save consumers billions of dollars in medical bills, he said.

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