The proposed project will evaluate the 11 initial standards for electronic prescribing that have been proposed by the U.S. Department of Health and Human Services (DHHS). The overall purpose of these standards is to deliver information to the point of care that enables more informed decisions about appropriate and cost effective medications; the proposed project will assess the extent to which each standard is capable of efficiently achieving this goal. These project will evaluate the initial standards within the New Jersey E-Prescribing Action Coalition, an industry-academic partnership involving RAND Health, Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ), the e-prescribing vendors AllScripts, Caremark iScribe, and InstantDx, Caremark's prescription benefit management plans, the electronic prescription routing companies RxHub and SureScripts, Caremark's mail-order pharmacy and Walgreen's retail pharmacies, and Anthony Schueth, a leader of standards development efforts for electronic prescribing. Standards that are not already in production in the Coalition will be tested initially within RxHub's and SureScripts's secure testing environments. Standards already in use will be evaluated among the 1000 physicians who are enrolled in Horizon's highly successful E-Prescribe program. Prescribers in this program are being activated at a rate of about 100 per month, and recent prescribing volumes are 40,000 per month. The proposed project will tailor the evaluation of every initial standard to its current stage of development and adoption. Evaluation will be guided by quantitative models of physician and pharmacist work processes. The technical ability of standards to meet their goals will be assessed by an panel of technical experts, using semistructured interviews and Delphi expert panel processes. Five standards that are currently in use among all Coalition partners will be evaluated by comparing work processes, assessed through site visits, and clinical outcomes, assessed using Caremark's and Horizon's secondary data, before and after the implementation of e-prescribing with this package of standards. Three additional standards for prescriber-pharmacy messaging will be pilot tested through a collaboration between AllScripts, SureScripts, and retail pharmacies, with effects monitored prospectively. The standard for prior authorization will be evaluated by a field evaluation of a new iScribe prototype. RxNorm and the structured and codified Sig standards will be evaluated primarily through laboratory testing. These will be implemented as additions to the existing standards if they improve information delivery.
