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How can I prescribe electronically over the Surescripts network?

Physicians interested in e-prescribing must use e-prescribing software or an Electronic Medical Record (EMR) that has been certified to connect to the Surescripts network. Surescripts certifies software used by prescribers for access to the three core services: Prescription Benefit, Prescription History, and Prescription Routing.

If your practice already has an EMR system, it is likely that your system has been certified by Surescripts.  You simply need to contact your vendor representative and ask about getting connected to the Surescripts network for access to our Prescription Benefit, Medication History, and Prescription Routing services.

If you do not yet have an EMR or e-prescribing software in your practice, you will need to acquire a solution that fits your practice needs.  A comprehensive list e-prescribing technologies that have been certified by Surescripts is available on our web site.

How will a connection to the Surescripts network benefit my practice?

A Safer and More Accurate Prescribing Process.

• Prescription Benefit services allow easy selection of medications that are preferred by the patient's health plan, that meet therapeutic guidelines and are cost effective for the patient.
• Medication History services allow prescribers to access critically important information on their patient's current and past medications from pharmacy benefit managers and community pharmacies. This helps inform prescribers about potential medication issues with their patients and can improve safety and quality.
• Prescription Routing services allow legible new prescriptions to be sent directly to the computer at the pharmacy of the patient's choice. Renewal authorization requests can be sent directly to the practice computer. Prescribers can then review and respond to pending requests with a few keystrokes.
• Enhanced Productivity. The reduction in pharmacy faxes and phone calls associated with refill requests, legibility issues, and drug incompatibility or ineligibility problems provides physicians and their staffs with more time to devote to patient care or other reimbursable activities.

What is the different between Surescripts and my e-prescribing/EMR software vendor?

Surescripts does not sell, develop or endorse software.  Instead, Surescripts works with existing medical software companies to certify their prescribing software for these services. This way you get to choose the software that best suits the needs of your practice - from simple prescribing software to more robust electronic medical record (EMR) systems.

We provide a comprehensive list of e-prescribing technologies that have been certified by Surescripts on our web site

While Surescripts operates the E-Prescribing Resource Center to provide general education about the benefits of e-prescribing, information to help you get started, and best practices to help your practice achieve optimal results, your vendor representative should be your primary point of contact for all sales and support-related issues.

What are the minimum requirements for getting started?

Office configurations will vary depending on the e-prescribing system chosen. However, regardless of the e-prescribing system, practices must have a good Internet connection (preferably high speed), as well as desktop, laptop or tablet computers, or hand-held PDAs, or a combination. If PDAs or tablets will be the primary technology used by prescribers, setting up a wireless network is recommended.

In choosing an electronic prescribing application (either stand-alone or EMR-based, your system must be certified to connect to the Surescripts network. A list of certified solutions can be found here or requested by calling Surescripts at 1-866-RxReady (866-797-3239).

Surescripts does not sell or develop electronic prescribing systems or applications, but instead acts as a neutral resource that certifies existing technologies to connect to its national electronic prescribing network. This way, physicians have an open choice of technology and can select the one that is right for their practices.

How much does e-prescribing cost?

Surescripts does not charge physicians for access to our network for core e-prescribing services (prescription routing, prescription benefit, and medication history). Costs a physician typically incur will vary depending on which kind of hardware and software (electronic medical record (EMR) systems vs. a stand-alone e-prescribing system) a practice chooses to purchase and implement via a software vendor or other technology provider.

EMR systems offer more comprehensive functionalities, but are more costly, complex and time consuming to implement. According to the Congressional Budget Office, office-based EMR systems cost about $25,000 to $45,000 per prescriber. Estimated annual costs to operate and maintain an EMR system (e.g., software licensing fees, technical support, and updating and replacing used equipment), range from $3,000 to $9,000 per physician per year.

Be sure to ask vendors specific questions about any incremental fees related to e-prescribing functionality as well as training. The figures above do not include the initial costs of the hardware required to support either an e-prescribing or an EMR system, or the costs of temporary decreases in productivity resulting from training or workflow redesign, practice management interfaces, customization, maintenance, upgrades, or data conversion.

Whether you choose a stand-alone e-prescribing application or an EMR system with integrated e-prescribing, cost is only one part of the equation. You should compare the costs - both direct and indirect, start-up and ongoing - with expected benefits such as improved efficiency and productivity, decreased administrative expenses and staff utilization to fully understand the value of e-prescribing to your practice.

What is Meaningful Use?

The Health Information Technology for Economic and Clinical Health (HITECH) Act is a key component of the American Recovery and Reinvestment Act of 2009 (ARRA). Under the Act, eligible prescribers can receive incentive payments by meeting qualitative and quantitative standards for the 'meaningful use' of a certified EMR starting in 2011. The Act also makes provisions for incentive payments to support the acquisition and use of certified EMR technology for prescribers who see high volumes of Medicaid patients, and makes federal matching funds available for some state Medicaid plans for programs that encourage adoption and use of EMR technology. E-prescribing is a key component of 'meaningful use'. Prescribers who wish to participate in this program should ensure that their chosen EMR system includes e-prescribing functionality that establishes an electronic connection with payers and pharmacies for Prescription Benefit, Medication History and Prescription Routing services.

Are there transaction fees for e-prescribing?

There are no transaction fees for prescribers to access or use the networking services provided by Surescripts.

However, prescribers must use an electronic prescribing system that is certified to connect to the Surescripts network before they can send and receive prescription information. A practice may be using a certified application already or it may need to acquire a new certified application. Costs for these systems are set by the companies that provide them.

Systems that are certified to connect to the Surescripts network range from simple electronic prescribing software to full-featured EMR systems.

The only time your practice would incur transaction fees for e-prescribing would be if the vendor you select charged your practice a transaction fee. Most vendors do not charge practices a transaction fee, but be sure to ask your potential vendors about this during system selection.

Prescribers can check to see if their electronic prescribing system is certified by clicking here.

Are there financial assistant programs available to help with e-prescribing costs?

There are a number of e-prescribing and EMR initiatives available at the national, state and regional levels designed to assist prescribers with the adoption of e-prescribing technology. To review a partial list of these programs, please click here.

What Is the Medicare Improvements for Patients and Providers Act?

The Medicare Improvements for Patients and Providers Act (MIPPA) went into effect January 1, 2009. Prescribers who use a qualified e-prescribing system to prepare and send electronic prescriptions as defined by MIPPA are eligible to receive higher levels of reimbursement under Medicare through 2013, with a maximum reimbursement rate of 2% available in 2009 and 2010. Prescribers who do not start to send e-prescriptions by 2012 will suffer a penalty on their Medicare reimbursements starting at 1 percent.

Qualified systems include the ability to generate a medication list (with information from payers or pharmacies, if available); select medications, transmit prescriptions electronically using the applicable standards and warn the prescriber of possible undesirable or unsafe situations; provide information on lower-cost therapeutically appropriate alternatives; and provide information on formulary or tiered formulary medications, patient eligibility and authorization requirements received electronically from the patient's drug plan.

For more information on the MIPPA program, click here.

Does e-prescribing cost patients more money?

Patients pay the same amount and can use the same payment methods for electronic prescriptions as they do for traditional paper ones. With e-prescribing, however, prescribers will likely have information about the patient's formulary at the time of prescribing, which may allow prescribers to prescribe a medication with a lower co-pay or cost to the patient if paying out of pocket.

Which retail and mail-order pharmacies can accept e-prescriptions via the Surescripts network?

At the end of 2010, approximately 91 percent of community pharmacies in theU.S. were connected for prescription routing, and six of the largest mail order pharmacies were able to receive prescriptions electronically.  More than 98 percent of chain pharmacies and 73 percent of independent pharmacies were connected to the Surescripts network for prescription routing in 2010. Of community pharmacies that are not connected, approximately 97 percent have pharmacy management software that has been certified for e-prescribing.

In addition, the following mail order pharmacies can accept e-prescriptions via the Surescripts network:

• CVSCaremark
• Express Scripts (Wellpoint, NextRx)
• Medco Health Solutions
• Prescription Solutions
• Prime Therapeutics (Prime Mail)
• Walgreens Mail Service

Click here to search for e-prescribing pharmacies in your area.

If you know of any pharmacies in your area that are not currently accepting e-prescriptions, resources are available to help you encourage them to get started.

How will I know if pharmacies are properly loaded in my e-prescribing system?

It is best to provide your e-prescribing vendor with a comprehensive list of pharmacies that your patients frequently use. The vendor can then match this list with the pharmacy records information in your application. This will help ensure that your frequently used pharmacies are appropriately matched to the master pharmacy file from the beginning, and thus are enabled for electronic prescriptions. If your practice application allows you to create customized pharmacy records (customized name, address, or phone and fax number), then it is also important to ensure that the application system matches such records in the master pharmacy lists provided by the Surescripts network.

What if the patient's pharmacy only receives faxes?

If the pharmacy selected to receive the prescription does not have electronic prescription capabilities, the electronic prescribing application you use may present options to fax or print. Or, as you write new prescriptions, your application may have the capability to determine if the pharmacy can receive the prescription electronically or via fax.

Please check with your vendor for specifics on this process for your system. Pharmacies receiving fax-based communications will not be able to send you refill requests electronically until they establish their own connection to Surescripts.

If you would like to encourage non-connected pharmacies to e-prescribe, communication resources are available by clicking here. More than 97% of the nation's pharmacies use systems that can be enabled for e-prescribing. At the end of 2010, more than 91% were enabled for e-prescribing.

Can I reply to a faxed prescription renewal request with a new e-prescription?

Yes - although this process can make it difficult for pharmacies to match the new prescription order to the original request. As a result the pharmacy may send a duplicate renewal request or follow-up with a phone call to your office to ensure that the request is responded to. To prevent this from happening, please place a note on your new e-prescription that states that the prescription is a response to a separate renewal request and include the original prescription number. E.g.) "Relates to Rx#123456" or "Relates to faxed Rx#123456"

Remember, any request for a controlled substance must be responded to in accordance with DEA requirements - which currently do not permit these prescriptions to be managed electronically. And, if you feel that you are getting a significant number of faxed requests from pharmacies that should be sending them to your practice electronically, please report them to your vendor.

How is electronic prescribing viewed by the Medicare requirement to submit prescriptions using serialized/tamper-proof prescription forms?

On October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) enacted a regulatory change requiring that all written Medicaid prescriptions be on a tamper-resistant blank. Electronic prescriptions are exempt from this requirement.

How secure is the information that the pharmacy and I exchange via the Surescripts network?

Surescripts and those who connect to the network use secure connections in accordance with applicable law and industry standards.

Why do some pharmacies send me faxes even though I use electronic prescribing software?

Although in most circumstances, electronic prescribing can replace voice and paper-based communications with a totally electronic process, there are exceptions.

1. Have you sent at least 5 new prescriptions electronically?

Pharmacies will begin sending refill requests electronically once a prescriber sends at least five new prescriptions electronically via the Surescripts network. This is to help ensure that your practice has been trained on your e-prescribing orEMRsystem and is ready to receive and respond to refill requests electronically.

Additionally, the pharmacies need time to update their prescriber directories once they recognize that you are using your system to send new prescriptions electronically. The amount of time varies by pharmacy.

2. Is the pharmacy that faxed the refill request enabled for e-prescribing?

More than 91% of the nation's pharmacies are enabled for e-prescribing. However, pharmacies that are not yet enabled for e-prescribing will continue to fax refill requests to you. You can search for e-prescribing enabled pharmacies by using the search feature located at the top of every page on our web site.

3. Is the renewal request from a mail order pharmacy?

Although six of the largest mail order pharmacies are connected to the Surescripts network, not all e-prescribing software vendors are certified to process prescription renewal requests electronically from mail-order pharmacies. You can search for e-prescribing enabled pharmacies by using the search feature located at the top of every page on our web site.

4. Have you been responding to renewal requests within the last 24 hours?

To help ensure that patients' refill requests are processed in a timely manner, some pharmacies will automatically fax a duplicate refill request if they do not hear back from you within 24 hours.

Finally, there is the chance that your individual prescriber record did not get updated correctly in the pharmacies' systems. This should be reported through your normal support desk process as soon as possible so that the pharmacies can be contacted and the problem can be investigated. Your prescriber record should match the information found on your prescription forms. This way the pharmacies will have a one-to-one match between your e-prescribing record and your existing record on their databases. You can also open up a support ticket for this issue with Surescripts by clicking here .

What should I do if a patient or pharmacy calls and reports that they did not receive a prescription that I sent to them electronically?

Although the vast majority of e-prescriptions are dispensed without incident, issues such as mishandled prescriptions may occur from time to time.

Possible Causes:

• A technical issue with your electronic prescribing software, the pharmacy computer system, or network connectivity may have caused you to receive an error message on the prescription's transmission.
• The prescription may have arrived to the pharmacy's fax machine instead of their computer. Reasons can include the medication being a controlled substance, a temporary loss of network connectivity, or the fact that the pharmacy is not yet enabled for e-prescribing.
• The prescription may have been successfully received but put "on hold" due to an out-of-stock medication, an interruption during dispensing, or other issue. A simple miscommunication between staff members to the patient or to your office may have reported it as "not received".
• If the pharmacy is inexperienced with e-prescribing, the staff member may not have adequately checked their pharmacy system for the successfully delivered prescription.

What to do:

1. To ensure that the patient's needs are taken care of, provide the pharmacy with the verbal order for the prescription so it can be dispensed immediately.
2. Review your e-prescribing system for any errors that may indicate the prescription was not successfully delivered and that it was addressed to the correct pharmacy.
3. If the prescription was successfully delivered, ask the pharmacy to ensure that, in the future, they review their computer system, their fax machine, and all points within their workflow before calling for a verbal order.
4. Report the incident to your e-prescribing software vendor so that they can open a support case on your behalf which will help reduce the chance of a future occurrence.

How can I be certain that the pharmacy will receive my new prescription or renewal authorization when I send it electronically?

Surescripts manages a central directory of pharmacies and physicians that have signed up for electronic prescribing, and the technology vendors they use work closely with Surescripts and their customers to stay in sync. The chances of the pharmacy not receiving a prescription sent electronically are very small. However, if a pharmacy you are sending to is not enabled to accept a prescription electronically, the request will be sent by fax. If you send an electronic prescribing message that cannot be delivered to the destination within a certain time period (a specified number of minutes) because of other issues, Surescripts will send an error message notifying you that the message could not be delivered. Please make sure that you are familiar with how to find these messages in your system.

What should I do if I receive an error message that my electronic prescription didn't go to the pharmacy?

If the electronic prescription did not go to the pharmacy because the pharmacy is not enabled to accept electronic prescriptions, it will automatically be sent by fax. For all others, depending upon the urgency of the prescription, you may want to call the pharmacy and arrange for an alternate way of sending the prescription. You should also contact your physician technology vendor to report the error so it can work to limit the chance of a reoccurrence.

How are the prescribing messages that I send handled at the pharmacy?

Pharmacies generally have a centralized area to which all pending prescriptions are routed. From there, the pharmacy personnel can see the incoming prescriptions and refills and prioritize them accordingly. Pharmacies usually handle prescriptions and renewal authorizations in the order in which they arrive, but because electronic prescriptions are sent electronically, they can get into the dispensing area quicker than if patients were to drop them off. Still, patients should leave sufficient time for the pharmacy to receive, process and dispense their prescription orders. Two or three hours is normally sufficient.

Does electronic prescribing offer the patient advantages?

For patients, an important advantage of a prescription being sent electronically is that the message is already formatted in such a way that the pharmacy computer can assimilate the information for rapid dispensing. You also have the comfort of knowing that an accurate, legible prescription will arrive at the pharmacy and that it won't get lost, misplaced, destroyed or forgotten by the patient. Plus, patients can avoid making one trip to the pharmacy to drop off a prescription and another to pick it up.

Is the information sent to the pharmacy sold or shared with any third party?

No. Information sent over the Surescripts network is private and confidential. It is not shared with any third party.

When I prescribe electronically, will the system try to influence my decisions?

No. One of Surescripts' founding principles is to ensure that there is no commercial messaging allowed on its electronic prescribing network. Electronic prescribing applications that are connected to this network signify that your vendor completed a certification process to ensure that there is no commercial messaging at the point of care. Surescripts also protects your choice of therapy and your patients' choice of pharmacy. All prescribing applications certified to connect to the Surescripts network are required to abide by these rules, and only physician technology companies that agree with this philosophy are allowed to connect.

If certain local pharmacies do not accept electronic prescriptions today, how can I get them to start?

Contact your local pharmacies and let them know that you are using an electronic prescribing application that is connected to the Surescripts network. More than 95% of the nation's pharmacies have software that is enabled to connect, although not all have activated their connections yet. Urge pharmacies that have not yet activated their connections to contact their vendors to activate them or tell them when their software will be enabled.

Can electronic prescribing be used for Medicaid prescriptions? What restrictions apply?

Surescripts has worked closely with regulatory and other agencies  to determine functionality that would satisfy the intent of the regulation for electronic prescribing for "Brand Medical Necessary"/ "Dispense As Written" (DAW). The process was approved in August 2010 and updated guidance is being provided to the states to support this functionality.

Do pharmacies wait until they hear from me to start sending me prescription renewal requests electronically?

As soon as you send five new prescriptions electronically via the Surescripts network, pharmacies will be alerted and, within a few days to a few weeks, will begin to send you prescription renewal requests electronically as opposed to fax or phone requests.

How can I prepare for my e-prescribing training?

Personalized one-on-one training using a variety of common scenarios seems to work best for most prescribers. It is important to ask detailed questions during your training sessions, including:

• What happens if the patient is not matched in the system when a pharmacy sends renewal requests?
• Can I cover for my colleagues when they are on leave, and under whose name will the prescriptions be sent to the pharmacy?
• How does the system handle controlled substance prescriptions and pharmacy renewal requests for controlled substances?
• How do I write prescriptions to the pharmacy when a patient calls in a request via phone?
• How do I know whether the prescription was successfully sent to the pharmacy?
• How do I handle mail-order prescription writing?
• How do I create my favorite medication list?
• How do I search pharmacies within the practice database?

A good resource to help you prepare is the Clinician's Guide to E-Prescribing which is a free download available on our web site.

Can I work offline using my e-prescribing system?

Some e-prescribing programs allow access offline, which would enable prescribers to prepare multiple scripts and then transmit them when they have Internet access again. However, queuing or 'batching' prescriptions before sending them to pharmacies electronically is not recommended. Sending prescriptions to pharmacies as soon as possible after they are prepared ensures that the pharmacy has adequate time to receive the prescriptions before patients arrive to pick them up.

How do I introduce e-prescribing to my patients?

Introducing e-prescribing to patients is important, as well as communicating its benefits and implications. Some patients may express initial reluctance in response to a new system, but prescribers can make patients more comfortable by explaining how e-prescribing works and its benefits to patients, providers and pharmacies.

In the initial phases, it's important for you and your practice staff to educate and reinforce the benefits of e-prescribing with your patients. Talking points include:

• Fast - E-prescribing allows you to electronically send prescriptions directly to the patient's choice of pharmacy. The prescription travels from your computer to the pharmacy's computer before the patient leaves the exam room, giving that prescription a head start. However, this does not necessarily mean that the prescription will be at the pharmacy when the patient arrives. Patients should leave a few hours between their visit and the trip to the pharmacy to pick up their prescriptions.
• Convenient - The patient no longer has to make an additional trip to the pharmacy to drop off his or her prescriptions.
• Safe and Secure - Prescription information is not sent over the open Internet and is not sent via e-mail. E-prescriptions are sent electronically through a private, secure and closed network - the Surescripts network.
• Legible - The staff in the pharmacy no longer has to spend time interpreting handwriting or dealing with blurry faxes.
• Informed - The availability of formulary information from health plans allows for a choice of medications that are more affordable, and e-prescribing allows drug-to-drug interaction checking and allergy-drug interaction checking for safer choices.
  
  

If an e-prescribing physician leaves the practice should he or she notify you of their change in employment?

The physician should communicate this change to his/her software vendor. The vendor will disable the prescriber's record in the Surescripts Directory so that no additional prescription renewals will be sent to the prescriber from pharmacies. Any additional new prescriptions sent by this prescriber would be returned in error by Surescripts.

Who should I contact if I am having technical problems with my e-prescribing/EMR system?

Your e-prescribing/EMR vendor representative should always be your first point of contact for technical support.  If your vendor is not being responsive to your inquiry, Surescripts is able to open support tickets on your behalf for a limited number of issues such as e-prescriptions that cannot be located by the pharmacy or faxed refill requests that should be arriving electronically.

My vendor said Surescripts has a form I can use to obtain patient consent to view medication history. Is this true?

Surescripts does not provide any sort of form/template for gaining patient consent.  It is up to the practice to make sure they are gaining patient consent before accessing a patient's medication history through their e-prescribing/EMR software system.  Please contact your software vendor for more information.

Does Surescripts provide my e-prescribing application’s drug database?

Surescripts plays no role in providing a drug database, or facilitating the provision of drug database information within e-prescribing applications.  E-prescribing software/EMR vendors typically hold a relationship with third-party database providers for this purpose.  Please ask your e-prescribing/EMR vendor for more information on how your system receives and integrates the drug database information.

What is the status of electronic prescribing for controlled substances?

On September 11, 2011, Surescripts announced that it had upgraded its nationwide network to support electronic prescribing of controlled substances (EPCS). In addition to its deployment of the network upgrade, Surescripts has begun its initial certification of prescriber software vendors and pharmacy applications for EPCS. Certified vendors and pharmacies have, in turn, begun the initial deployment of EPCS in the United States. The deployment involves a select number of certified and audited vendors and their users located in states where EPCS is legal.

The announcement represents an important step in the industrywide collaboration between pharmacies, technology vendors, pharmacy benefit managers, Surescripts and other networks to plan and implement support for U.S. Drug Enforcement Administration and state pharmacy board rules.

For this initial deployment of EPCS, Surescripts is actively monitoring the end-to-end characteristics of EPCS usage. Aspects such as physician credentialing, workflows, processing times, quality and others are being actively monitored across the Surescripts network as well as for participating vendors, prescribers and pharmacies. At the completion of this initial monitoring period, which currently is planned to end later this year, Surescripts will make EPCS support available to all appropriately certified participants.

All software vendors and pharmacies that have developed their own software systems must complete Surescripts certification and DEA-required third-party audits before connecting to the Surescripts network for EPCS. Surescripts will be supporting both of the DEA-recognized approaches to securely signing a prescription - i.e., supporting both public key infrastructure and the indication of a signing "flag." By establishing a framework by which prescribers can electronically prescribe controlled substances, the DEA provided a path for prescribers to manage all their prescriptions within an electronic workflow, rather than separate paper-, telephone- and fax-based methods for controlled substances and electronic processes for all other medications.

In order to electronically prescribe controlled substances, some of the major DEA requirements prescribers must adhere to include:

• Use of an e-prescribing application that is certified for this purpose.
• Completion of a compliant identity-proofing process.
• Use of a secure, two-factor authentication process to sign prescriptions for controlled substances.