Biopharma: Electronic Dosing Instructions

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HIP Perspectives Biopharma Insights – February 2017

Electronic Dosing Instructions: Opportunities for Sales Team

By Brian Bamberger,  Practice Lead, Life Sciences

Electronic prescribing (ePrescribing) is no longer in its infancy. Today, 80% of ambulatory physicians use this method to prescribe medications for their patients and send that information electronically to the pharmacy. With that in mind, the industry will be concentrating on the remaining functionalities that already exist — but are seldom used — in the National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard v. 10.6, which is one of the main ePrescribing transaction standards. An example is the Structured and Codified Sig (short for Signatura). This part of the prescription communicates dosing instructions to the pharmacy, which will then relay them to the patient.

Work on the Structured and Codified Sig has been ongoing for more than a decade. With impetus from the government and a federal advisory group, a task group was convened to address the issue by the NCPDP, which develops and maintains the SCRIPT standard. The idea was to standardize communication of dosing instructions within the ePrescribing process to create unambiguous and complete directions for the pharmacy filling the electronic prescription (ePrescription). Other benefits include decreased opportunities for transcription errors and improved efficiencies and work flows for both prescribers and pharmacists.

How it works. Currently, there are several ways for prescribers to indicate their dosing directions in ePrescribing using NCPDP SCRIPT v. 10.6. The first is a mandatory 140-byte free text field. The second is the optional use of additional separate fields that provide coded data for the various components of the instructions: the verb, route, dosage form, indication, vehicle, site, timing and duration.

Some electronic health records (EHRs) — the main vehicle for ePrescribing — offer drop-down menus and favorites lists for Sig elements, which map back to the NCPDP SCRIPT fields. Even so, many prescribers simply prefer to enter their dosing instructions in the free text field.

Manually entering dosing instructions into the free text field is an efficiency issue for prescribers as well as pharmacists, who must rekey the information from free text Sig into the pharmacy system once an ePrescription is received. This creates the potential for numerous time-consuming calls for clarification between pharmacists and physicians. All this manual entry and rework additionally open the door to errors and have implications for the quality and safety of patient care.

As a result, there is a push for the industry to enhance Sig functionality. Vendors will be pushed to respond to demand for the Structured and Codified Sig in response to regulatory mandates.

Why it is important. Use of the Structured and Codified Sig is now optional for use under the new final rule on October 14 for implementing the Medicare Access and CHIP Reauthorization Act of 2015. It details new ways physicians and other clinicians will be paid now that the old payment system, based on the reviled sustainable growth rate formula, has been abolished. It also contains several provisions that directly relate to the required use of certified EHRs and health information technology (health IT).

ePrescribing is one of the basic requirements to meet these measures, which help determine a physician’s base score for Medicare payment, bonus adjustment or payment decrease for noncompliance. Failure to use ePrescribing will immediately earn a physician a zero for the entire category on health IT usage, which accounts for a quarter of the total payment score. That will get doctors’ attention.

If that’s not enough, we believe use of the Structured and Codified Sig will be required in the new physician pay formula in the not so distant future. We also believe private payers will eventually follow suit. As Medicare goes, so do all the other payers.

Opportunities for sales teams. While the Structured and Codified Sig is not quite mainstream, it will be. Preparing for it creates opportunities for sales teams. For example:

  • Materials will need to be updated. With the health care world going electronic, sales materials need to be updated to reflect various changes in the arena. For example, including a picture of a paper prescription in advertisements and educational materials is old school. What doctors need is a screen image (real or mock-up) showing how a product’s dosing instructions can be represented in ePrescribing via the Structured and Codified Sig.
  • Work with EHR vendors. Sales teams should work with vendors in implementing the Structured and Codified Sig to make its use easier for prescribers. This could create competitive advantage. For example, vendors could improve Sig favorites capabilities by including the most commonly used Sigs. Many of these have already been identified by NCPDP. As a best practice, Surescripts (a major ePrescribing infrastructure provider) recommends that vendors should determine the 100 most commonly prescribed Sig concepts and ensure the system can fully accommodate construction and transmission of these Sig strings. Sales teams should work with vendors to ensure their products’ Sigs are well represented.
  • Training is needed. Physicians will have to be educated about the need for — and use of — the Structured and Codified Sig so it can be used to its full potential, especially if a product is not a tablet. Although it is part of a technical transaction and should be invisible to the user, prescribers must be educated about functionalities available in the electronic Sig and their importance to quality and safety of patient care. This is an opportunity for sales teams to work with physicians on their products’ electronic dosing instructions. It adds value to the visit and reinforces the brand.

Point-of-Care Partners has experts in ePrescribing and the Structured and Codified Sig. Send us an email or give us a call. We’d be happy to give you a deeper dive into the issues and potential solutions.