Electronic Prescribing:Electronic Prescribing:

Planning and Implementation to Planning and Implementation to Achieve Success and Maximize ValueAchieve Success and Maximize Value

Jonathan TeichJonathan TeichPat HalePat Hale

Peter BaschPeter BaschBob ElsonBob Elson

Rick RatliffRick Ratliff

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www.ehealthinitiative.org/initiatives/erx

Electronic Prescribing: Electronic Prescribing: Introduction - the Value - Stages of Introduction - the Value - Stages of

eRxeRx

Jonathan Teich, MD, PhDJonathan Teich, MD, PhD

SVP and Chief Medical OfficerSVP and Chief Medical Officer

HealthvisionHealthvision

Chair, eHI Electronic Prescribing Chair, eHI Electronic Prescribing ProjectProject

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What is electronic prescribing?What is electronic prescribing?

““Electronic prescribing” or Electronic prescribing” or “Computerized prescribing” = all “Computerized prescribing” = all systems that use a computer to systems that use a computer to enter, modify, review, and enter, modify, review, and communicate drug prescriptions. communicate drug prescriptions.

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PDA’sPDA’s

•Useful where space is limited, or for multi-room practice

•Wireless and stand-alone

•Security concerns – “the floor and the door”

•EHR/EMR connected systems usually desktop-based

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Formulary CheckingFormulary Checking

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Rx in EHR

Rx in EHR

ConnectivityConnectivity

Med Profile Management

Med Profile Management

Allergy, Formulary, AgeAllergy, Formulary, Age

Basic Rx Entry / Dose checkBasic Rx Entry / Dose check

Reference onlyReference only

Stages of Stages of eRxeRx

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eRx ValueeRx Value

There are significant errors and ADE’sThere are significant errors and ADE’sGandhi: ADE’s in 5-18% of ambulatory pts/yrGandhi: ADE’s in 5-18% of ambulatory pts/yr

CITL: Nationwide adoption of “ACPOE” predicted CITL: Nationwide adoption of “ACPOE” predicted to eliminate 2.1 million ADE’s/year (136,000 life-to eliminate 2.1 million ADE’s/year (136,000 life-threatening)threatening)

There are significant inefficienciesThere are significant inefficienciesCGEY: Nurses save 2.87 minutes per faxed RxCGEY: Nurses save 2.87 minutes per faxed Rx

Illinois study: 50% reduction in pharmacy Illinois study: 50% reduction in pharmacy callbackscallbacks

Electronic Prescribing: Electronic Prescribing: Planning and Implementation to Achieve Planning and Implementation to Achieve

Success and Maximize ValueSuccess and Maximize Value

A Provider’s PerspectiveA Provider’s Perspective

Peter Basch, MDPeter Basch, MD

Medical Director Medical Director

MedStar e-Health InitiativeMedStar e-Health Initiative

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MedStar’s e-Health InitiativeMedStar’s e-Health Initiative

MedStar Health – 7-hospital system in the MedStar Health – 7-hospital system in the Baltimore-Washington corridorBaltimore-Washington corridor

MeHI started in 2000 toMeHI started in 2000 toProvide guidance to physicians from physicians, on Provide guidance to physicians from physicians, on practical e-health technologiespractical e-health technologies

Syndicate selected e-health products and servicesSyndicate selected e-health products and services

e-Prescribing was an early target for syndicatione-Prescribing was an early target for syndicationFar easier and cheaper than inpatient CPOE, a “near Far easier and cheaper than inpatient CPOE, a “near term doable”term doable”

Goals – enhance patient safety while improving Goals – enhance patient safety while improving workflow within the physician’s practice (as well as workflow within the physician’s practice (as well as wins for other stakeholders)wins for other stakeholders)

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MeHI’s approach to eRx – 2001 MeHI’s approach to eRx – 2001

Investigated marketInvestigated marketUsed a consultant to do a preliminary vendor Used a consultant to do a preliminary vendor analysisanalysis

Demos + “demo-lition derby”Demos + “demo-lition derby”

Selectively engaged with finalist vendorsSelectively engaged with finalist vendorsFar easier to do in an emerging market with startupsFar easier to do in an emerging market with startups

Became part of process / political redesignBecame part of process / political redesignBetter productBetter product

Align costs / benefitsAlign costs / benefits

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MeHI’s approach to eRx – 2003-nowMeHI’s approach to eRx – 2003-now

Preferred pricing arrangements for any MD Preferred pricing arrangements for any MD affiliated with our hospitals with 2 vendorsaffiliated with our hospitals with 2 vendors

Participation in the eHealth Initiative report on eRxParticipation in the eHealth Initiative report on eRx

1-yr pilot with DrFirst and CAQH1-yr pilot with DrFirst and CAQH4 of every 1000 prescriptions (~2/day) were deemed 4 of every 1000 prescriptions (~2/day) were deemed by the prescriber to be by the prescriber to be significantsignificant mistakes (and mistakes (and were changed before being sent to the pharmacy)were changed before being sent to the pharmacy)

93% of meds were written as generic or allowed to 93% of meds were written as generic or allowed to be substitutedbe substituted

30% of meds were substituted for a formulary 30% of meds were substituted for a formulary alternativealternative

Benefit for providers is less clearBenefit for providers is less clear

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Moving ahead with eRx…Moving ahead with eRx…

Getting clinicians’ attentionGetting clinicians’ attention

Choosing a vendorChoosing a vendor

A lingering question… standalone A lingering question… standalone eRx vs. EHR?eRx vs. EHR?

Incentives – aligning costs / benefitsIncentives – aligning costs / benefits

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Getting clinicians’ attentionGetting clinicians’ attention

Creating the imperativeCreating the imperativePaper-based prescribing is fraught with error - sure Paper-based prescribing is fraught with error - sure there’s bad handwriting, missing decimal points, there’s bad handwriting, missing decimal points, and just bad judgment…and just bad judgment…

But if you want to be But if you want to be heardheard by doctors… by doctors…• Exponential increase in new drugsExponential increase in new drugs• More patients with multiple conditions taking More patients with multiple conditions taking

multiple medsmultiple meds• Multi-tasking is efficient but can lead to errorsMulti-tasking is efficient but can lead to errors• eRx is the right thing to do, and can be done eRx is the right thing to do, and can be done

todaytoday• eRx will be the standard of careeRx will be the standard of care

The challenge – busy clinicians still have to The challenge – busy clinicians still have to slow down to listen to this messageslow down to listen to this message

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Choosing a vendorChoosing a vendorDesign and usabilityDesign and usability

Web-based for PC, tablet, and PDA useWeb-based for PC, tablet, and PDA usePDA issuesPDA issues

• Pocket PC vs. PalmPocket PC vs. Palm• Synchronous vs. asynchronousSynchronous vs. asynchronous

Consider incremental adoptionConsider incremental adoption if office e-readiness is low if office e-readiness is low (start with refills, progress to point-of-care prescribing)(start with refills, progress to point-of-care prescribing)Usability is criticalUsability is critical

WorkflowWorkflowPhysician and staff workflowPhysician and staff workflow

Integration with practice management systemIntegration with practice management systemRobust bidirectional connectivityRobust bidirectional connectivity

Information gatewayInformation gatewayTransactional gatewayTransactional gateway

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Standalone eRx vs. EHRStandalone eRx vs. EHR

Standalone eRx is cheaper and easier than an EHRStandalone eRx is cheaper and easier than an EHRBut it doesn’t do the functions that makes embedded eRx But it doesn’t do the functions that makes embedded eRx desirable (Rx + med list + chart documentation)desirable (Rx + med list + chart documentation)

To make it fit clinician workflowTo make it fit clinician workflow• Either keep medication database separate from the chartEither keep medication database separate from the chart• Always print it for the chart, orAlways print it for the chart, or• Always open the eRx application with the chart (for staff and Always open the eRx application with the chart (for staff and

doctors)doctors)

Point-of-care prescribing and renewals should never be done in Point-of-care prescribing and renewals should never be done in a vacuuma vacuum

Embedded eRx in an EHREmbedded eRx in an EHRClear advantages to workflow and staff efficiencyClear advantages to workflow and staff efficiency

May not require any additional incentivesMay not require any additional incentives

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SummarySummary

Without mandates and/or incentives, getting Without mandates and/or incentives, getting clinician attention / engagement takes workclinician attention / engagement takes work

Even with mandates, incentives are Even with mandates, incentives are necessary to align costs and benefits necessary to align costs and benefits

Choosing a good vendor should make the Choosing a good vendor should make the work of implementation much easierwork of implementation much easier

While standalone eRx may work for some While standalone eRx may work for some clinicians, for others it may make more clinicians, for others it may make more sense to start by adopting eRx as part of an sense to start by adopting eRx as part of an EHREHR

Electronic Prescribing:Electronic Prescribing:Managing Implementation - Managing Implementation -

Pointers and PitfallsPointers and Pitfalls

Patricia L. Hale, MD, PhDPatricia L. Hale, MD, PhD

CMIO Glens Falls HospitalCMIO Glens Falls Hospital

Chair of MISC - American College of Chair of MISC - American College of PhysiciansPhysicians

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Implementing eRxImplementing eRx

PlanningPlanningGather key stakeholdersGather key stakeholdersUnderstand your needs and your feasibilities Understand your needs and your feasibilities

System SelectionSystem SelectionFeaturesFeaturesPrice – pricing modelsPrice – pricing modelsPotential for upgrading to EHRPotential for upgrading to EHR

Hardware and servicesHardware and servicesWorkflow issuesWorkflow issuesDesktopDesktopPDA’sPDA’s

ListsListsTraining/startup periodTraining/startup period

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Implementation RecommendationsImplementation Recommendations

Access important resources including the Access important resources including the vendor and similar organizations that have vendor and similar organizations that have already deployed the same application. already deployed the same application.

Ensure adequate infrastructure and devices. Ensure adequate infrastructure and devices.

Pay attention to organizational culture and Pay attention to organizational culture and behavior change management from the behavior change management from the start.start.

Before selecting and implementing an Before selecting and implementing an electronic prescribing application, plan for electronic prescribing application, plan for migration towards a complete EMR.migration towards a complete EMR.

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Implementation ProcessImplementation Process

Purchase and install system hardware

Establish users and roles

Load lists: patients, pharmacies, formularies, favorites, etc.

(Possibly) load prior patientmedical or medication data

Identify and address major implementation issues before selecting a system.

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Implementation Implementation IssuesIssues

Address startup and interface issues Address startup and interface issues early:early:

Integration with a practice Integration with a practice management system to gain access to management system to gain access to registration and schedule information, registration and schedule information, Loading patients’ initial medication lists Loading patients’ initial medication lists from the previous system or from paper from the previous system or from paper records; and records; and Selecting and loading the appropriate Selecting and loading the appropriate payer and formulary information.payer and formulary information.Communication with pharmacies, Communication with pharmacies, health plans, etc.health plans, etc.

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Implementation IssuesImplementation Issues

Identify Hardware and Service Needs:Identify Hardware and Service Needs:

In-office siting and connectionsIn-office siting and connections

Networking / Internet / wireless Networking / Internet / wireless

Communications services (e.g., to Communications services (e.g., to pharmacies)pharmacies)

What are your pharmacies ready for?What are your pharmacies ready for?

How will you access Health Plan How will you access Health Plan information?information?

Can you communicate with other Can you communicate with other providers?providers?

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Implementation IssuesImplementation Issues

Prepare Lists:Prepare Lists:UsersUsers

Patient load Patient load oror PM connection PM connection

FormulariesFormularies

FavoritesFavorites

Initial medication loadInitial medication load

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Implementation IssuesImplementation Issues

Keys to Success:Keys to Success:

Strong leadership & commitmentStrong leadership & commitment

Incremental approachesIncremental approaches

High support staff involvementHigh support staff involvement

Medication history preloadMedication history preload

The “basics” well planned in The “basics” well planned in advanceadvance

PMS interface, network, devices, PMS interface, network, devices, training & supporttraining & support

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Implementation IssuesImplementation Issues

Challenges:Challenges:Good application not sufficientGood application not sufficientCultural issues/managing behavior Cultural issues/managing behavior changechangeStartup issues and problem resolution.Startup issues and problem resolution.Rollout timing and sequencing.Rollout timing and sequencing.Higher relative cost for small practicesHigher relative cost for small practices

Electronic Prescribing:Electronic Prescribing:Managing Implementation – Managing Implementation –

Clinical Decision Support, Formulary, Clinical Decision Support, Formulary, Medication ListsMedication Lists

Bob Elson, MD, MSBob Elson, MD, MS

VP Medical AffairsVP Medical Affairs

RxHub, LLCRxHub, LLC

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Implementation: Decision Implementation: Decision SupportSupport

List maintenanceList maintenanceActive medications, allergies, problemsActive medications, allergies, problemsOther key data: weight, lab resultsOther key data: weight, lab results

Warnings management / workflowWarnings management / workflowUser roles / privilegesUser roles / privilegesOverride justification / documentationOverride justification / documentationDe-activation / disabling of warningsDe-activation / disabling of warnings

Knowledge base updatingKnowledge base updatingCustom warnings?Custom warnings?

Understand decision support “holes”Understand decision support “holes”ApplicationApplication safety “czar” safety “czar”

Bell, DS. A conceptual framework for evaluating eRx systems. JAMIA, 2004.11:60-70.

Fernando, B. Prescribing safety features of GP computer systems. BMJ. 2004;328:1171

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“Intelligent Intervening Provider”

Application Safety: User vs. System Application Safety: User vs. System ErrorError

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Implementation: FormularyImplementation: Formulary

Getting the dataGetting the dataOn vs. off-formulary, preferred, restrictions, On vs. off-formulary, preferred, restrictions, copaycopayHealth plan coverageHealth plan coverageData costs?Data costs?

Mapping a patient to the right formularyMapping a patient to the right formularyWorkflowWorkflow

Pointers to preferred alternativesPointers to preferred alternativesOverridesOverridesPrior authorizationPrior authorization

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Implementation: Medication Implementation: Medication ListsLists

Building initial medication listsBuilding initial medication listsThe “backfile conversion” problemThe “backfile conversion” problem

Medication list maintenanceMedication list maintenance““brown paper bag” intakebrown paper bag” intake

Active vs. inactive medsActive vs. inactive meds

Medications prescribed by other Medications prescribed by other physiciansphysicians

Assessing complianceAssessing compliance

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Implementation: “Front-End” Implementation: “Front-End” ConnectivityConnectivity

Eligibility-driven formulary mappingEligibility-driven formulary mapping

Claims-based prescription historyClaims-based prescription history

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Member ID Load

Member ID Load

Member ID Load

Eligibility-driven Formulary MappingEligibility-driven Formulary Mapping

PBM

PBM

PBM

Multiple responses combined

Clinic System(eRx, EMR)

Master Person Index

MPI

Eligibility Request

Unique patient

identification

Eligibility Request

Eligibility Request

Eligibility Response

Eligibility Response

Eligibility Response

eRxUtility

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Claims-based Prescription HistoryClaims-based Prescription History

PBM

PBM

PBM

Medication History Request

Medication History Request

Med History Response

Medication History Response

Clinic System(eRx, EMR) eRx

Utility

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Sample Rx Claims History Sample Rx Claims History “Report”“Report”

Patient Filled Prescription Report:

Patient ID: PATID1234Name: JONES, WILLIAM A.Address: 1200 N ELM STREET

GREENSBORO, NC 27401-1020DOB: 06/15/1961 Gender: Male

Filled Prescription Date Range: 08/01/2002 – 08/01/2003

CAUTION: Certain information may not be available or accurate in this medication claims history, including over-the-counter prescriptions, prescriptions paid for by the patient or non-participating sources, or errors in insurance claims information. The provider should independently verify medication history with the patient. 

----------------------- FILLED PRESCRIPTION SUMMARY -------------------Summary:Drug Name: Strength Oldest Most Recent #of

Dosage Fill Date Fill Date FillsHYDROCHLOROTHIAZIDE 50 MG 07/01/2002 08/01/2003 2INSULIN 100 U/ML 08/01/2002 08/01/2003 13GLUCOVANCE 2.5/500 12/15/2002 07/25/2003 8GLUCOTROL XL 10 MG 8/01/2002 07/20/2003 12PREVACID 30 MG 10/23/2002 06/30/2003 7

15 MG 09/23/2002 09/23/2002 1SLOW K 10 MG 10/29/2002 06/29/2003 6

----------------------- FILLED PRESCRIPTION DETAIL --------------------HYDROCHLOROTHIAZIDE Drug: HYDROCHLOROTHIAZIDE 50 mg Filled: 08/01/2003Form: 50 mg TABLETQuant: 30 Days: 60 Pharm: JOES PHARMACY #02236 Source: PBM AMD/DO: JEFFRIES,RHONDA

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Impact of Rx Claims on Clinical Impact of Rx Claims on Clinical DetectionDetection

Bieszk. Detection of nonadherence through review of pharmacy claims data Am J Health-System Pharm. 60:360-366, 2003.

231 visits w/ or w/o 6 months Rx claims report231 visits w/ or w/o 6 months Rx claims report

Mean age 61 yrs; 5.5 drugs per patientMean age 61 yrs; 5.5 drugs per patient

Abstractor-detected non-adherence: 57 vs. 58%Abstractor-detected non-adherence: 57 vs. 58%

MD-detected non-adherence: 30.5% vs. 0%*MD-detected non-adherence: 30.5% vs. 0%*

Drug changes: 1.3 vs. 0.3* (*p < 0.001)Drug changes: 1.3 vs. 0.3* (*p < 0.001)Dose changes, drug additions, discontinuations (all Dose changes, drug additions, discontinuations (all p<0.05)p<0.05)

46% of MDs saved 1-3 min per encounter46% of MDs saved 1-3 min per encounter

Henry Ford Health System Clinics

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Implementation: A Few Key Implementation: A Few Key AreasAreas

Decision SupportDecision Support

FormularyFormulary

Medication ListsMedication Lists

Electronic Prescribing:Electronic Prescribing:Physician - Pharmacy Issues; Physician - Pharmacy Issues;

Building Community InitiativesBuilding Community Initiatives

Rick RatliffRick Ratliff

Chief Operating OfficerChief Operating Officer

SureScriptsSureScripts

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Four Core IdeasFour Core Ideas

1.1. Electronic prescribing is a Electronic prescribing is a processprocess

2.2. Quality and efficiencyQuality and efficiency

3.3. The journey begins with a first The journey begins with a first stepstep

4.4. Community and trustCommunity and trust

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The prescribing process is more than just The prescribing process is more than just writing a prescription and dispensing a writing a prescription and dispensing a

medicationmedication

Before EncounterBefore Encounter

Schedule patient

Pull patient chart

Review patient chart

After EncounterAfter Encounter

Re-file chart

Clarification calls

Prescription benefits issues

Renewal authorizations

P H Y S I C I A NP H Y S I C I A N

Acquire PrescriptionAcquire Prescription

Drop Off, Phone, Fax, IVR

Insurance ID card

Data input into computer

CommunicateCommunicate

Review of DUR alerts

Handling of payer issues

Patient counseling

Renewal requests

P H A R M A C I S TP H A R M A C I S T

EncounterEncounter

Interview patient re: meds

Decide medication therapy

Write prescription

Document Rx in note

Process PrescriptionProcess Prescription

Pharmacy DUR

Claims: Payer DUR

Claims: Eligibility / benefits

Order fulfillment / dispense

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Errors and inefficiencies in the Errors and inefficiencies in the encounterencounter

Patient monitoringPatient monitoring

Unknown meds?Unknown meds?

Did pt fill the prescription?Did pt fill the prescription?

Clinical decisionsClinical decisions

Access to expert infoAccess to expert info

Complex drug coverage rulesComplex drug coverage rules

Writing the scriptWriting the script

Handwritten scripts are error-Handwritten scripts are error-proneprone

Est. 2.1 million ADE’s could be Est. 2.1 million ADE’s could be prevented with eRx (CITL)prevented with eRx (CITL)

Before EncounterBefore Encounter

Schedule patient

Pull patient chart

Review patient chart

After EncounterAfter Encounter

Re-file chart

Clarification calls

Prescription benefits issues

Renewal authorizations

P H Y S I C I A NP H Y S I C I A N

EncounterEncounter

Interview patient re: meds

Decide medication therapy

Write prescription

Document Rx in note

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Productivity and satisfaction…Productivity and satisfaction…key moment: after the encounterkey moment: after the encounter

Callbacks for clarification Callbacks for clarification

Handwriting, abbreviations, Handwriting, abbreviations, unclear verbal orders, fax unclear verbal orders, fax problems…problems…

Coordinating prescription benefit Coordinating prescription benefit issuesissues

Payer formularies and prior Payer formularies and prior authorizationauthorization

Managing the renewal authorization Managing the renewal authorization processprocess

Calls and faxes taking unnecessary Calls and faxes taking unnecessary hours of staff and physician time hours of staff and physician time (>2 hrs/day in a 3-MD practice)(>2 hrs/day in a 3-MD practice)

Nurses burdened with admin tasksNurses burdened with admin tasks

Before EncounterBefore Encounter

Schedule patient

Pull patient chart

Review patient chart

After EncounterAfter Encounter

Re-file chart

Clarification calls

Prescription benefits issues

Renewal authorizations

P H Y S I C I A NP H Y S I C I A N

EncounterEncounter

Interview patient re: meds

Decide medication therapy

Write prescription

Document Rx in note

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Physicians and pharmacists Physicians and pharmacists collaborate for improvementcollaborate for improvement

Patient Safety&

Care Quality

Patient Safety&

Care Quality

Clinical PracticeEfficiency

Clinical PracticeEfficiency

&

Before EncounterBefore Encounter

Schedule patient

Pull patient chart

Review patient chart

After EncounterAfter Encounter

Re-file chart

Clarification calls

Prescription benefits issues

Renewal authorizations

P H Y S I C I A NP H Y S I C I A N

EncounterEncounter

Interview patient re: meds

Decide medication therapy

Write prescription

Document Rx in note

Acquire PrescriptionAcquire Prescription

Drop Off, Phone, Fax, IVR

Insurance ID card

Data input into computer

CommunicateCommunicate

Review of DUR alerts

Handling of payer issues

Patient counseling

Renewal requests

P H A R M A C I S TP H A R M A C I S T

Process PrescriptionProcess Prescription

Pharmacy DUR

Claims: Payer DUR

Claims: Eligibility / benefits

Order fulfillment / dispense

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Roadmap of prescribing services for physician Roadmap of prescribing services for physician and pharmacy collaborationand pharmacy collaboration

Services Providing Services Providing True ConnectivityTrue Connectivity

Renewals Renewals

New scriptsNew scripts

Foundation for Foundation for future future collaborationcollaboration

Fair and open Fair and open networknetwork

Services Impacting Services Impacting Patient CostPatient Cost

Payer formulariesPayer formularies

Prior authoriz’nPrior authoriz’n

Rx change messageRx change message

Switch in classSwitch in class

Services Impacting Services Impacting Patient SafetyPatient Safety

Drug interaction Drug interaction checks + safety netchecks + safety net

Medication historyMedication history

Patient compliancePatient compliance

Patient-focused Patient-focused care managementcare management

Prescribing Plus: Prescribing Plus: Collaborate in the Collaborate in the JourneyJourney

Billing and Billing and schedulingscheduling

Lab resultsLab results

Payer Payer communicationscommunications

ReferralsReferrals

Diagnostic Diagnostic reportsreports

Charge capture Charge capture and codingand coding

Clinical notesClinical notes

BasicBasicPrescribingPrescribing

BasicBasicPrescribingPrescribing

Advanced Advanced PrescribingPrescribingAdvanced Advanced PrescribingPrescribing

Toward anToward anAutomated PracticeAutomated Practice

Toward anToward anAutomated PracticeAutomated Practice1 2 3

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Elements of Community Adoption Program Elements of Community Adoption Program (CAP)(CAP)

Alignment of stakeholdersAlignment of stakeholdersPhysician organizations, health plans, health systems, Physician organizations, health plans, health systems, pharmacies, pharmacist organizations, government agencies, pharmacies, pharmacist organizations, government agencies, othersothers

Key outcomesKey outcomesShared vision and public endorsement of initiativeShared vision and public endorsement of initiative

Physician outreach through educational seminarsPhysician outreach through educational seminars

Incentive programs (best are pay-for-utilization)Incentive programs (best are pay-for-utilization)

Tipping point modelTipping point modelStart with key opinion leadersStart with key opinion leaders

Develop proof points in local marketsDevelop proof points in local markets

Develop physician to physician programsDevelop physician to physician programs

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Market Example: Rhode Island Electronic Market Example: Rhode Island Electronic Prescribing ProjectPrescribing Project

Stakeholders engaged in the project by Rhode Stakeholders engaged in the project by Rhode Island Quality InstituteIsland Quality Institute

Physician involvement was driven by a core Physician involvement was driven by a core group of physicians who collaborated on the group of physicians who collaborated on the planning and implementation of the projectplanning and implementation of the project

Over 70% of the state’s retail pharmacies Over 70% of the state’s retail pharmacies connected into the electronic prescribing networkconnected into the electronic prescribing network

Approximately 300 physicians participating with Approximately 300 physicians participating with an expectation of 50% of physicians within Rhode an expectation of 50% of physicians within Rhode Island participating by end of Summer 2004Island participating by end of Summer 2004