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Standards for Electronic Prescribing

A coalition led by the RAND Corporation was selected by the U.S. Department of Health and Human Services (HHS) to conduct pilot tests evaluating a set of proposed standards for transmitting prescriptions and related information electronically between doctors, pharmacies and prescription drug plans. The RAND-led effort was centered on an initiative created by Horizon Blue Cross Blue Shield of New Jersey that sponsored the implementation and ongoing use of electronic prescribing among 1,000 physicians. Dr. Douglas Bell, a RAND researcher, was principal investigator of the project.

The project evaluated all six of the standards that were under consideration to be required for e-prescribing under the Medicare prescription drug benefit. Overall, each standard was expected to contribute to improved patient care by improving the delivery of important information to the point of care.

These standards were:

• The NCPDP Formulary & Benefit Standard (F & B) for transmitting insurance coverage information for patients' specific health plans
• The Medication History function of NCPDP SCRIPT
• The Fill Status function of NCPDP SCRIPT for informing prescribers when a prescription is filled
• Standards for Medication Prior Authorization, including X12N 278 and 275 with the HL7 claims attachment
• The RxNorm drug nomenclature from the National Library of Medicine
• The NCPDP Structured & Codified Sig standard for patient dosing instructions

The study took take place within the New Jersey E-Prescribing Action Coalition, an industry-academic partnership involving RAND Health, Horizon Blue Cross Blue Shield of New Jersey and the e-prescribing vendors AllScripts, Caremark iScribe, and InstantDx. Other partners are: the electronic prescribing information exchange companies RxHub and SureScripts; Caremark's mail-order pharmacy; Walgreens retail pharmacies; the University of Medicine and Dentistry of New Jersey; and Point of Care Partners, a consulting group that has led standards development efforts for electronic prescribing.

The project was supported through a cooperative agreement with the U.S. Agency for Healthcare Research and Quality (AHRQ) and the U.S. Centers for Medicare and Medicaid Services (CMS).

   Download the project's report of preliminary results to AHRQ.