Electronic Prescribing in Ambulatory Care: A Market Primer and Implications for Managed Care Pharmacy

This paper proposes an episode of care payment system for patients with chronicillnesses, extending earlier published work on this model of ambulatory care (Duckett& Jackson 1993). The payment system relies on annual voluntary enrolment andsome marginal broadening of Medicare coverage in exchange for patients? willingnessto participate in an ambulatory managed care arrangement. In the context ofAustralian health ministers? enthusiasm for managed care, the proposal embodiesan intermediate policy approach which supports greater health care efficiency whileminimising the prospect for reductions in patient autonomy or serious distortionsin patterns of care. The policy is not designed to be applied population-wide, butto address the issues involved with a resource-intensive patient group, those requiringongoing management of chronic conditions.

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Mandatory Statewide Medicaid Managed Care in Florida and Hospitalizations for Ambulatory Care Sensitive Conditions

Health Services Research ◽

10.1111/1475-6773.12613 ◽

2016 ◽

Vol 53 (1) ◽

pp. 293-311 ◽

Cited By ~ 5

Author(s):

Tianyan Hu ◽

Karoline Mortensen

Keyword(s):

Managed Care ◽

Ambulatory Care ◽

Ambulatory Care Sensitive Conditions ◽

Medicaid Managed Care ◽

Ambulatory Care Sensitive ◽

Sensitive Conditions

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Evaluating the implementation of RxNorm in ambulatory electronic prescriptions

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocv131 ◽

2015 ◽

Vol 23 (e1) ◽

pp. e99-e107 ◽

Cited By ~ 3

Author(s):

Ajit A Dhavle ◽

Stacy Ward-Charlerie ◽

Michael T Rupp ◽

John Kilbourne ◽

Vishal P Amin ◽

...

Keyword(s):

Ambulatory Care ◽

Electronic Prescribing ◽

Free Text ◽

National Library ◽

Unique Identifier ◽

Software Applications ◽

National Drug ◽

Electronic Prescriptions ◽

Term Type ◽

Pharmacy Chain

Abstract Objective RxNorm is a standardized drug nomenclature maintained by the National Library of Medicine that has been recommended as an alternative to the National Drug Code (NDC) terminology for use in electronic prescribing. The objective of this study was to evaluate the implementation of RxNorm in ambulatory care electronic prescriptions (e-prescriptions). Methods We analyzed a random sample of 49 997 e-prescriptions that were received by 7391 locations of a national retail pharmacy chain during a single day in April 2014. The e-prescriptions in the sample were generated by 37 801 ambulatory care prescribers using 519 different e-prescribing software applications. Results We found that 97.9% of e-prescriptions in the study sample could be accurately represented by an RxNorm identifier. However, RxNorm identifiers were actually used as drug identifiers in only 16 433 (33.0%) e-prescriptions. Another 431 (2.5%) e-prescriptions that used RxNorm identifiers had a discrepancy in the corresponding Drug Database Code qualifier field or did not have a qualifier (Term Type) at all. In 10 e-prescriptions (0.06%), the free-text drug description and the RxNorm concept unique identifier pointed to completely different drug concepts, and in 7 e-prescriptions (0.04%), the NDC and RxNorm drug identifiers pointed to completely different drug concepts. Discussion The National Library of Medicine continues to enhance the RxNorm terminology and expand its scope. This study illustrates the need for technology vendors to improve their implementation of RxNorm; doing so will accelerate the adoption of RxNorm as the preferred alternative to using the NDC terminology in e-prescribing.

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