NewCrop has been in business since 2003, and has directly benefited from the knowledge and experience of two industry veterans, founders Lawrence Susnow, M.D. and Craig Wagener. They have been involved in all aspects of electronic prescribing for the last ten years. Their unique depth of understanding of the quality and efficiency of electronic prescribing drives NewCrop.
The project was never completed at the HMO, however, soon after concept development, it became the basis for the mature product you see today. Dr. Susnow supplied to concept and Craig Wagener joined to provide the technical know-how and vision to create the user interface and web design.
The biggest differentiation for NewCrop was that it was designed hand-in-hand with physician input. To that end, the user interface was to be kept clean and intuitive with a minimum of disruption to the prescribing process. The NewCrop philosophy then and today was, “If doctors were inconvenienced or slowed down, they simply would not use the system.” Other e-rx systems at the time displayed frequent disruptive “alerts,” many of which doctors considered unimportant distractions. NewCrop choose to place all but the most severe items on a single “Review Page,” color-coded for instant review. It is interesting to note 10 years later, that we have kept our core workflow unchanged: it works and the end user appreciates the simplicity.
Another early NewCrop decision was to focus on providing services to electronic medical records (EMRs) rather than to individual doctors. Deemphasizing “retail” marketing, allowed us to direct our resources to building the robust and versatile system we have today. By concentrating on providing value to partnering EMRs and others, we have built a system that is quickly and easily installed, providing the transparent workflow needed for efficient use. (We now provide a full range of integration options, from the complete integrated user interface, to use of all or some of our individual comprehensive drug content and connectivity data services.)
Initially, patient safety was not an obvious factor in the adoption of electronic prescribing. It was certainly recognized that prescribing errors could occur rarely until To Err is Human, a report from the Institute of Medicine in 1999, estimated that medical errors, and particularly prescribing errors, resulted in 50,000+ deaths yearly. Patient safety became a given, no longer needing explanation.
Early production had its own challenges and seemed to be a tremendous barrier. Our use of now standard https Internet communication, at the time, broke new ground, forcing all parties to build new infrastructure. When our first e-prescriptions hit pharmacies, we discovered the phenomenon of the “missing” prescription. The Rx was in their system, but often there was little, if any, visual indication. Thus, the pharmacist would tell the patient and the doctor it had not been received. To this day, we always know when a doctor is the first e-prescriber in town: we get a cluster of “missing prescription reports.”
Along with our friendly user interface, we needed all the pieces of back-end infrastructure. Initially, this was only the Surescripts retail delivery system, no known as Routing. Next was RxHub, now Surescripts Benefit and Drug History. At an early meeting, we pointed out that the all-doctor drug history could be available to the treating doctor, pulled from the healthplan’s record of paid prescriptions: a very useful quality and safety tool. The response was the information was “confidential.” (This was before HIPAA was completely understood!) However, upon further consideration, it was recognized that providing information to the treating physician was not a breach of confidentiality.
Despite the many benefits of e-prescribing, wide-spread implementation required, literally, an act of Congress. Actually, three acts of Congress.
This began to change on 2005 when the Department of Health and Human Services began to cite the requirement for EMRs certified by a “Recognized Certification Body.” In conjunction with HHS, the Certification Commission for Health Information Technology (CCHIT) was created to fill this role. Electronic prescribing was a required component.
CCHIT was a significant driving force, but the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) that created Medicare Part D, also provided financial incentives for doctors to implement, followed in 3 years by penalties for not participating. For the first time, there was a formal definition of e-prescribing. (Electronic faxing was disallowed and formulary information, specifically from Surescripts Benefit was required.)
HITECH and MU, beyond the financial incentives, have also addressed the concern of “choosing too soon.” Prior to MU, each EMR was unrelated to the next. Information was difficult if not impossible to exchange and there was always the risk that the EMR would fail. This had been the case in the past, leaving early adopting doctors with a very bad experience. MU, by emphasizing interoperability and creating a common standard, has mitigated this concern. Thus, doctors can choose from a wide, and growing, range of EMRs, finding one that matches their needs.
Financial incentives and disincentives combined with resolution of structural barriers have resulted in rapid and growing adoption. Thus, in the next few years, we will see near universal use of e-prescribing.
MU’s components include laboratory ordering and results, vaccine registries, PQRS reporting (formerly known as PQRI), and CCD/CCR generation. In addition, ONC has added a new interoperability standard, “Direct.” EPCS adds another new aspect. Each of these has its own complex architecture and data requirements. Over the next year, NewCrop will be expanding our capabilities to address aspects of Meaningful Use … and whatever else comes along. We are on top of it!
NewCrop began by connecting doctors to improve patient care. 10 years later, we find ourselves doing exactly the same thing. We invite you to join us as the adventure continues.