MA-SHARE: e-Prescribing Utility Boosts Massachusetts’ Rx Standards

Massachusetts leads the United States in the electronic prescribing of medication, and CSC-designed Rx Gateway is an important part of this success.

Rx Gateway is a community utility that avoids errors and reduces costs by replacing paper, phone and fax-based prescription processes. It connects physician, insurance and pharmacy computer systems via national and regional prescription data delivery services, eliminating expensive point-to-point interfaces.

Using Rx Gateway, doctors can see a patient’s drug history, avoid adverse drug events, prescribe the least costly drug available through the patient’s insurance, and route the prescription directly to the patient’s pharmacy of choice.

“CSC built something of great value in Rx Gateway,” says John Halamka, M.D., chief information officer of Harvard Medical School and chief executive officer of MA-SHARE, LLC, which coordinated and funded the Rx Gateway project. “CSC took a long-term approach in how it partnered with the community. We trust CSC to execute, and that’s why we keep giving them work.”

Diagnosing a problem

From the moment a doctor scrawls out a prescription to the moment a pharmacist hands the medication to the patient, the traditional prescription process is slow and open to mistakes.

These mistakes cost lives and dollars. A July 2006 report by the Institute of Medicine estimates that at least 1.5 million Americans suffer adverse drug events each year. The same report asserts that one in every 131 ambulatory patient deaths can be attributed to a medication error. The eHealth Initiative estimated in April 2004 that the financial benefits of e-prescribing in the United States would be $2.9 billion annually.

These catalysts spurred MA-SHARE, a consortium of Massachusetts healthcare stakeholders, to partner with CSC and facilitate e-prescribing. According to Halamka, CSC’s previous work on the New England Healthcare Electronic Data Integration Network, or NEHEN, provided the foundation for the Rx Gateway project.

Prescription: two doses of SOA

NEHEN got its start in the mid-1990s with the passage of the Health Insurance Portability and Accountability Act (HIPAA) by the U.S. Congress. IT companies began competing to enable standards-based healthcare data exchange.

“We convinced five clients in Massachusetts to let us build an online healthcare network for them,” says Greg DeBor, a CSC health solutions partner. “That network grew into NEHEN, which has been self-sustaining since its launch in 1997.”

NEHEN’s purpose was to connect insurer, hospital and physician systems with each other and with state systems for care, reimbursement and billing. Before choosing CSC for the project, stakeholders considered complicated solutions costing as much as $50 million.

CSC’s approach — based on service-oriented architecture (SOA) — cost just $1 million to build. NEHEN now facilitates between four and five million insurance transactions a month, serving more than half the hospitals in Massachusetts and upwards of 10,000 office physicians. The network, designed to facilitate medical procedures and referrals, drove down the cost of insurance transactions from $5 to 25 cents each.

“Several of the organizations that benefited from the success of NEHEN decided to build a similar exchange for e-prescribing,” says Gail Fournier, a CSC health solutions partner. NEHEN became the model for MA-SHARE, which initiated the Rx Gateway project in 2005.

A healthy system

CSC completed Rx Gateway on time and on budget. MA-SHARE launched Rx Gateway pilot programs at Beth Israel Deaconess Medical Center in 2006 and later at the Partner HealthCare System, both in Boston.

Due in large part to the e-prescription traffic generated by Rx Gateway, Massachusetts won top honors in the 2007 Safe-Rx Awards. Massachusetts achieved the highest percentage of electronically delivered retail prescriptions of any state, as measured by the nation’s largest pharmacy-based data exchange service, SureScripts.

Key features of Rx Gateway led to this success. The utility doesn’t require significant changes to participating systems, some of which date from the 1970s, saving stakeholders millions of dollars. It also enables MA-SHARE to manage the interrelationships of its network participants, who only need to sign one agreement — with MA-SHARE — rather than separate agreements with all of the parties with whom they exchange data. “The Rx Gateway customer avoids the cumbersome and expensive process of managing the technology and relationships through a large number of point-to-point interfaces,” says Fournier.

The effectiveness of the Rx Gateway and NEHEN infrastructure has led to a third project in Massachusetts, supporting an even broader exchange of clinical data. Six more hospital organizations and two large physician groups have joined the original Rx Gateway participants to share summary patient care records with all providers treating a particular patient and with state and municipal public health agencies. In addition to helping the provider organizations comply with federal standards, this project will help them earn Medicaid and Medicare incentive payments for meaningful use of electronic health records.