Improving Care Quality using ePrescribing: CancelRx

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Electronic prescribing (ePrescribing) is ubiquitous, but there is still room for improvement. Many, including RAND researchers, put the CancelRx transaction at the top of the list, because of its implications for patient safety, care quality and cost savings. One study showed that 1.5% of medications that were discontinued by prescribers were subsequently dispensed. These prescriptions can result in adverse patient outcomes, with patients continuing to receive refills of medications that were cancelled by their physician.

The clinical challenge is compounded by the use of automatic refill. For patient convenience, many pharmacy systems automatically refill prescriptions. Without a computerized method for the prescriber to notify the pharmacy of discontinuation, many cancellations are never sent to the pharmacy. The result: so-called “zombie” prescriptions that never die because the prescribing and dispensing systems do not coordinate. Patients end up picking up these unnecessary prescriptions – driving up cost –  and taking the medications, adversely affecting outcomes and care quality.

The solution is CancelRx, an electronic message sent via the prescriber’s electronic health record (EHR) to the pharmacy to cancel a previously written prescription which has remaining refills. Electronic Data Interchange (EDI) standards to support the ability to electronically discontinue a prescription have been around for a while. The Medicare and CHIP Reauthorization Act (MACRA) requires that EHRs support the ability to cancel prescriptions using the NCPDP SCRIPT v10.6 EDI standard.

While MACRA requires that the EHR support CancelRx, there is no mandate that prescribers use it or that pharmacies receive or process these messages. To make a difference, widespread use of CancelRx must be initiated. Several actions could be taken:

  • Prescribers need to be educated about the availability of CancelRx and the MACRA requirements for its use, and the potential benefits, especially as healthcare delivery evolves to quality-based reimbursement.
  • Prescribers and pharmacies can put pressure on their technology providers to incorporate CancelRx into their respective systems.  Vendors respond to the squeaky wheel.

The value of ePrescribing will be more fully realized through use of value-add EDI transactions such as CancelRx. The quality and safety of health care demand taking ePrescribing to the next level.