Objective 4: Electronic Prescribing (eRx)

What the objective requires   What that means for you   Are you excluded from having to do this?
Generate and transmit permissible prescriptions electronically (eRx).  

More than 50 percent of permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.

  

Any EP who meets one of the following criteria:

  • Writes fewer than 100 permissible prescriptions during the EHR reporting period; or
  • Does not have a pharmacy within his or her organization, and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his or her reporting period.

If you will be writing prescriptions during the reporting period, you must have the e-prescribing version of CTRx. When you sign up for CTRx, select the e-prescribing version of the service.

Follow the instructions under Objective 3: CPOE for Medication, Lab and Radiology Orders to record a patient medication order and to prescribe medication. 

The steps to complete this measure are almost the same as to complete Objective 3, Measure 1 with one key difference: when completing your prescription order, you must send the new prescription to the pharmacy electronically.

To count this activity toward your compliance with Objective 4: E-Prescribing, you must transmit the new prescription to the pharmacy electronically.

  1. After you've generated your prescription, locate it under the Pending Prescription heading.
  2. Click either the Send button or the Send and Print button below the Signature Password field.
    • Send—Transmits the prescription to the pharmacy electronically.
    • Send and Print—Transmits the prescription to the pharmacy electronically and prints out a copy of the prescription for your records
      .
  3. Close the CTRx service. When you click the Calculate button in the EHR Dashboard application, the software will reflect your progress toward Objective 4 compliance on the EHR dashboard under e-Prescribing (eRx).

Permissible Prescriptions – “Permissible prescriptions” may include or not include controlled substances based on provider selection and where allowable by state and local law.

Prescription – The authorization by an EP to a pharmacist to dispense a drug that the pharmacist would not dispense to the patient without such authorization.

Use this equation to determine whether you meet the attestation requirement.

Numerator ÷ Denominator = Result
The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using CEHRT  

The number of permissible prescriptions written during the EHR reporting period for drugs requiring a prescription in order to be dispensed.

  

The resulting percentage must be more than 50% in order for an EP to meet this measure.

 

You can claim an exclusion if you are an EP who:

  • Writes fewer than 100 permissible prescriptions during the EHR reporting period; or
  • Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EPs practice location at the start of his/her EHR reporting period.

The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology (CEHRT).

Authorizations for items such as durable medical equipment, or other items and services that may require EP authorization before the patient could receive them, are not included in the definition of prescriptions. These are excluded from the numerator and the denominator of the measure.

Instances where patients specifically request a paper prescription may not be excluded from the denominator of this measure. The denominator includes all prescriptions written by the EP during the EHR reporting period.

As electronic prescribing of controlled substances is now possible, providers may choose to include these prescriptions in their permissible prescriptions where feasible and allowable by state and local law.

An EP needs to use CEHRT as the sole means of creating the prescription, and when transmitting to an external pharmacy that is independent of the EP's organization such transmission must use standards adopted for EHR technology certification.

EPs should include in the numerator and denominator both types of electronic transmissions (those within and outside the organization) for the measure of this objective.

For purposes of counting prescriptions "generated and transmitted electronically," we consider the generation and transmission of prescriptions to occur concurrently if the prescriber and dispenser are the same person and/or are accessing the same record in an integrated EHR to creating an order in a system that is electronically transmitted to an internal pharmacy.

Providers can use intermediary networks that convert information from the certified EHR into a computer-based fax in order to meet this measure as long as the EP generates an electronic prescription and transmits it electronically using the standards of CEHRT to the intermediary network, and this results in the prescription being filled without the need for the provider to communicate the prescription in an alternative manner.

Prescriptions transmitted electronically within an organization (the same legal entity) do not need to use the NCPDP standards. However, an EP's EHR must meet all applicable certification criteria and be certified as having the capability of meeting the external transmission requirements of §170.304(b). In addition, the EHR that is used to transmit prescriptions within the organization would need to be CEHRT. For more information, refer to ONC’s FAQ at http://healthit.hhs.gov/portal/server.pt/community/onc_regulations_faqs/3163/faq_22/21286.

Providers may limit their effort to query a formulary to simply using the function available to them in their CEHRT with no further action required. If a query using the function of their 3 CEHRT is not possible or shows no result, a provider is not required to conduct any further manual or paper-based action in order to complete the query, and the provider may count the prescription in the numerator.

EPs practicing at multiple locations are eligible for the exclusion if any of their practice locations that are equipped with CEHRT meet the exclusion criteria.

EPs who are part of an organization that owns or operates its own pharmacy within the 10 mile radius are not eligible for the exclusion regardless of whether that pharmacy can accept electronic prescriptions from EPs outside of the organization.

In order to meet this objective and measure, an EP must possess the capabilities and standards of CEHRT at 45 CFR 170.314(b)(3) and (a)(10).