PQRI: E-Prescribing by Group Practices

2010 Electronic Prescribing Incentive Program –
Adoption/Use of Medication Electronic Prescribing Measure
GROUP PRACTICE REPORTING OPTION (GPRO) USE ONLY: Participation is limited to group
practices selected to participate in the Physician Quality Reporting Initiative (PQRI).
2010 GPRO REPORTING OPTIONS FOR THE ELECTRONIC PRESCRIBING (eRx) MEASURE:
• Claims-based Reporting
•

Qualified Registry-based Submission

•

Qualified EHR-based Submission – To report the eRx GPRO through a qualified EHR, refer to
the 2010 eRx EHR measure specification and instructions, located on the CMS Electronic
Prescribing Incentive Program website under “Alternative Reporting Mechanisms.”

THESE SPECIFICATIONS DO NOT APPLY TO REPORTING OPTIONS: INDIVIDUAL CLAIMS-BASED, INDIVIDUAL
REGISTRY-BASED OR INDIVIDUAL EHR-BASED.

IN ORDER TO REPORT THIS MEASURE, A QUALIFIED ELECTRONIC PRESCRIBING (eRx) SYSTEM
MUST HAVE BEEN ADOPTED.
DESCRIPTION:
Documents whether the eligible professional has adopted a qualified electronic prescribing (eRx) system
and the extent of use in the ambulatory setting. A qualified eRx system is one that is capable of ALL of the
following:
•
•
•
•

Generate a complete active medication list incorporating electronic data received from applicable
pharmacies and pharmacy benefit managers (PBMs) if available
Select medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts
(defined below)
Provide information related to lower cost, therapeutically appropriate alternatives (if any). (The
availability of an eRx system to receive tiered formulary information, if available, would meet this
requirement for 2010)
Provide information on formulary or tiered formulary medications, patient eligibility, and
authorization requirements received electronically from the patient’s drug plan (if available)

The system must employ, for the capabilities listed, the eRx standards adopted by the Secretary for Part D
by virtue of the 2003 Medicare Modernization Act (MMA).
INSTRUCTIONS:
In order to report this measure, a qualified eRx system that meets the above requirements must have been
adopted. The measure is to be reported for those patient visits that meet the denominator coding criteria for
which a selected group practice has electronically prescribed at least one prescription for a patient with
Medicare Part B. Denominator coding criteria for this measure includes various ambulatory care settings.
There is no specific diagnosis required for this measure. Selected group practices (using their Tax
Identification Number [TIN]) that generate and transmit at least one eRx associated with a patient visit on
2,500 or more occasions during the reporting period will be eligible for incentive payment.
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Measure Reporting via Claims:
Submit both a denominator CPT code and the numerator G-code on the claim. All measure-specific coding
should be reported ON THE SAME CLAIM (Faxes do not qualify as electronic prescribing).
Measure Reporting via Qualified Registry:
A denominator CPT code and an electronically generated and transmitted prescription (not faxed) are
required to report the measure.
REPORTING NUMERATOR:
A qualified eRx system (as specified above) has been adopted and the following G-code applies to the
patient visit
Numerator: eRx Quality-Data Code for Successful Reporting:
Prescription(s) Generated and Transmitted via Qualified eRx System
G8553: At least one prescription created during the encounter was generated and transmitted
electronically using a qualified eRx system
REPORTING DENOMINATOR:
Any patient visit for which one (or more) of the following denominator codes applies and is included on the
claim
Denominator Criteria (Eligible Cases):
Patient visit during the reporting period (CPT or HCPCS): 90801, 90802, 90804, 90805, 90806,
90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202,
99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308,
99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337,
99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109
RATIONALE:
Automation of the ambulatory prescribing process has many potential benefits including:
• Patient safety through computerized transmission of legible prescriptions directly to the pharmacy
and checks for harmful interactions
• Patient satisfaction in a process that results in fewer errors and less waiting time
• Avoidance of unnecessary phone calls for clarification between eligible professionals and
pharmacies
• Easier data collection of physician prescribing patterns and improved formulary compliance for
health plans, pharmacy benefit managers and employers
DEFINITIONS:
Electronic Prescribing (eRx) – The transmission, using electronic media, of prescription or prescriptionrelated information between a prescriber, dispenser, pharmacy benefit manager, or health plan either
directly or through an intermediary, including an eRx network. Electronic prescribing includes, but is not
limited to, two-way transmissions between the point of care and the dispenser. (Faxes do not qualify as
electronic prescribing).
Electronic Prescribing Event – For the purposes of this measure, an electronic prescribing event includes
all prescriptions electronically prescribed during a patient visit.

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Successful Group Practice Electronic Prescriber - Incentive Eligible – A successful group practice eRx
prescriber, eligible to receive an incentive payment, must report one or more eRxs associated with a patient
visit a minimum of 2,500 unique visits per year. Each visit must be accompanied by the eRx G-code
attesting that during the patient visit at least one prescription was electronically prescribed. Electronically
generated prescriptions not associated with a denominator eligible patient visit do not count towards the
minimum of 2,500 different eRx events. Additionally, 10% of the group practice’s Medicare Part B charges
must be comprised of the codes in the denominator of the measure to be incentive eligible.
Alerts – Written or acoustic signals to warn prescriber of possible undesirable or unsafe situations,
including potentially inappropriate dose or route of administration of a drug, drug-drug interactions, allergy
concerns, or warnings and cautions.
DME Supplies – Prescriptions for diabetic supplies may be electronically prescribed. Some pharmacies
may require additional documentation secondary to internal policies which may be mandatory in case of
audits; others may require a signed copy of the order with signature to be kept for verification purposes.
EVIDENCE SUPPORTING THE CRITERION OF THE QUALITY MEASURE:
Overall Evidence Grading: SORT Strength of Recommendation B: considerable patient-oriented evidence,
i.e., re: reduction of adverse drug events, reduction of unnecessary utilization, and improved patient safety,
but not consistently high quality evidence
Corley, S. T. (2003). "Electronic prescribing: a review of costs and benefits." Topics in Health Information
Management 24(1): 29-38.
Corley estimated cost savings from reduction of adverse drug events following implementation of electronic
prescribing.
Study quality level 2 (limited-quality patient-oriented evidence)
Hillestad, R., et al. (2005). "Can electronic medical record systems transform health care? Potential health
benefits, savings and costs." Health Affairs 24(5): 1103-1117.
This article concludes that two-thirds of the approximately 8 million adverse drug events that occur in the
outpatient setting would be avoided through the widespread use of computerized order entry (CPOE).
Study quality level 2 (limited-quality patient-oriented evidence)
Kohn, L., et al. (1999). To err is human: Building a safer health system. Washington, D.C., National
Academy Press.
This report concluded, from a case analysis, that there is supporting evidence to show that adverse drug
events (ADE) resulted in an increase in physician office and emergency department visits, and of those
physician office visits, more than 50% were “judged to be unnecessary and potentially avoidable.”
Additionally, the report stated, “Physicians do not routinely screen for potential drug interactions, even
when medication history information is readily available.”
Study quality level 2 (limited-quality patient-oriented evidence)
Middleton, B. (2005). The value of health information technology in clinical practice. Pennsylvania eHealth
Initiative, Harrisburg.
Dr. Middleton discusses the value of ambulatory computerized order entry (ACPOE). A model was
developed based on data derived from HIT implementation in the Partners Healthcare System. When
applied nationally, this model predicts a potential savings of $44 billion and the prevention of 2 million
adverse drug events per year.
Study quality level 2 (limited-quality patient-oriented evidence)
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Shekelle, P., Morton, S., Keeler, E. (2006). Costs and benefits of health information technology. Evidence
Report/Technology Assessment, AHRQ. 132.
Electronic prescribing is widely believed to improve accuracy of the prescription process and thereby
reduce potential for medical errors and increase health care quality. Shekelle et al. observe that EMRs with
electronic prescribing improve patient safety by reducing adverse drug events in the inpatient setting.
Study quality level 2 (limited-quality patient-oriented evidence)
Bell, D. S., Friedman, M. A. (2005). "E-Prescribing and the Medicare Modernization Act of 2003." Health
Affairs 24(5): 1159-1169.
This article discusses the potential impact that e-Prescribing could have on improving patient safety by
decreasing adverse drug events (ADE) as well as the cost benefits
Roland, M. O., et al. (1985). "Evaluation of computer assisted repeat prescribing program in a general
practice." British Medical Journal (Clin Res Ed) 291(6493): 456-458.
Roland et al. showed that EMRs with electronic prescribing saved provider time and reduced costs.
Schade, C. P., et al. (2006). "e-Prescribing, efficiency, quality: Lessons from the computerization of UK
family practice." Journal of American Medical Informatics Association 13(5): 470-475.
General practitioners in the UK generally report improved practice efficiency using computerized
prescription systems.
Teich, J., et al. (2004). Electronic prescribing: Toward maximum value and rapid adoption. eHealth
Initiative, Washington, D.C.
In 2004, the Electronic Health Initiative published a study of e-Prescribing concluding that it could improve
safety, quality, efficiency, and cost of medical care.

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