US20090157424A1 - Multi-path electronic prescription processing system - Google Patents

Abstract

An electronic prescription processing system which is capable of direct two-way electronic communication between the physician and the pharmacist, in one example, uses a multi-path clearinghouse between the physician's office practice management system and a pharmacy computer system. In one example, the multi path electronic prescription processing system allows a physician to create electronic prescriptions using an electronic signature, and using the multi-path clearinghouse, allow for interface with the pharmacy computer system such that an image of an electronic prescription and prescription information are directly auto-populated into an entry screen of the pharmacy computer system.

Description

REFERENCE TO RELATED APPLICATIONS
• This application claims the benefit of the filing date of U.S. Provisional Patent Application No. 61/014,218 filed Dec. 17, 2007, the disclosures of which are hereby incorporated herein by reference.
FIELD OF THE INVENTION
• The field relates to electronic prescription systems.
BACKGROUND
• Currently, many pharmacists or technicians contact the physician directly through telephone or facsimile, if they have questions with a particular prescription but such a process is time consuming and can be expensive.
• U.S. Pat. No. 5,883,370, describes how the physician writes a prescription by entering the prescription into a computer which prints out a bar-coded prescription that may be taken by the patient to the pharmacy, or a future modem path, which would enable the physician to send the prescription directly to a particular pharmacy computer. However, the pharmacist would have to scan the bar code on the prescription and manually enter the prescription into the pharmacy computer or scan the prescription slip bar code into the pharmacy computer directly and the system described is only a one-way system, from the physician to the pharmacist, as disclosed in col. 5, Ins. 16-27. Prior art systems, such as the one described in this reference, do not provide for seamless, automated two-way communications between a prescriber and a pharmacist, however.
• U.S. Pat. No. 7,072,840, describes a prescription generation system where patient-identifying data, prescribed drug identification data, drug quantification data, and other prescription information are entered, which are then used to create a prescription. The system does not provide for seamless, automated two-way communications between a prescriber and a pharmacist, and the system has no way of notifying a prescriber if a particular drug in a drug formulary is available at a pharmacy or the price of the drug or the cost of the drug to the patient and/or the patient's insurance company.
SUMMARY OF THE INVENTION
• An electronic prescription processing system is capable of two-way electronic communication between a physician and a pharmacy or pharmacist. The system may use a multi-path clearinghouse between the physician's office practice management (OPM) system and a pharmacy computer system. A physician may create electronic prescriptions using an electronic signature. An interface is provided with a pharmacy computer system such that an image of an electronic prescription and prescription information may be directly auto-populated into an entry screen of a pharmacy computer system for checking and fulfilling prescriptions. In addition, the system processes communications between the pharmacy and the physician's OPM system. A pharmacist may query the physician's office, without any need to speak with the physician or staff by telephone. Preferences may be entered into the processing system for messages internal to the processing system or for notifications by email, text messages, instant messages and the like. The physician's office may respond to individual messages or may batch process a plurality of communications.
• In one example, an electronic prescription processing system includes at least one pharmacy system connected to a network capable of two-way digital communications between a plurality of physician office practice management systems and the at least one pharmacy system. The at least one pharmacy system displays an image of the information entered as an electronic prescription by a prescriber using one of the plurality of physician office practice management systems on a display and the information entered as an electronic prescription is auto-populated in entries for a prescription entry screen of the at least one pharmacy system. In one example, a clearinghouse is electronically disposed between physicians' office practice management systems and computer systems for a plurality of pharmacies. One advantage of using a clearinghouse is that each pharmacy system may query, electronically, any of the prescribers, seamlessly and automatically, without speaking by telephone, to resolve questions about the electronic prescription. A multi-path clearinghouse automatically correlates the query with an answer from the prescriber, such as using a unique. query identifier, when a prescriber of one of the plurality of physician office practice management systems responds to the query from the at least one pharmacy system.
• In one example, a clearinghouse system correlates each of the queries with each of the answers from the prescriber, when the office management systems responds to the pharmacy using a batch process for answering a plurality of queries from one or more pharmacies. A single electronic transmission from the office management system to the clearinghouse may be used to communicate with a plurality of pharmacies, for example.
• In one example, the clearinghouse provides access to information from a drug file database from one or more pharmacy systems. Then, a prescriber has access to drug inventory and prices, immediately, and can discuss with the patient whether a lower cost alternative that is pharmacologically equivalent or acceptable as an alternative is desired, rather than a more expensive alternative. In another example, a lower cost pharmacy may be recommended within a reasonable distance from the patient's preferred pharmacy. For example, the clearinghouse is capable of automatically providing notification to the prescriber of alternative prescription items available at at least one pharmacy and the alternative pricing, and the clearinghouse allows the prescriber the opportunity to substitute an alternative prescription item or alternative pharmacy, electronically, in response to a query generated by the prescriber's system for entry of an electronic prescription. For example, a clearinghouse system may notify the prescriber, or may provide to the prescriber's system for notifying of the prescriber, generic equivalents available at a pharmacy or an alternative pharmacy, together with pricing information, such as cost to the patient and/or the patient's insurance company.
• In one example, the clearinghouse automatically provides notification to the prescriber of a recalled drug or information that a drug is not recommended for the indications entered into the prescriber's practice management system or electronic health record of the patient. Alternatively, a pharmacy system may provide such information to a physician, either automatically or using an automated, two-way communication protocol between the pharmacist and the prescriber. In addition, a clearinghouse automatically may provide a suggestion of an acceptable alternative to the recalled drug or a drug not suitable for treating a patient with the indications indicated in the patient's electronic health records. The clearinghouse may provide the prescriber an opportunity to substitute the at least one acceptable alternative of a recalled drug, electronically, in response to a query, for example. Alternatively, the query may originate from a pharmacy system upon receipt of a prescription from the pharmacy system.
• In one example, an electronic prescription processing system verifies the identity and authority of the prescriber to enter the electronic prescription using an electronic signature, biometric data, a password or a combination thereof. For example, the clearinghouse may be used to authenticate the prescriber using an electronic signature. In another example, a biometric data reader may be used to capture biometric data of a prescriber, and the electronic prescription processing system, the clearinghouse or the pharmacy system uses the biometric data of the prescriber to authenticate a prescription or a change to a prescription authorized by the prescriber. For example, after a prescription is authenticated by the electronic prescription processing system, the information may be encrypted for transmission to a pharmacy system, such as by a standard public key encryption system, which may be decrypted by the clearinghouse and/or the pharmacy system using a private key, for example.
• In one example, an interface system may be coupled to a physician's office management system, such that the interface system couples the office management system to the clearinghouse and/or the pharmacies' systems, wherein two-way communications are established with the interface system. The interface system is coupled to a data input and editing device and a display, for example. The data input and editing device may include a keyboard, a voice recognition system, a pointing device, a touch screen, a bar code reader, a scanner or a combination thereof, for example.
• In one example, an insurance formulary from an insurance company or a government insurer is maintained in a clearinghouse, a physician office practice management system, an interface system, or a pharmacy system, and the system is capable of notifying the prescriber, automatically, if a particular prescribed item is not included in the at least one insurance formulary. Then, the system may provide one or more acceptable substitutes for selection by the prescriber, for example.
• In one example, the system includes a database, and all queries and answers to the queries are stored in the database and are tracked, such as within a database of a pharmacy system, for example. An alert may be provided automatically to a prescriber, a pharmacist and/or the clearinghouse, if the prescriber and/or the pharmacist does not timely reply to a query or response in the system, for example. Thus, unnecessary delays may be greatly reduced by managing the timeliness of responsed in the system. For example, the system may present an alert to a pharmacist responsible for processing the prescription, automatically, via the pharmacy system, after receipt of an answer from the prescriber to the query by the pharmacist or the pharmacy system.
• A method of processing an electronic prescription uses the electronic prescription system to fill prescriptions after installing pharmacy systems and physician practice management systems and/or interfaces, which are each coupled to a clearinghouse, for example. The system is capable of storing an image of a prescription together with auto-populated fields relating to the image of the prescription in a database, and transmits such information from physician office practice management systems to the pharmacies, such as by using the clearinghouse. The pharmacies systems receive the information, which may be stored in a pharmacy database, for processing and filling of a prescription. The information may be displayed on a display of a pharmacist such that the pharmacist is capable of verifying the auto-populated fields of the information in the database against an image of the prescription, for example. A two-way communication protocol for the pharmacist to electronically query a prescribing prescriber about the prescription and for the prescribing prescriber to provide the pharmacy system with an answer to the query is provided by the system. Querying the prescribing prescriber and receipt of answers to the query is seamless and automatic, providing the pharmacy system with the answer to its specific query, automatically notifying the pharmacist who made the query, or another pharmacist, of the receipt of the answer from the prescribing prescriber.
• According to one example, the method may automatically provide for verification and authentication of the prescriber and may be used for verifying that the prescription is ready to be filled. The system may automatically monitor the time elapsed between the time that the query is made and receipt of an answer and may flag delays. For example, a level of urgency may be increased if the answer is not received timely. For example, an elapsed time of two hours without receipt of an answer may prompt notification of the prescriber of a degree of urgency in answering the query. In one example, the alert includes a visual alert on the physician office practice management system. The alert may include sending an email, contacting a cellphone number or activating a pager, for example. Preferably, the method of alerting should allow the physician to respond, seamlessly and automatically, by selecting an answer or by providing comments in a response, and the system will match the response to the respective query, providing an answer to the pharmacist. For example, an email flagged as urgent may provide a selection of yes/no for responding to the query, and wherein selecting yes or no from the selection provides a response to the query, transmitting the response to the pharmacist or another pharmacist.
• One advantage of the electronic prescription system that it allows a physician to use a drug file of an intended pharmacy such that auto-population occurs when the pharmacy receives information from a physician's office. This reduces transcription errors and eliminates transcription costs.
• An additional advantage is that once the physician determines which pharmacy the patient uses, the physician may use the actual uploaded drug file information from the selected pharmacy when choosing the patient's medication. Yet another advantage is that the doctor and patient may be informed about the cost of a prescribed medication to the patient and may be provided with lower cost alternatives.
• Another advantage is there is no need to have a pharmacy point of sale computer because the electronic prescription system is capable of going directly to and from the physician's practice management system and the pharmacy computer system. All of the normal checks and verifications, such as checking multiple prescriptions for a patient having known adverse interactions may be checked on the pharmacy's computer system. Another advantage is that needless phone calls may be avoided, allowing the pharmacist's question to be resolved, and allowing the prescription to be dispensed.
• Another advantage is that failure of a physician to timely response, such as within two hours, to a query may flag a query as having an increased urgency. Yet another advantage is that the system may alert a physician of an urgent query, such as by an audible, vibrational, visual or other alarm.
• Yet another advantage is that the electronic prescription system allows for a two-way communication between the physician and the pharmacist. Yet another advantage is that the need for technician support and the chances of a prescription error are reduced especially errors in communication and transcription of prescriptions
• Still another advantage is the electronic prescription system allows physician to enter necessary prescription information, reducing errors caused by handwritten prescriptions. Another advantage is a secure system using an electronic signature avoiding prescription fraud. Still another advantage is that an image of the electronic prescription may be directly displayed on the pharmacist computer screen along with the auto-populated information which is found on the prescription entry screen.
• An additional advantage is that the auto-population process is integrated into the system and connects directly to the pharmacy computer system, including access to drug files, listing all the drugs which the specific pharmacy uses, including specified generics. Additionally, the drug file may be constantly updated including recall or advisory notices that the physician might not otherwise be aware of. Still another advantage is that the system identifies preferred drug switches and sends such information to the physician for a possible switch before the physician even sends out an electronic prescription.
BRIEF DESCRIPTION OF THE FIGURES
• FIG. 1 depicts an example of an electronic prescription processing system process.
• FIG. 2 shows another example.
• FIG. 3 illustrates an example of an electronic prescription.
• FIG. 4 shows an example of a known prescription process.
• FIG. 5 shows an example of a pharmacy processing a prescription using an example of an electronic prescription processing system.
• FIG. 6 displays an example of a pharmacist computer screen.
DETAILED DESCRIPTION
• The examples described and the drawings rendered are illustrative and are not to be read as limiting the scope of the invention as it is defined by the appended claims. In the drawings, lines of communication are shown by arrows that indicate direction. In each case, the same mode of communication may be used for sending and receiving electronic information or different modes may be used for such as internet, text message, instant message, dial-up access and the like, for sending or receiving electronic information.
• The term “physician” is not limited only to a medical doctor, as used herein, but is used broadly to describe any prescriber of medications or other prescription items, such as prescription medical equipment, biologics and the like. The term physician may include a medical doctor, dentist, psychiatrist, surgeon, or the like. The term “physician's office” is intended to include a physician and staff or a physician practice and staff. The term “pharmacy” is intended to include a pharmacist and staff or a pharmacy including at least one pharmacist and staff.
• InFIG. 1, a plurality of physician's offices may have a computer system which has a type of software used to create prescriptions, billing, patient profiles, etc., which is referred to as an office practice management (OPM) system. An OPM system is connected to the Internet another system for effectively communication with the electronic prescription processing system.
• In one example, as illustrated inFIG. 1, a plurality ofOPM systems100 are electronically coupled to aclearinghouse116, such as by a network such as the internet, forexample OPM system104 is integrated with an electronic prescription processing system. TheOPM system104 may be a third party system licensed for use by the physician's office. Aconnection112 electronically couples theOPM system104 to aclearinghouse116. Communication between theclearinghouse116 and theOPM system104 occurs via clearinghouse connection128, for example. Thesame connection112 that is used for coupling theOPM system104 to theclearing house116 may be used for two-way communication between the physician's office and the pharmacy, for example.
• In one example, a physician purchases or licenses ailOPM system102 that has an integrated electronicprescription processing system120 of a pharmacy, for example. Anotherconnection134, as shown inFIG. 1, couples aclearinghouse116 to anotherOPM system102, and adifferent connection114 couples thesame OPM system102 to theclearinghouse116. Theelectronic connection114,134 may be used for two-way communication between theOPM system102 and theclearinghouse116, for example.
• In another example, an existing physicianpractice management system106, which is not integrated with an electronic prescription processing system, uses an import/export interface with aninterface system108, which may be a stand alone terminal, a virtual machine, or an independent process operating on the same computer system as the OPM system. Aninterface connection110 couples theOPM system106 with theinterface system108, which may include two-way communication between theOPM system106 and theinterface system108. In one example, a physician's office uses a stand alone terminal108 to access the electronic prescription system'sclearinghouse116 without the use of anyOPM system106.
• Aninterface system108 may be coupled to aclearinghouse116 byinterface connections132,144, which may use the same channel of communication or different channels, provided that electronic information is passed without human intervention. Digital communication of information and queries are sent electronically avoiding transcription errors, for example.Electronic connection144 couples theclearinghouse116 to theinterface system108, using the internet, for example. Alternatively, a single electronic connection may be used for two-way communication. The interface system may be coupled, directly or indirectly, to a data input and editing device and a display, such as a voice recognition system, a keyboard, a pointing device, a touch screen, a bar code reader, a scanner or a combination of these, for example.
• Apharmacy connection124 couples apharmacy computer system120 to theclearinghouse116. Electronic communication between amulti-path clearinghouse116 andpharmacy computer system120 occurs viaelectronic connection118, for example. In one example, a plurality of pharmacies are coupled to asingle clearinghouse116. In one example, a pharmacy is selected by a patient and/or the physician's office according to availability, price, location or other criteria.
• Anotherpharmacy connection126 couples apharmacy computer system120 to a point ofsale system122 where prescriptions are entered or dispensed. In this example, aninternal pharmacy connection126 is shown as a single two-communication path126 such as an intranet, an extranet, a wide area network or another private data network. Alternatively, two or more electronic connections may be used, such as the internet or phone lines, power lines, transmitters/receivers, or the like. Information may be secured by encryption during transmissions.
• Information, such as patient name, address, insurance information, physician information, and the like, may be entered into any system such as those shown for the OPM systems and/orinterface systems100. Prescription in format may be entered by a point of care physician, for example. In one example, a drug file from apharmacy120 is uploaded to theclearinghouse116 and is sent to the appropriate practice management system that a point of care physician is using, such as anOPM system102,104,106 for example. When a physician's office chooses one or more pharmacies as preferred pharmacies, the physician may have access to the pharmacy drug files, including a list of drugs and generic drugs dispensed by each of the preferred pharmacies, and prices, for example.
• Once a particular drug and a pharmacy is selected, then an electronic prescription (e-script) is created. For example, the e-script may include animage300, a physician electronic signature, biometric data, electronic information identifying the pharmacy, the specific drug or drugs prescribed, patient insurance information, and the like. The physician may review and send the e-script using one of the systems to aclearinghouse116. For example, theclearinghouse116 forwards the e-script to the selectedpharmacy computer system120 that is selected by the physician/patient.
• Theclearinghouse116 is capable of uploading pharmacy drug files and preferred medications on specific drug plans. The drug files provide the electronic prescription processing system with the ability to notify the physician of suitable alternatives that are included in the patient's drug plan or are available at a reduced cost to the patient, allowing the physician and patient to interchange medications in the same drug category, for example. Once the electronic prescription has been routed to the correct pharmacy computer system, the prescription information may be auto-populated on an existing pharmacy prescription entry screen of the pharmacy computer. The auto-populated screen may contain all the fields used by the pharmacy to process a prescription including an e-script image so that the pharmacist could verify the populated fields against an image of the electronic prescription. Since the physician uses the drug file with the same generics that the pharmacy has or utilizes a brand name drug that could be changed to a generic drug if allowed by the physician, the prescription dispensing would continue as if a pharmacy technician imaged a prescription and entered the appropriate drug file information, without the chance of inadvertent transcription errors, for example. For legal purposes, the electronic prescription with the electronic signature may be printed in the pharmacy and identifying marks (i.e., bar codes) may also be printed for filing. In addition or alternatively, biometric data or an encrypted code, entered by a prescribing physician, may be used to verify the authenticity of the prescription. The electronic prescription system is capable of uploading drug formulary of pharmacies and approved drug formulary of other third parties, such as managed care plans, insurance companies, Medicare and the like. Accordingly, the drug formulary may be patient-specific, depending on which pharmacy and insurance company the patient uses, for example.
• If there are questions about the prescription or how the prescription affects the patient, such as drug interaction, a particular prescription being filled too soon, duplicate therapy, managed care issues and other issues, the physician may need to be contacted by the pharmacist. The pharmacist may use the system to communicate directly with the prescribing physician, such as typing a question in acomment field628, as shown inFIG. 6. Then, the information and question may be routed using the system to the physician via theclearinghouse116 or directly. The physician may resolve the issue and send back information to thepharmacy system120 for review by the pharmacist. The pharmacy may fill the prescription, which is delivered to the patient. In one example, a point of sale system is notified of the status of a prescription on hold for information from the physician. While transcription errors and human error are eliminated, surprisingly, costs are reduced, also, compared to the known system ofFIG. 4, for example. Cots that may be reduced include insurance costs, patient costs, costs of filling prescriptions by pharmacies, malpractice insurance costs, and the like. In addition, prescription drug prices, may be reduced by increasing awareness of suitable alternatives and generic equivalents of more expensive drugs.
• One advantage of the system is HIPAA compliance. The only sharing or exchange of patient identifying information is that required to fill the prescription. Communications between a pharmacist and a physician may be securely encoded, for example. In addition, the pharmacist has the ability to verify patient profile and send in questions to physician's office in order to safely dispense medications without undue delays caused by telephone inquiries. This eliminates the need to call the physician directly, which is a time consuming and costly process that substantially delays filling a prescription. Furthermore, questions may be queued up in a physician's computer, which may be accessed at any time by the physician. Accordingly, the physician's office may answer questions by pharmacists and return answers efficiently as a batch process using the system. In this way, delays in filling prescriptions may be reduced and costs of telephone inquiries eliminated, without interrupting point of care services.
• In one example, a communication from apharmacy computer system120 is routed through aclearinghouse116. Unlike known systems, the pharmacy communicates back with the physician using the system. Because of this two way communication feature, communications are improved, costs are reduced and errors reduced. Aclearinghouse116 may upload information about medications, which may be used to notify physician/patient about drugs available at a pharmacy from a pharmacy computer system and/or reimbursed by a specific insurance plans according to an insurance formulary. The system may identify generic equivalents and may provide a mechanism for switching to a preferred drug based on suitable indications, price, availability or a combination of these, for example. Theclearinghouse116 may identify these preferred drugs and may present such information to the physician's office in a standardized electronic form for the physician and/or patient to consider as a better alternative, such as a more suitable alternative for indications or a less costly alternative, for example. Such information may be queued on the physician's office and accessed at the convenience of the physician. If the physician selects an alternative or prefers not to select an alternative, such information may be transmitted to the pharmacy using the system. In one example, this all occurs as the physician is preparing and reviewing the e-script, prior to transmitting the e-script to the pharmacy. In another example, the system automatically provides alternatives after the e-script is received by the clearinghouse but prior to receipt by the pharmacy. The physician may consider if the alternatives are acceptable and may confirm substitution of an alternative prescription, easily. This eliminates phone calls and a wasting of a pharmacist's time, and also has the potential of saving substantial health care costs. Alternatively, messages from and to the physician/pharmacist may be queued up and accessed at a later time. This batch processing improves convenience and has the potential of increasing efficiency. In one example, the pharmacy system may automatically provide suitable alternatives for selection by a physician, based on lower cost, availability, or indications, for example.
• InFIG. 2, an example of a plurality ofOPM systems100 are illustrated, schematically. Anintegrated OPM system102 is an example of a computer system having a practice management system that has an electronic prescription processing system built into it. The integratedpractice management system102 meets multiple office needs (i.e., billing, storing of patient information, appointment schedules, etc.). The vendor of the OPM system incorporates the electronic prescription processing system integrally with these other functions, providing an integrated software package.
• AnotherOPM system104 is operable with an electronic prescription processing system, seamlessly, but the electronic prescription processing system operates as a separate program either accessing the same database, such as an SQL database, or communicating information to an from theOPM system104. Such asystem104 would license an electronic prescription processing system utility that is installed together with theOPM system104.
• Apreexisting OPM system106 may be an older system that is not capable of integrating or communicating with an electronic prescription system directly, for example. Instead, the pre-existing OPM system may communicate110 with aninterface system108. Theinterface system108 may capable of extracting data from thepre-existing OPM system106 and transferring e-script and other communications of the electronic prescription processing system to a pharmacy. Alternatively, theinterface system108 may be used as a stand alone system.
• InFIG. 3, one example of an image onelectronic prescription300 is schematically represented. For example, aname field302 displays the name of the sender, such as a physician.Issue date field304, for example, is the location the issue date.Doctor information field306, describes the doctor's name, address, DEA number, and fax number, for example. Patient data field308 describes the patient's name, address, date of birth, insurance company, insurance group, and insurance ID number, for example. Drug data field310 illustrates the drug name and strength.Drug amount field318 shows the drug quantity to be dispensed.Prescribed usage field312 provides instructions for the use of the medication.Refill data field320 indicates refills.Signature field314 shows an electronic signature by the physician, which is accepted in most states as a valid prescription. In addition, biometric data or a password may be required to authenticate a valid prescription and to reduce counterfeit and fraudulent prescription.Substitution authorization fields316 and322, respectively illustrate that the pharmacist may substitute or may not substitute an equivalent for the prescribed medication.Rx ID field324 depicts the prescription ID mark. In one example, the Rx ID mark/field324 includes a barcode.
• InFIG. 4, an example of a conventional process is shown. Doctor'soffice400 includes adatabase402, and apractice management system404. Such a system transmits info to the pharmacy via steps406 or434. For example in step406, the written prescription may be brought in by the patient, or may be mailed, a facsimile may be transmitted of the image of the scrip or otherwise transmitted. In another example, through step434, information relating to prescriptions may be communicated to a pharmacy by telephone, telephone network, fax or e-mail without an image of the written scrip. Regardless, either method requires a human to enter the information into the pharmacy system, which is prone to transcription errors, and is time consuming, inefficient, and leaves opportunities for errors to occur,
• The data entered from the prescription is transmitted408 by thepharmacy system110, which includes apharmacy database430. The actual written prescription is received412 by the pharmacy and is then scanned414 by the scanning department creating image of the prescription in the computer system. The header entry department enters pertinent information such as physician's name, office information, patient name, insurance information and any other type of information to identify the patient into thepharmacy computer416, which may be recorded in thedatabase430. The drug name, strength, quantity, refills, generic indication, brand indication, and directions are entered418 by a pharmacy technician.
• The pharmacist verifies420 and then dispenses422 the prescription. In theverification process420, the pharmacist may need to call thedoctor428, conductdrug utilization review426, or contact the managedcare department424, if there is managed care issue. Thepharmacy contacts432 the appropriate office or physician when there are issues about theprescription428, adrug utilization issue426, or managed care issue atstep424, for example. In some cases, multiple calls may be necessary to get a complete answer to a question or questions.
• When comparing this example with a system using an electronic prescription processing system of the present invention, many differences stand out. By eliminating certain steps a system that provides for direct two-way electronic communication and auto-population of prescription information substantially reduces errors and time required of a pharmacist, the physician and their staff to resolve errors or to request additional information.
• Eliminating unnecessary, steps, such asscanning414,data entry416,418 and the like reduces costs and errors, for example. Using an auto-populated pharmacy entry screen of the prescription image, such as shown in the example ofFIG. 6 allows a pharmacist to quickly verify prescription information, including any alerts, recalls, adverse drug interactions and the like. A pharmacist may pull the information on the screen, scroll down to see additional information about patient information, and verify or check the prescription, without the assistance of a technician that is normally required for data entry and reconciliation, reducing delays and eliminating pharmacy-side labor costs.
• Redundant steps, such as contacting432, multiple offices or physicians aboutprescription errors428,drug utilization426 and/or managedcare issues424, may be eliminated. For example, automated, two-way physician-pharmacist communication eliminates any need to call432. The two-way system allows the pharmacist to enter questions in apharmacist comment field628, as shown inFIG. 6, for example. Then, the question, alert or notification may be sent to the physician designated to respond in the electronic prescription. Any response from the physician is routed to the e-script, may automatically alert the pharmacist and may be reviewed by the pharmacist, which may be the same pharmacist or another pharmacist working at the same pharmacy who may be designated in the system.
• InFIG. 5, one example of how a pharmacy processes an electronic prescription is schematically illustrated. Many large pharmacies have a pharmacy computer system that is capable of connecting to all the pharmacy's locations. This may be a network, such as a cloud network, a wide area network or the like. Each computer at a particular location of the pharmacy communicates with the pharmacy's computer system, which may be a centralized server or mainframe in on example. Aclearinghouse116 sends information to the pharmacy including an e-script. The e-script is delivered118 to the pharmacy'scomputer120 and a pharmacist then verifies the information. A hard copy of an image of the electronic prescription is printed and filed, if desired. One verified a prescription is released126 to the point ofsale location122 for dispensing to a patient.
• In one example, a pharmacy computer system of a chain of pharmacy point ofsale locations122 stores all pharmacy data, electronically, in acentralized database510. Each chain pharmacy and computer terminal of the chain of pharmacies may be connected to thepharmacy computer system120 andcommunications126 occurs seamlessly. In one example,internal pharmacy communications126 occur seamlessly with a mainframe, for example. In an alternative example, a centralized server replaces the mainframe, and all communications are seamless. In yet another example, the pharmacy computer system is a distributed system, and only thedatabase510 is centralized. A centralized system may inform a distributed system of a newly released prescription ID, and the distributed system accesses information from acentralized database510. Herein, acentralized database510 does not infer that all data is stored at a single location. Instead, it means that all distributed systems have access to the same data, which, may be stored as a SQL database at one or more storage locations.
• Communication124,118 between aclearinghouse116 andpharmacy computer system120 may provide for two-way communication, for example. A single electronic connection may be used for two-way communication or multiple modes and pathways may exist to provide two-way communications118,124.
• Apharmacy computer system120 includes adatabase510. Information relating to an electronic prescription is transmitted126 to theindividual pharmacy locations122. In one example, a local pharmacist verifies the information provided by theelectronic prescription504, an e-script may be printed502, and the pharmacy dispenses medication associated with a verified e-script to thepatient506. The pharmacist may opt to use aconventional process508 of filling a prescription by forwarding500 the prescription for processing according toFIG. 4, for example. Two-way communication126, electronically, between the pharmacy and thepharmacy system120 and theclearing house116 permits safe, secure queries between a pharmacist and the prescribing physician to occur rapidly. Delivery and read status indicators can be used to track progress in resolving discrepancies with one or more offices and/or physicians. Answers may alert the appropriate pharmacist to review the answer and to take further actions as appropriate. All queries and answers may be automatically logged to thepharmacy system database510 by thepharmacy system120. Timeliness of responses to queries may be tracked and an additional query may be transmitted or the urgency of a query may be increased. In on example, a query may be flagged for immediate response or may present an audible, vibrational or other alert, when a response is not timely.
• InFIG. 6, an example of apharmacist computer screen600 is shown. Thepharmacist entry screen606 includes an image of the prescription on the screen as well as an area to enter information from the image into the pharmacist computer. The system allows information from the physician to be directly presented to the pharmacist. All fields may be auto-populated with information reducing entry and transcription errors. In one example, the pharmacist may edit information on theentry screen606. The pharmacist may hit a single key or button to release the e-script for filling. Then, a label may be printed, the label may be adhered to a bottle and/or attached to a bag and the corresponding medication may be dispensed. This eliminates many of the steps shown inFIG. 4. Furthermore, communications between pharmacist and physician are greatly enhanced and timeliness is measured and improved.
• Prescription image viewer602 allows visual verification between an image of theprescription604 and theentry screen606. In one example, theentry screen606 includesphysician information608,patient information610,insurance information612,drug name614,drug strength616,directions618,quantity620, days ofsupply622, dosages perday624,refills626 or any other information necessary for verifying and filling the prescription. Thepharmacist comment area628, may be used by the pharmacist to enter comments or questions for an office or physician. For example, if a prescription needs to be sent back through the system to the prescribing physician for clarification of any questions or alert the physician about any other matter requiring physician interaction, then a pharmacist may enter or select a specific query question, alert or notification and may press a key or button (on screen or otherwise), to transmit the question, alert or notification to designated physician office or other responsible party. For example, the physician or office may receive an alert by text message, email, instant message or the like, An alert may provide notification to the physician to access the physician's OPM system, for example, or may provide a link or access to a reply server. In one example, aclearinghouse116 sends a message allowing the physician to answer a yes/no question using a cell phone, mouse, pointing device or voice command, for example. Then, a response may be transmitted answering the posed question(s). Biometric data, a password or an electronic signature may be required for authenticating an answer.
• In another example, the physician may not have entered a prescription and a pharmacy may enter a prescription subject to approval by the physician. An e-script is may be transmitted to the doctor for his or her approval with questions or comments. Once the physician answers the questions, which may be required prior to proceeding, the physician may send the electronic prescription to the pharmacy for further processing. In one example, unique ID and/or password is required to update information stored on a pharmacy computer system, for example.
• In one example, the generation system disclosed by U.S. Pat. No. 7,072, 840, may be used to generate an e-script, for example. Alternatively, an e-script may be generated by a third party OPM system. Aclearinghouse116 may automatically require population of certain required fields necessary for verification of an e-script by a pharmacist, for example. In one example, the e-script is automatically rejected by theclearinghouse116 with a request for specific information to be entered into fields of an e-script. An interface program, capable of coupling to a MEPPS system, for example, may auto-populate prescription information for a pharmacist entry screen such as illustrated inFIG. 6. The system may further upload drug formulary of a specific pharmacy or pharmacies and insurance company or companies. For example, a formulary for a managed care plan may alert a physician to availability of alternatives to a drug not included in the formulary or drugs that are less expensive. Thus, alternative prescription items may be suggested or recommended for selection by the physician.
• Alternative combinations and variations of the examples provided will become apparent based on this disclosure. It is not possible to provide specific examples for all of the many possible combinations and variations of the embodiments described, but such combinations and variations may be claims that eventually issue.

Claims (31)

1. An electronic prescription processing system comprises:

at least one pharmacy system connected to a network capable of two-way digital communications between a plurality of physician office practice management systems and the at least one pharmacy system, wherein the at least one pharmacy system displays an image of the information entered as an electronic prescription by a prescriber using one of the plurality of physician office practice management systems on a display and the information entered as an electronic prescription is auto-populated in entries for a prescription entry screen of the at least one pharmacy system;

a clearinghouse electronically disposed between the plurality of physician office practice management systems and the at least one pharmacy system, such that the at least one pharmacy system may query, electronically, the prescriber, without speaking by telephone, to resolve questions about the electronic prescription, and the multi-path clearinghouse automatically correlates the query with an answer from the prescriber, when the prescriber of one of the plurality of physician office practice management systems responds to the query from the at least one pharmacy system.

2. The electronic prescription processing system ofclaim 1, wherein the clearinghouse correlates the query with the answer from the prescriber, when the one of the plurality of physician office management systems responds to the at least one pharmacy system using a batch process for answering a plurality of queries from one or more of the at least one pharmacy systems in a single electronic transmission.

3. The electronic prescription processing system ofclaim 1, wherein the clearinghouse provides access to information from a drug file database of the at least one pharmacy system, such that a prescriber using one of the plurality of physician office management systems has access to drug inventory and prices.

4. The electronic prescription processing system ofclaim 3, wherein the clearinghouse is capable of automatically providing notification to the prescriber of alternative drugs available at the at least one pharmacy and pricing, and the clearinghouse allows the prescriber the opportunity to substitute an alternative drug, electronically, in response to a query.

5. The electronic prescription processing system ofclaim 4, wherein the clearinghouse notifies the prescriber of any generic equivalent available at the at least one pharmacy and pricing.

6. The electronic prescription processing system ofclaim 3, wherein the clearinghouse automatically provides notification to the prescriber of a recalled drug.

7. The electronic prescription processing system ofclaim 6, wherein the clearinghouse automatically provides at least one acceptable alternative to the recalled drug.

8. The electronic prescription processing system ofclaim 7, wherein the clearinghouse provides the prescriber an opportunity to substitute the at least one acceptable alternative of the recalled drug, electronically, in response to a query.

9. The electronic prescription processing system ofclaim 1, wherein the clearinghouse verifies the identity and authority of the prescriber to enter the electronic prescription using an electronic signature, biometric data, a password or a combination thereof.

10. The electronic prescription processing system ofclaim 9, wherein the clearinghouse verifies the identity and authority of the prescriber to enter the electronic prescription using an electronic signature.

11. The electronic prescription processing system ofclaim 1, further comprising the plurality of physician office management systems, wherein the plurality of physician office management systems include a utility for a prescriber to answer queries from the at least one pharmacy system in batch mode, and the clearinghouse correlates a single transmission from a prescriber operating in batch mode to a plurality of queries from one or more of the at least one pharmacy systems.

12. The electronic prescription processing system ofclaim 1, further comprising a biometric data reader, wherein the biometric data reader captures biometric data of a prescriber, and the electronic prescription processing system uses the biometric data of the prescriber to authenticate a prescription or a change to-a prescription authorized by the prescriber.

13. The electronic prescription processing system ofclaim 1, further comprising an interface system coupled to at least one of the plurality of physician office management systems such that the interface system couples the at least one of the plurality of physician office management systems to the clearinghouse, wherein two-way communications are established between the interface system and the clearinghouse.

14. The electronic prescription processing system ofclaim 13, wherein the interface system is coupled to a data input and editing device and a display.

15. The electronic prescription processing system ofclaim 14, wherein the data input and editing device includes a keyboard, a voice recognition system, a pointing device, a touch screen, a bar code reader, a scanner or a combination thereof.

16. The electronic prescription processing system ofclaim 15, wherein the data input and editing device includes a keyboard and a pointing device.

17. The electronic prescription processing system ofclaim 1, wherein the at least one pharmacy system is a plurality of pharmacy systems, and the plurality of pharmacy systems are electronically coupled to the clearinghouse, wherein the clearinghouse couples each of the plurality of physician office practice management systems with a selected one of the plurality of the plurality of pharmacy systems for two-way communications.

18. The electronic prescription processing system ofclaim 17, wherein the clearinghouse, at least one of the plurality of physician office practice management systems, an interface system coupling at least one of the plurality of physician office practice management systems and the clearinghouse, or at least one pharmacy system includes at least one insurance formulary, and the prescriber is notified, automatically by the at least one of the plurality of physician office practice management systems or the interface system if a drug prescribed is not included in the at least one insurance formulary.

19. The electronic prescription processing system ofclaim 18, wherein the at least one of the plurality of physician office practice management systems or the interface system provides at least one alternative drug, if the at least one alternative drug is an acceptable substitute for the drug prescribed by the prescriber, the at least one alternative drug is included in the at least one insurance formulary, and the at least one alternative drug is available from the pharmacy.

20. The electronic prescription processing system ofclaim 19, wherein the at least one of the plurality of physician office practice management systems or the interface system provides notification of an alternative pharmacy, if the drug or the at least one alternative drug is not available from the pharmacy originally selected, but is available from the alternative pharmacy, or if the drug or the at least one alternative drug is available at lower cost to the patient or the insurance plan at the alternative pharmacy.

21. The electronic prescription processing system ofclaim 1, wherein the pharmacy system includes a database, and all queries and answers to the queries are stored in the database and are tracked by the pharmacy system.

22. The electronic prescription processing system ofclaim 21, wherein the pharmacy system, the clearinghouse, one of the plurality of physician office management systems or a combination of these may present an alert to the prescriber if the prescriber does not timely reply to a query from the pharmacy system.

23. The electronic prescription processing system ofclaim 22, wherein the pharmacy system may present an alert to a pharmacist responsible for processing the prescription, after receipt of an answer from the prescriber to the query by the pharmacist or the pharmacy system.

24. A method of processing an electronic prescription using the system ofclaim 1, comprising:

installing the at least one pharmacy system such that the at least one pharmacy system is coupled to the clearinghouse, and the at least on pharmacy system includes a pharmacy database for storing an image of a prescription together with auto-populated fields relating to the image of the prescription transmitted by one of the plurality of physician office practice management systems to the clearinghouse;

receiving the image of the prescription together with auto-populated fields relating to the image of the prescription and displaying the image of the prescription together with auto-populated fields relating to the image of the prescription on a display of a pharmacist such that the pharmacist is capable of verifying the auto-populated fields;

providing a two-way communication protocol for the pharmacist to electronically query a prescribing prescriber about the prescription and for the prescribing prescriber to provide the pharmacy system with an answer to the query electronically;

querying the prescribing prescriber to provide the pharmacy system with the answer to the query;

notifying the pharmacist or another pharmacist of the receipt of the answer from the prescribing prescriber; and

verifying that the prescription is ready to be filled.

25. The method of processing an electronic prescription ofclaim 24, wherein the query and the answer are stored in the pharmacy database.

26. The method of processing an electronic prescription ofclaim 24, further comprising:

monitoring the time elapsed between the time that the query is made in the step of querying and receipt of the answer, if any; and

flagging the query as having a higher urgency if the answer is not timely received.

27. The method of processing an electronic prescription ofclaim 26, wherein the step of flagging occurs if two hours is elapsed from the time that the query is made in the step of querying without receipt of the answer.

28. The method of processing an electronic prescription ofclaim 26, further comprising:

alerting, automatically, the prescribing prescriber of the query if the query is flagged as urgent.

29. The method of processing an electronic prescription ofclaim 28, wherein the step of alerting includes a visual alert on the physician office practice management system.

30. The method of processing an electronic prescription ofclaim 28, wherein the step of alerting includes an email sent to the prescribing prescriber, wherein the email is flagged as urgent.

31. The method of processing an electronic prescription ofclaim 30, wherein the email flagged as urgent provides a selection of yes/no for responding to the query, and wherein selecting yes or no from the selection provides a response to the query, transmitting the response to the pharmacist or another pharmacist.

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