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06 ― EHR Availability

The integration of ePA within EHR systems is potentially transformative to providers and their staff by providing decision support at the point of prescribing and a method for completing PA in workflow.

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07 - Payer Availability

Realizing this potential is largely dependent on vendors supporting retrospective, prospective and all-payer capabilities.

Electronic prior authorization integrations that incorporate these capabilities essentially eliminate the need for paper PA forms. Integrations that are missing one or more of these capabilities will still require providers and their staff to use multiple methods for completing PA requests.

EHR Availability?

Current percentage of the EHR market, representing the majority of market share, committed to an ePA solution.15

EHR Availability Data Representation
EHR Vendor Committed Available Capabilities
Epic Systems
GE Healthcare
Greenway Health
NextGen Healthcare
Practice Fusion

   · · · · · ·    Retrospective Functionality

   · · · · · ·    Prospective Functionality

   · · · · · ·    All Payer Submission Functionality

Vendor Assessment

It is important to understand how an ePA vendor will accomplish key goals needed to successfully complete PA requests. The wrong solution could create administrative waste, cause confusion between stakeholders (payer; pharmacy; provider) and hinder a patient getting the medication they need to be healthy.

Does the ePA vendor allow for both prospective and retrospective requests? How does the solution support retrospective pharmacy-initiated requests?

A prospective ePA occurs when a provider initiates the request before a rejection occurs at the pharmacy. With the right vendor, it is possible to proactively begin a request at the point of prescribing, directly within the EHR system.

Retrospective ePA occurs when a pharmacy is alerted that PA is needed when they bill insurance for the medication. The pharmacist can initiate the PA directly in their pharmacy system, which triggers a notification to the provider. Retrospective PA accounts for the majority of PA volume today.

A preferred vendor provides both capabilities. Good questions to ask are: How many pharmacies currently leverage your ePA functionality? How many pharmacy-initiated requests are generated through your system?

How much does the ePA solution cost?

While it is important to find out how much it will cost to integrate a solution into an EHR, it is also important there be full disclosure in subscription fees and any other costs that may be accrued or assessed. Health systems often cite cost as a barrier for not implementing an electronic solution, so it’s important to get this information in advance.

Electronic prior authorization delivers the greatest benefits when it is free to use for providers, pharmacists and their staff.

Does the ePA vendor provide a financial model that benefits the entire health care network?

The market stands to save billions of dollars when all stakeholders, especially providers, adopt ePA solutions at scale. Financial models that are free for providers and pharmacists encourage ubiquity and are therefore in the best interest of all stakeholders.

Does the ePA vendor technology support APIs?

The technology for ePA solutions will grow and change with the industry; therefore, API support makes it easier for technology teams at EHR, payer and pharmacy systems to quickly implement new and optimized ePA solutions. Documented, standards-based ePA APIs will be a key to driving adoption in the market.

Is there a dedicated team of PA experts focused solely on assisting with PA?

Providers will have questions as they adopt an ePA solution, so it’s important that your vendor provides direct, user support. The support staff should be easily reachable by phone, email and chat and be subject matter experts on the ePA solution.

Electronic prior authorization, as with any new IT solution, does require a change in workflow; therefore, it’s important to support providers and their staff.

Key Takeaway

Key Takeaway

EHRs representing 79% of market share are committed to implementing ePA. With the right ePA partner, an electronic solution can be a significant revenue opportunity for EHRs and time-saver for health systems, while benefiting the provider and their patient. Additionally, ePA in EHRs is an effective way to add ePA legislative compliance to the E-Prescribing experience.