Developing a highly functional eRx module for a medical software vendor to gain a competitive edge

To create a full-service ecosystem of clinical applications, our client had to meet the following objectives with the help of a reliable technology partner:

How our cooperation started

Our client wanted to start with a minimum viable product (MVP) version of the eRx platform first to allow end users to create orders for drugs and laboratory tests. The main requirements were:

• Deliver orders directly to a pharmacy or laboratory information system
• Help providers spend less time calling pharmacies
• Help labs clarify orders and spend more time with patients
• Include basic clinical decision support functionality to automatically compare prescribed medications with a patient’s chart and treatment history
• Detect any potentially dangerous or fatal drug–drug or drug–allergy interactions
• Instantly alert providers about potential interactions so providers can make informed decisions regarding patient safety

Soon, however, the client realized this would not be enough to effectively compete with current third-party e-prescription tools used by the healthcare establishments they served.

Yalantis conducted several rounds of negotiations with the client and our team of business analysts rolled out a plan for an extended MVP version that would be competitive enough to effectively cater to end users’ needs but still allow our client to stay within their planned budget and deadlines.

5 functional components of the eRx module

The final version of the eRx product is capable of the following:

1. Comprehensive management of medication orders

• Placing single prescription and multiple prescription orders:
  
• Sending orders to a preferred pharmacy:
  
• Refilling prescriptions:
  
• Tracking order statuses:
  

2. Ensuring patient safety with well-thought-out clinical decision support (CDS) functionality

At the client’s request, our team equipped the eRx module with CDS functionality to enable drug–drug and allergy alerts to reduce preventable adverse drug events (ADEs). The CDS-enabled eRx system is now capable of:

• checking a prescribed medication against a patient’s medical data (age, weight, diagnoses, allergies, history of previous and current treatments)
• alerting prescribers of possible contraindications, dangerous doses, potential adverse reactions, and duplicate therapies
• providing clear instructions on how to provide better treatment

To deliver the best possible experience with CDS functionality and ensure prescribers remain attentive to drug–drug interactions, allergies, and overdose warnings, the Yalantis team:

• removed alerts for patients with low levels of risk
• enabled alerts only for patients who belong to a higher-risk group such as elderly people, people with chronic diseases, and pregnant women
• included functionality to replace medication with an alternative that is considered safer for a patient right at the point of order entry
• allowed prescribers to proceed with the original medication by overriding alerts on possible interactions and side effects by specifying an overriding reason from a standard list of coded reasons together with a free-form explanation

3. Simplified ordering and managing of lab and radiology tests

Our team also enabled prescribers to:

• send computerized laboratory and radiology test orders to a laboratory of a patient’s or provider’s choice and receive results right within the EHR system
• activate basic decision support to avoid duplication of test orders, which could be dangerous for a patient
• access patients’ test results and share them with patients and other providers
• save the most commonly used test patterns for a patient for more convenient and faster reordering

4. Automatic verification of drug eligibility for each patient

• Checking prescriptions against patients’ formularies

To help our client meet ONC Health IT Certification Program requirements and attain Certified EHR Technology (CEHRT) status, the eRx-enabled EHR system was required to successfully perform automatic checks of available drug formulary lists for a given patient and medication.

Every insurance company maintains its own formulary database containing different types of medications assigned to specific formulary tiers that are covered by certain insurance policies. The Yalantis team enabled:

• integrations with both insurance formulary databases and pharmacy benefits management databases to ensure the eRx module has access to exhaustive formulary information
• benefit verification functionality in our eRx module to communicate the status of each medication prescribed by accessing a patient’s eligibility information

This helps prescribers choose the most clinically appropriate and cost-effective medication for a patient. If a patient’s coverage information is not available, the prescribing provider can check a full list of alternative medications to find the best affordable treatment.

• Electronic pre-authorization

The system also automatically notifies prescribers if a selected drug requires prior authorization (for example, if a desired medication is not on a patient’s benefit list but is still determined as medically necessary by the prescribing physician).

Providers can also instantly react to such alerts by submitting prior authorization requests via the EHR system to get instant feedback from payers or pharmacy benefit managers while still interacting with a patient at the point of care. This helps healthcare providers to:

5. Enabling highly secure electronic prescribing of controlled substances (EPCS)

Our client requested that the eRx system should be able to fill out electronic prescriptions for controlled substances in three US states – California, Texas, and Michigan. By fully relying on the US Drug Enforcement Administration (DEA) Interim Final Rule requirements, our team enabled the following:

Result: Taking into account the client’s requirements for the product’s security and interoperability, Yalantis has developed a fully HIPAA-compliant eRx software solution capable of not only meeting DEA EPCS requirements but also obtaining ONC Health IT Certification.

Under the hood of eRx module development