Section 05: EHR Availability

The integration of ePA within EHR systems provides a method for completing PA requests in workflow for providers and their staff to help patients get their medications more quickly.

Learn about ePA at the point of prescribing
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Value of In-workflow ePA

Since 2014, ePA volume through EHR systems who have partnered with a large ePA vendor has increased by over 60,000 percent and this exponential growth is expected to continue.26

An graph depicting the growth of ePA volume through EHRs

* Retrospective and prospective ePA volumes are shown as fractions of total ePA volume from 2018.

Analysis of year-over-year ePA volume through EHR systems by a large ePA vendor reveals that ePA requests are more likely to be started prospectively, with more than two prospective requests for everyone one retrospective request.27 This trend is expected to continue as more providers realize the benefits of the prospective ePA workflow and point of prescribing decision-support tools, like real-time benefit check (RTBC) become more widely available.

During just three months of simultaneous operation, ePA and RTBC solutions paired within EHR systems contributed to a near five percent increase in submission of prospective PA requests by providers.28

Analysis of turnaround times for PA requests reveal a 13.2-day acceleration in time to therapy when completed prospectively compared to retrospectively.29

Such success highlights the value of the prospective ePA workflow and can be used to promote provider adoption of ePA. 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 request 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

Percentage of the EHR market, representing the majority of market share by prescription volume, committed to an ePA solution.30

* The remaining 11 percent of the EHR market is comprised of many smaller EHR system vendors.

EHR Vendor Committed Available CAPABILITY
Epic Systems
GE Healthcare
Greenway Health
NextGen Healthcare
Practice Fusion

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 for there to 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 healthcare 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 application programming interfaces (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 Icon

Key Takeaway

EHR systems representing 89 percent of market share are committed to ePA. With the right ePA partner, an electronic solution can be a significant revenue opportunity for EHR systems and time-saver for health systems while benefiting the provider and patient. Additionally, ePA in EHR systems encourages prospective ePA workflows and can be coupled to RTBC solutions to drive maximal value and provider adoption.