BOSTON - August 1, 2008 - Based on a study supported by Blue Cross Blue Shield of Massachusetts (BCBSMA), researchers estimated that the nearly 104,000 prescriptions changed by eRx Collaborative prescribers in 2007 prevented 724 potential adverse drug events (ADEs). An estimated $630,000 in cost savings is attributable to ADEs prevented by the eRx Collaborative.

BCBSMA supported researchers at the Center for Patient Safety at Dana-Farber Cancer Institute and their collaborators to investigate the impact of drug interaction alerts on physician behavior, patient safety and the economic implications of accepting or overriding alerts. For example, the combination of sertraline and trazodone, both antidepressants, generates a drug interaction alert when prescribed in combination. Patients should be monitored by their clinicians for signs of "serotonin syndrome" - the result of elevated serotonin levels in the brain. Researchers found that drug alerts lead prescribers to modify prescriptions. Alerts also cue clinicians to:

• counsel patients about potential reactions
• learn more about interactions
• prompt close patient monitoring
• look up information in medical references

"The opportunity to catch potentially harmful drug-drug interactions or drug-allergy interactions is an integral safety feature of electronic prescribing," said Andrew Dreyfus Executive Vice President of Health Care Services at BCBSMA. "The results of this study demonstrate how e-prescribing aligns with our goal of increasing the quality and affordability of patient care in Massachusetts."

Dr. Saul N. Weingart, VP for Patient Safety at Dana-Farber led the study, "Medication Safety Alerts in e-Prescribing: Understanding Clinicians' Acceptance of Alerts and their Economic and Patient Safety Impact." Dr. Weingart and his team are currently preparing to publish the results and conclusions of their research in a peer-reviewed journal.

A key component of the study's design was the development of an analytic model to calculate the likelihood of a drug interaction, the impact of the interaction on the health and safety of the patient, and the subsequent utilization of health care services that would be required to address the interaction. The team extrapolated their results to estimate the impact the eRx Collaborative had on patient safety and cost in 2007.

Based on this approach, the team estimated that 724 minor to serious potential ADEs were prevented in 2007 when prescribers accepted an alert they received using ePrescribing technology. While this estimate is based on a mathematical model rather than direct observations, it is thought to be a conservative assessment.

The researchers found that some physicians believe that safety alerts are too frequent and often not clinically meaningful. Few prescribers were willing to pay out-of-pocket for the technology. Nevertheless, clinicians believe that e-prescribing is a valuable tool for preventing medication errors and that drug interaction alerts prevent injuries in their practices. The majority of prescribers also believe that the technology improves patient care, patient satisfaction, and office efficiency.

Last year, the Commonwealth of Massachusetts earned the number one ranking at the second annual Safe-Rx Awards. The Safe-Rx Award is given annually by the nation's community pharmacies to the top 10 e-prescribing states in the nation and to three physicians in each winning state who have demonstrated outstanding leadership in their use of e-prescribing technology. Massachusetts' first-place ranking last year represents a jump from its third-place finish in 2006.

e-Prescribers are able to access enhanced information when prescribing for patients in participating plans, such as patient eligibility and formulary information. In addition, the program enables prescribers to:

• Access patient-specific drug histories to determine the patient's current and past prescriptions
• Create new and renew prescriptions electronically
• Send prescriptions for non-controlled substances directly to the pharmacy via fax or by Electronic Data Interchange (EDI) and/or print the prescription to paper
• Receive renewal requests from the pharmacy electronically
• Check for drug-drug and drug-allergy interactions
• Access a drug reference guide

The eRx Collaborative continues to sponsor new prescribers, and to evaluate the best way to expand awareness and adoption of ePrescribing in Massachusetts for this year and beyond.

The Collaborative views ePrescribing as a foundation to future practice technology, and has seen evidence of this through our prescribers who have left the program to implement electronic medical records with ePrescribing functionality. A fully electronic practice is one of the pathways to reach the ultimate goal for healthcare: to improve patient safety, quality and delivery.

In 2006, providers who used an e-prescribing device were able to choose more cost-effective drugs and saved 5 percent on their drug costs relative to those prescribers who did not use this technology. Of that savings, BCBSMA members saved approximately $800,000 in co-payments associated with their prescriptions. The company's Primary Care Physician Incentive Plan, which rewards providers for meeting certain nationally-recognized quality standards and patient safety goals, offers physicians an additional incentive for implementing e-prescribing in their practice. Of the $22 million paid to physicians who earned an incentive as part of the 2006 PCPIP program, approximately $7 million was awarded to physicians who used electronic technology or decision support aids.

BCBSMA has implemented a dynamic strategy to promote the use of technology to improve the safety, quality, affordability and efficiency of a patient - centered health care system. In 2008 the company has announced that:

• After 2012, BCBSMA will require hospitals to implement and utilize Computerized Physician Order Entry (CPOE). BCBSMA has decided to include the standards to be established by the MA CPOE Initiative as a threshold for participating in their quality and incentive programs.
• In partnership with Google Health and WebMD, members can choose, at their own discretion, to request their Personal Health Record (PHR) to manage all their health information in one place, and share it with health care providers who currently don't have access to their data.
• BCBSMA and ZixCorp are conducting a joint pilot of disease management enrollment alerts. Using ZixCorp's PocketScript e-prescribing service, the disease management enrollment system will notify physicians at the point of care that their patient may be eligible for enrollment in a BCBSMA disease management program.

BCBSMA believes that these technology initiatives are an integral part of the company's goal of achieving a long-term solution that will improve the quality and affordability of health care.

About the eRx Collaborative
The eRx Collaborative was formed by Blue Cross Blue Shield of Massachusetts (BCBSMA), Tufts Health Plan and Neighborhood Health Plan (NHP) with technology partners DrFirst, Inc and Zix Corporation (ZixCorp®), (Nasdaq: ZIXI), to collaboratively promote and enable the use of electronic prescribing in Massachusetts to improve patient safety, health care affordability, quality and delivery. For more information, visit our website http://www.erxcollaborative.org/