Electronic Health Records

Adoption & Implementation News

Majority of Physicians Seeking Prior Authorization in EHRs

According to a recent survey, about 64 percent of healthcare providers want electronic prior authorization functionality in their EHR systems.

By Jacqueline LaPointe

As the healthcare industry continues to move away from paper-based processing and into the digital era, more healthcare provider are seeking electronic prior authorization methods that integrate with their current EHR systems.

According to a recent survey by SureScripts, approximately 64 percent of healthcare providers agreed that EHR vendors should provide a service that streamlines prior authorization.

“Many EHR software systems have incorporated electronic prior authorization capabilities, but the functionality may not yet be a standard option, despite vendor acknowledgment that it can improve clinician workflow and quality of care,” explained Joe Delisle, Surescripts Senior Business Management Analyst.

Most healthcare providers will agree that manual prior authorization can be a daunting task. The process requires a physician to determine if medications are covered by a patient’s health insurance provider.

By allowing providers to verify coverage, prior authorization is designed to reduce healthcare costs, but with manual processes, healthcare staff are spending more resources on it, the survey pointed out.

Researchers found that healthcare support staff are spending an average of five to eight hours a week on manual prior authorizations and related tasks.

The survey also reported that about 80 percent of all prior authorizations requests need additional work, rework, or a follow-up.

The process can oftentimes cause major bumps in a practice’s workflow. About 30 percent of incoming calls at a practice are from patients inquiring about their prescriptions, which may be in the process of being verified via prior authorization.

Manual prior authorization can cause delays in the amount of time it takes for a patient to receive his or her prescriptions. About 66 percent of healthcare providers reported that it can take two or more days for patients to obtain their medications if prior authorization is involved.

Due to delays in the process, an estimated 40 percent of prescriptions are never picked up from the pharmacy. Researchers suggested that time-consuming prior authorizations may lead to decreased medication adherence and reduce care quality.

To optimize the process, more healthcare providers are searching for methods to electronically process prior authorizations. About 83 percent of physicians surveyed reported that adding this function is a top priority.

EHR vendors are also acknowledging the growing importance of adding electronic prior authorization to EHR systems. Eight-eight percent of vendors stated that they are aware of the demand for this functionality from their customers.

Additionally, about 86 percent of EHR vendors said that electronic prior authorization is a functionality that customers anticipate the systems to provide.

“The inefficiency of manual PA processing translates into hours of wasted time, contributes to workflow inefficiency and impedes a practice’s ability to deliver optimal and timely care,” said Delisle. “The time to enable electronic prior authorization is now.”

Researchers recommended that healthcare providers ask their current EHR vendors if electronic prior authorization is available.

According to the report, providers should inquire when electronic prior authorization will be available on their system and if the function is fully automated. Many electronic methods still require fax or web portals that may delay the workflow.

Providers should also encourage their EHR vendors to fully automate or implement an electronic prior authorization function that can integrated into established workflows.

“One of the big differences with ePA is that some of the answers to the questions can come automatically from the EHR system,” said David Yakimischak, Executive SureScripts Vice President and General Manager of Medication Network Services to HealthITAnalytics in December 2014. “The EHR system knows my date of birth.  A provider doesn’t have to type that in each time.  We can prepopulate that data into the form.  Every time someone doesn’t have to retype something, you can reduce the possibilities for errors and you can speed up efficiency.  So there’s a big interest in the healthcare community for automating this prior authorization, and we think that over the next couple of years it’s really going to take off and become the predominate method.  Three to five years from now, we think paper will be in the minority.”

With the push to transition to value-based care, incorporating more integrated and electronic functions of EHR systems is becoming a bigger priority for healthcare providers. Electronic prior authorization could help physicians spend less time with administrative tasks and more time caring for patients.




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