E-prescribing growing, but most practices still don't use it
■ About 70% of physicians who do e-prescribe use an application on their EMRs, a new study found.
A new report finds a significant uptick in the number of physicians who prescribe electronically. But the e-prescribers still only account for about one in four physicians, or 26% of office-based doctors.
The numbers come from Surescripts, which operates the nation's largest e-prescribing network. It released its annual e-prescribing progress report on March 2. The report found that although there was significant progress in adoption of electronic prescribing, there are still barriers to overcome.
The report found that the percentage of eligible prescriptions sent electronically increased from 6% to 18% from the end of 2008 to the end of 2009, as measured by tracking traffic through the Surescripts network. The 2009 total represented 190 million out of about 1.6 billion eligible prescriptions for an overall annual rate of 12%, according to the report, "Advancing Healthcare in America."
"For e-prescription use to jump from 6% to 18% in one year indicates several things," said Harry Totonis, president and CEO of Surescripts, in a prepared statement. "First, that the federal government's leadership and incentive structures are working. Second, that the benefits of e-prescribing -- including increased safety, lower costs and increased efficiency -- are widely understood. And last, that the nation's experience with e-prescribing -- in building the network and the ecosystem to support it -- provides a definitive road map for how to drive adoption of a broader electronic health record for all Americans."
The Surescripts report found that about 70% of physicians who do e-prescribe use an application on their EMRs. Company spokesman Rob Cronin said many EMRs might not have been certified in 2009 for e-prescribing under the rules that qualify physicians for incentives. Many of those systems are now becoming certified, and that accounted for a large chunk of the e-prescribing growth.
On the subject of electronic prescribing's safety benefits, in February Weill Cornell Medical College in New York released the results of its study comparing the safety of e-prescribing with paper-based prescribing.
The authors found that nearly two of every five paper prescriptions contained an error. The authors reviewed 3,684 paper-based prescriptions at the start of the study, and 3,848 paper-based and electronic prescriptions written one year later. It found that after a year, the percentage of errors dropped from 43% to 7% for physicians and other prescribers using the electronic system.
The Centers for Medicare & Medicaid Services e-prescribing incentives, which started in January 2009, also were a motivator for adoption of electronic prescribing, according to Surescripts. And the incentives that will be made available through the American Recovery and Reinvestment Act to stimulate EMR growth are expected to motivate even more to adopt e-prescribing, experts said. E-prescribing is one criteria that must be met to qualify for EMR incentive money.
Also cited as drivers of e-prescribing adoption were numerous public and private efforts, including the American Medical Association's June 2009 introduction of its Zero-In Rx e-prescribing learning center.
But some experts wonder if e-prescribing adoption rates would be higher if it weren't for a Drug Enforcement Administration rule that requires all controlled substance prescriptions be written on paper.
David Hunt, MD, officer of provider adoption support for the Office of the National Coordinator for Health Information Technology, told a crowd of physicians and others gathered in March for the annual meeting of the Healthcare Information and Management Systems Society that he himself doesn't e-prescribe because of the DEA issue. Dr. Hunt, a surgeon, said a large percentage of his prescriptions are not eligible for electronic submission. Instead of running his practice with two workflows, to incorporate e-prescribing, he said he has stuck with his paper pad.
Other experts say physician resistance to e-prescribing is not as clear-cut.
In New Hampshire, for example, there was an aggressive campaign launched in 2007 aimed at getting 100% of physicians e-prescribing within one year. New Hampshire State Rep. Cindy Rosenwald, whose husband is a cardiologist, said that three years later, 50% of doctors in New Hampshire use some form of an EMR, but only 20% have e-prescribing capabilities.
"That's going to be a huge challenge for us," Rosenwald said at a public policy forum held during HIMSS, which met in early March in Atlanta.
Rosenwald said another contributing factor in New Hampshire could have been a state law that was passed, after the e-prescribing initiative was announced, giving patients the right to a paper prescription for the purpose of shopping around.
Other barriers mentioned by Surescripts in the report were the limited number of state Medicaid programs that can provide formulary and eligibility information to prescribers.
It also says prescriber and pharmacy directories need to be maintained actively to ensure that prescriptions that can be sent electronically are transmitted electronically as often as possible. Generally, a prescription that is sent electronically but comes to the pharmacy as a fax -- because the pharmacy doesn't have the technology to accept the transmission -- is not considered e-prescribing.