Are You Ready for E-prescribing?

Placing "e" in front of everything may be trendy, but electronic prescribing is far more than a trend.

E-prescribing has gained much public attention for saving lives and money by addressing medication errors. Statistics show that medication errors kill 7,000 Americans annually, have injured 1.5 million people, and cost billions of dollars in emergency department visits and other complications [1] [2].

Obviously these numbers are troubling. Many state governments are already planning to introduce software technology to address the problem, and several progressive private-sector companies are hurrying to promulgate e-prescribing nationwide

Congress is also moving on the matter. The Senate introduced S2408, designed to hasten adoption of e-prescribing, which is considered a key component in a national system of EMRs-electronic medical records. The House of Representatives introduced HR4296, Medicare Electronic Medication and Safety, which amend title XVIII (Medicare) of the Social Security Act to require the Secretary of Health and Human Services to make incentive payments for physician use of e-prescribing, and reduce by 10 percent the fee schedule amount for failure to use it. Further, CMS is performing a five-year e-prescribing demonstration project.

In addition, the current system of prescribing controlled substance medication is an anomaly. The DEA's logic is shaped to support the pen and prescription pad, and does not allow e-prescribing of controlled substances. Compounding the lack of DEA regulations on e-prescribing, about 30 percent of pharmacies are not able to receive electronic drug orders, so physicians still need to retain a paper-based prescription system as a backup. Having to maintain two systems would not get much efficiency or savings, according to the AMA's American Medical News.

Arizona is well on the path. Physicians, payers, and pharmacies will be pressured to be the national model for healthcare technology transformation because the state wants to be a kind of seismic center for EMRs and e-prescribing. Arizona Health e-Connection reports that Arizona was recently recognized at the Third Annual Safe-Rx Awards as having the national eighth highest percentage of electronic prescribing.

??In Tucson, AZ, the IM practice New Pueblo Medicine modernized several years ago, improving its operation with EMRs, and recently with e-prescribing. While EMRs now come naturally to the physicians and staff, the e-prescribing is a new and powerful tool. Substantial benefits from user-friendly to intuitive software cannot be denied. While more than two hours per day are saved on not handling paper, faxing, or waiting for a pharmacist, the silent but real benefit is fraud prevention, and the most accurate prescription order and filling system to date. Other benefits include:

?????? Physician access to the system anytime and anywhere.

?????? Assurance of accuracy in medication, quantity, patient profile and instructions.

?????? Avoidance of duplication of calling another prescription when one is already in process.

?????? The physician knows whether a particular medication is covered by a patient's insurance.

?????? The physician is warned of potentially dangerous interactions or allergies.

As with any new methodology, there is resistance or fear of change. Breaking down old habits and customs is difficult because having a prescription pad in hand, or waiting to speak to a pharmacist, is a more reassuring task than electronically sending a prescription, although the methodology is secure and HIPAA-compliant. Further, in a poll taken of 400 physicians, only seven percent actually transmitted prescriptions electronically, and 63 percent said implementing the technology is not a priority, according to a 2007 Wall Street Journal report. The pad-and-pen have become 20th-century work.

At New Pueblo Medicine, continuing training and education are a way of life. NPM's pharmacy tech is the catalyst for the training and reminding physicians of the value in using e-prescribing. About one hour is spent on training new physicians to use the software. She is also the support and go-to person on e-prescribing.

While modernized medical practices employ e-prescribing, pharmacies are lagging in standardizing its software. Just as medical practices use various e-prescribing software, so do pharmacies. The key is interoperability: software databases talking to each other, so no matter what pharmacy the patient uses to fill his or her prescription, it can be filled without a system glitch.

The goal is to have nearly all prescriptions in Arizona be e-prescriptions by April 2013. So far, only 2.89 percent here are, though that exceeds the national average of two percent reported by Arizona Health E-Connection.

The e-prescribing movement is not to be denied. Are Arizona physicians ready? If the speed of similar technology adoption is an indicator, they will be.

[1] Kerry J, Gingrich N. Saving lives and saving money with electronic prescribing. Wall Street Journal 11/16/07.

[2] Institute of Medicine. Preventing Medication Errors. 7/06.