While e-prescribing grows, obstacles limit widespread adoption

New report examines the current state of U.S. e-prescribing. Source: Veer

More than 35 million prescription transactions were sent electronically in 2007, a 170 percent increase over the previous year, according to a report developed collaboratively by the eHealth Initiative (eHI) and The Center for Improving Medication Management. The report offers a detailed examination of the progress made, obstacles that remain and recommendations for helping U.S. prescribers migrate from paper-based prescriptions to an electronic system.

The report, “Electronic Prescribing: Becoming Mainstream Practice,” developed collaboratively by the eHI and The Center, with guidance and leadership from a Steering Group of healthcare stakeholders, summarizes the national experience with e-prescribing over the past four years and outlines additional steps that should be taken to realize optimal results in healthcare improvement. 

The report includes corresponding guides that offer practical information for healthcare payors to support effective adoption, and for consumers to better understand e-prescribing’s benefits and use. A third guide for prescribers is under development now, in collaboration with leading medical societies. 

“Our report and the guides released today reflect a broad consensus among consumers, physicians, pharmacies, employers, insurers and others that e-prescribing can offer significant benefits in terms of patient safety, improved outcomes and cost savings, especially if remaining challenges are addressed.  The report contains several consensus recommendations to address those challenges effectively, and we look forward to working with all healthcare stakeholders to move those recommendations forward immediately,” said Janet Marchibroda, CEO, eHI.

“E-prescribing works and its benefits for many stakeholders are proven,” said Kate Berry, executive director of The Center. “However, education, incentives and implementation assistance are needed.”

At the end of 2007, at least 35,000 prescribers were actively e-prescribing. By the end of 2008, estimates indicate there will be at least 85,000 active users of e-prescribing. While e-prescribing is growing rapidly, the adoption level at the end of 2007 represents only about six percent of physicians. As a result: only 2 percent of the prescriptions eligible for electronic routing in 2007 were transmitted electronically.

Among the challenges listed in the report that limit widespread adoption of e-prescribing technology are:

• Financial burdens: Physician practices face varying financial burdens related to e-prescribing, including covering the implementation, training and maintenance costs.
• Workflow changes and change management: Although e-prescribing efficiencies and time savings are gained in the long run, introducing e-prescribing and EHRs can be difficult, time consuming, and requires adequate planning, training and support, particularly in the beginning.
• Continued needs for greater connectivity: The infrastructure exists for connectivity among pharmacies, physician practices, payors and pharmacy benefit managers (PBMs), but some pharmacies, payors/PBMs and mail-order pharmacies are not yet connected.
• Medication history: Although e-prescribing is an improvement over relying on paper medical records and patients’ memories, the information that is available may not always be comprehensive or accurate and therefore tools to adequately reconcile medication histories from multiple sources are needed.  

The report also provides concrete recommendations to address these barriers and move e-prescribing into mainstream practice.  Recommendations in the report include:

1. Adoption and effective use of e-prescribing: All prescribers should adopt e-prescribing as it becomes a mainstream model of care, including small practices, small hospitals and long-term care facilities.

2. Replicate and expand successful incentive programs: Align incentives developed by federal and state governments, payors, employers, health plans and health systems.

3. Address the DEA ban on e-prescribing controlled substances: The federal government should end the DEA ban on e-prescribing of controlled substances to eliminate the need for physicians to manage duplicative work processes.

4. Create a public-private multi-stakeholder e-prescribing advisory body: The e-prescribing advisory body must be created to monitor, assess and make recommendations to accelerate the effective use of e-prescribing, and should be made up of diverse stakeholders across every sector of healthcare.

5. All stakeholders should advance the e-prescribing infrastructure: The industry should encourage all pharmacies to accept e-prescriptions and provide medication history information; all payors/PBMs to deliver formulary, eligibility and medication history information through e-prescribing; and all vendors to deploy and support high-quality e-prescribing applications.

6. Continue development of additional standards for e-prescribing: While connected e-prescribing is delivering real benefits based on today’s national standards, additional standards development and adoption processes should be supported and accelerated and all stakeholders, including the federal government and the private sector, must be involved.

eHI and The Center have also collaborated with U.S. medical societies, including the American Academy of Family Physicians (AAFP), the American College of Physicians, the American Medical Association (AMA) and the Medical Group Management Association (MGMA) to create a detailed practical guide for prescribers. 

For more information about e-prescribing, the policy landscape, and additional challenges and recommendations, view the full report at www.ehealthinitiative.org and www.theCIMM.org.