Technology was used for 2% of prescriptions in 2007, will rise to 7% this year

E-prescribing appears to be one of those glass half-empty, half-full situations: solid progress looked at one way; slow take-up (primarily by prescribing physicians) looked at another. While the volume of e-prescribing nearly tripled, to 35 million, in 2007 (from 2006’s 13 million), that volume represents about 2% of the almost 1.5 billion prescriptions “eligible” for e-prescribing (i.e., were not controlled substances, or were not pre-authorized refills).

These are some of the data reported by SureScripts, a joint effort by the National Community Pharmacists Assn. and NACDS that operates the Pharmacy Health Information Exchange, a vendor-neutral communications facility for e-prescribing. E-prescribing is defined as the electronic generation of a legal prescription via a certified software solution, transmitted via in a secure, standards-based format” by SureScripts; it does not include faxed transmissions, nor (necessarily) formulary or medication history.

E-prescribing is maddeningly simple in concept, especially when compared to the consequences of incorrectly transcribed prescriptions via physician’s paper pads that are partly responsible for the 400,000-some medication errors, and 7,000 deaths, caused annually by medication errors. In its report, SureScripts says that 70% of the 57,000 community pharmacy locations in the United States are “e-ready,” and that this number will grow to 45,000, or 79%, by the end of this year.

Generally speaking, pharmacies like e-prescribing because it represents less effort to get the necessary data into pharmacy ordering and data-storage systems. Managed-care organizations and, especially, PBMs, like e-prescribing because it gives them a better handle on prescribing trends, and can be merged with medical records to monitor health outcomes. Ultimately, some of these data and trends come back to pharma manufacturers, where they can be used to track distribution channel activity, prescribing patterns (with, of course, patient information “de-identified”) and, conceivably, to guide production and inventory activity.

The physician obstacle
The main holdup has been—and will continue to be—physicians, who complain that the IT systems are hard to use and represent a cost to themselves while the savings accrue elsewhere. Not so, asserts SureScripts and others, pointing out that e-prescribing can cut a large percentage of the follow-up queries from pharmacies when a prescription is received, and will thereby save physicians’ administrative overhead.

According to the SureScripts report, over 35,000 physicians are currently active e-prescribers, representing about 6% of office-based physicians. In 2008, this is projected to rise to 85,000, representing 15%. The number could be 150,000 without much additional effort if physicians could be made to understand that the electronic systems they are using today to send faxes could be used instead to e-prescribe; SureScripts launched a “Get Connected” program in 2006 to emphasize this point.

Another spur will come from CMS, whose Medicare/Medicaid offices are advocating e-prescribing as a preferred method to obtain reimbursements more quickly.

Going for the gold
An additional bit of cheerleading for the cause that SureScripts is engaged in is to certify qualified vendors as GoldRx software vendors, based on how well they meet the operability standards of the organization. In January, three vendors—DrFirst, NextGen and Allscripts—won this certification. Overall, there are some 105 physician technology solutions that have been certified by SureScripts.

Still ahead, from SureScripts’ perspective, is getting DEA to allow e-prescribing of controlled substances. In theory, an e-prescription should be no more prone to abuse than a conventional scrip (in fact, it could be more secure), but DEA has been reluctant to make changes. Then-president Kevin Hutchinson of SureScripts testified before a Senate committee in December, noting that “the inability to electronically prescribe controlled substances is one of the most frequently cited reasons for not e-prescribing, he testified, noting that physicians complain that they would have to maintain two systems—one pager-pased and one electronic—handle these prescriptions. No immediate legislative activity was taken.

Other next steps recommended in the report are to have Congress grant CMS authority to mandate e-prescribing, as recommended early by the American Health Information Community; to create “utilization-based incentives”—i.e., money—to encourage high-prescribing physicians to switch over.