Everyone Loves e-Prescribing! Right?

Daniel Hier, MD, MBA
Published: Wednesday, Nov 12, 2008
Electronic prescribing is rapidly gaining support from a diverse array of healthcare organizations, government agencies, and technology corporations, including CMS; the American College of Cardiology; the Department of Defense; the Institute of Medicine; Blue Cross and Blue Shield Association; all of the major pharmacy chains; as well as Dell, Microsoft, Sprint, Fujitsu, and Cisco. Although it may seem as though everyone loves electronic prescribing, there are a few notable exceptions, especially within the physician community.

Pharmacists dispensed nearly 4 billion prescriptions in 2007, accounting for roughly 10% of healthcare costs, or about $286.5 billion. Forrester Research has estimated 900 million prescription-related phone calls per year, with 30% requiring callbacks to physician offi ces to clarify prescriptions (Forrester Research, 2002; Medco Health, via ePharmaceuticals). In addition, pharmacists make 500 million calls to physician offices annually to get approval for expired refills. The Institute for Safe Medical Practices estimates up to 3 million of the 8.8 million adverse drug events that occur annually are preventable. Preventable errors include unclear telephone orders, ambiguous orders, illegible handwriting, incorrect dosages, and unclear abbreviations. Electronic prescribing has been heralded as a technology that will improve effi ciency, reduce these errors, and decrease costs. But is everyone on board?

Vendors love e-prescribing

Increased electronic prescribing will benefi t the electronic prescribing vendors, as they earn revenue by selling software to physicians. E-prescribing vendors include standalone e-prescribing software, as well as software integrated into EHRs. Refer to the table for a list of standalone products and vendors off ering EHRs with integrated e-prescribing capabilities, or standalone e-prescribing software, along with Web addresses for each.

The NEPSI eRx Now product is Web-based and currently available at no charge to physicians in the US. Cost of other standalone or integrated e-prescribing programs varies from $20 to $80 per physician, per month.

Capabilities of e-prescribing software vary by vendor. SureScripts has identified five core features: e-prescribing (the ability to transmit prescriptions electronically to pharmacies); eRefills (the ability to receive refill requests from pharmacies electronically); Rx history (the ability to access a patient’s prescription history); eligibility (the ability to determine a patient’s prescription benefits); and formulary (the ability to determine the cost of drugs for each patient depending on the benefits plan). SureScripts has currently certified six products as GoldRx, meaning that they are capable of each of these functions. The vendors are Allscripts, eRx, DrFirst, eClinicalworks, NextGen, and Networking Technologies (vendor for RxNT).

CMS loves e-prescribing

CMS has been a strong advocate for e-prescribing, and as a result of legislation passed in July 2008, beginning January 1, 2009, doctors will get a 2% bonus for e-prescribing, continuing into 2010. The bonus drops to 1% in 2011 and 2012, and then to 0.5% in 2013. CMS believes that e-prescribing will increase generic drug prescribing, reduce drug costs, reduce adverse drug events, and improve effi ciency of the healthcare system.

CMS has defined e-prescribing as “the transmission, using electronic media, of prescription or prescription-related information between a prescriber, dispenser, pharmacy benefi t manager, or health plan, either directly or through an intermediary, including an e-prescribing network. E-prescribing includes, but is not limited to, two-way transmissions between the point of care and the dispenser.”

Insurers and third-party payers love e-prescribing

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