March 5, 2010 — In a testament to how the federal government can change what happens in a physician's exam room, the number of prescriptions that were routed to pharmacies electronically increased by 181% in 2009 compared with in 2008, according to a group formed by the pharmacy industry to promote this technology.
Although it has yet to become standard practice in medicine, electronic prescribing — aggressively pushed by the federal government — accounted for 18% of all prescriptions except those for controlled substances in December 2009 compared with 6.6% at the end of 2008. Furthermore, the number of physicians, nurse practitioners, and physician assistants who prescribe this way more than doubled in 2009 to 156,000, representing 1 in 4 office-based prescribers.
These trends emerged in an annual report published this week by Surescripts, which operates a national data network connecting physicians, pharmacies, insurers, and pharmacy benefit managers. The group also collaborates with organized medicine to help physicians become electronic prescribers. The Surescripts data for 2009 apply to transactions on its own network, which accounts for the vast majority of electronic prescriptions in the country, according to Rob Cronin, a company spokesperson.
Cronin attributes the surge in electronic prescribing during 2009 in large measure to several federal programs that encourage physicians to go paperless.
"This is one of the more prominent examples of where the government has stepped into healthcare," Cronin told Medscape Medical News. "Their plan is working."
In 2009, the Medicare program began awarding a 2% bonus to physicians who electronically prescribe for Medicare patients under the Medicare Improvements for Patients and Providers Act of 2008. Likewise, the economic stimulus legislation passed by Congress last year promises billions of dollars in incentive payments — starting in 2011 — to physicians who invest in electronic health record (EHR) systems. To earn that money, however, they'll have to be a "meaningful user" of their EHR, which by definition includes electronic prescribing.
Federal carrots also come with sticks. The Medicare Improvements for Patients and Providers Act penalizes physicians who are not electronically prescribing for Medicare patients by 2012, and physicians who are not "meaningful users" of EHRs by 2015 also will have their Medicare reimbursements docked.
Electronic Access to Prescription Benefit, History Data Also Growing Dramatically
Technically speaking, electronic prescribing means transmitting a script from the prescriber's computer to the pharmacy's computer through a technology called electronic data interchange. Faxing a software-generated prescription to a pharmacy does not qualify as electronic prescribing.
Most electronic prescriptions make their way to pharmacies over the Surescripts network, which also helps e-prescribers tap into valuable patient data from participating pharmacies, insurers, and pharmacy benefit managers. As clinicians prepare to order a medication for a patient on a computer or smart phone, they can view the patient's prescription benefit information, including the health plan formulary. The clinicians also can see a list of medications that other clinicians have prescribed and avoid ordering a duplicate medication or one that might interact adversely with others.
Use of this electronic prescribing data grew even faster in 2009 than electronic prescribing per se. Requests for prescription benefit data increased 284%. Almost two thirds of the time, that information was available on the network and transmitted to the clinician. Meanwhile, prescription histories delivered to clinicians grew by 395%.
Despite Rapid Gains, Electronic Prescribing Faces Barriers
By the end of 2009, the Surescripts network had signed up enough healthcare organizations to give clinicians access to the prescription benefit and history data of more than 65% of American patients. That's the same level of access that Surescripts reported for 2008 — a relative plateau compared with the rapid growth in electronic prescribing.
Even with e-prescribing nearly tripling in 2009, the technology still faces some speed bumps, according to the Surescripts annual report:
Independent pharmacies have been slower to retool their computer systems for electronic prescribing than the big chains such as Walgreens.
Only 9 state Medicaid programs by the end of 2009 had made prescription benefit data available to network prescribers.
Small practices often short on time and money have lagged behind larger practices in digitizing prescriptions.
The federal Drug Enforcement Agency still bans electronic prescribing for controlled substances. The hassle of having to switch back and forth from computer software to a pad of paper for ordering medications, depending on their class, dissuades some physicians from giving e-prescribing a try in the first place, according to Surescripts.
The Drug Enforcement Agency has studied the implications of electronic prescribing for years. In 2008, during the George W. Bush administration, the agency issued a rough draft of a regulation permitting the technology's use for controlled substances, but it has not followed up with a final version. Surescripts' Rob Cronin told Medscape Medical News that the Obama administration appears to be revisiting the issue.
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