E-Prescribing Growth Could Bode Well for Med Adherence

May 18, 2012

May 18, 2012 — The latest snapshot of the state of e-prescribing shows that the percentage of physicians who use this technology grew by a whopping 67% in 2011. With that trend comes a much smaller, but still significant, statistical increase that could bode well for patient outcomes and healthcare costs.

In its annual report on e-prescribing, released yesterday, a pharmacy industry group called Surescripts said that the technology improves the rate at which patients actually pick up a new prescription at the pharmacy.

Patients picked up their meds 69.5% of the time among physicians who telephoned in, faxed, or hand-wrote new prescriptions, according to a 2011 Surescripts study of some 40 million prescription records between 2008 and 2010. Among physicians who e-prescribed between 30% and 40% of the time, this "first fill" rate rose to 76.5%, or by 10%, according to Surescripts, which operates a nationwide network connecting the computer systems of physicians and pharmacies.

One problem with paper scripts is that too many patients either lose or otherwise abandon them. Going untreated, these patients get sicker and rack up higher medical expenses down the road. Surescripts estimates that a 10% increase in first-fill rates combined with other e-prescribing efficiencies could save between $140 billion and $240 billion over the course of 10 years.

The technology also promises to help researchers better understand and cure the problem of medication nonadherence, said Michael Fischer, MD, an assistant professor of medicine at Harvard Medical School, Boston, Massachusetts, during a Webcast briefing on the Surescripts report.

"With e-prescribing, we can see prescriptions that were sent to the pharmacy and never picked up, where before, those paper prescriptions were not trackable in any practical way," said Dr. Fischer, who has researched medication adherence and e-prescribing. "We can actually know the scope of the problem in a way that wasn't as possible before."

36% of Scripts Now Zapped to Pharmacy

In addition to touting a medication-adherence dividend, the annual Surescripts report rattled off some impressive numbers on the growth of e-prescribing, spurred by federal incentive and penalty programs:

  • Roughly 317,000 physicians were e-prescribing by the end of 2011, an increase of 67% over 2010. They represented 58% of all office-based physicians. Internists, family physicians, cardiologists, and endocrinologists led the way with adoption rates of 75% or more.

  • In all, some 390,000 clinicians, including nurse practitioners and physician assistants, used e-prescribing software in 2011 compared with 234,000 in 2010. That also came to a 67% increase.

  • The number of e-prescriptions rose from 326 million in 2010 to 570 million in 2011, or by 75%. The percentage of prescriptions that were electronically transmitted increased from 22% to 36% during that same period.

  • An electronic connection to the pharmacy means physicians can receive information on a patient's medication history and, if he or she is insured, drug benefits, including the plan formulary. The percentage of patient visits in which physicians electronically accessed benefit information rose from 36% to 62%. For medication histories, that figure rose from 24% to 31%.

The Inside Dope About E-Prescribing Controlled Substances

E-prescribing might be growing even faster if it did not face impediments posed by controlled substances, which account for nearly 20% of all prescribed medications. Nine states do not permit physicians to electronically prescribe schedule 1 or schedule 2 drugs, and in 13 other states, the regulatory status of e-prescribing any controlled substance is unclear, according to Surescripts. The US Drug Enforcement Administration lifted a long-standing ban on the e-prescription of controlled substances in 2010, but its requirements for physicians are complicated and deterring. Furthermore, pharmacies, makers of e-prescribing software, and other related parties are still in the process of coming into compliance with the federal rules.

The net result is that most physicians still use paper scripts for the likes of methylphenidate and oxycodone, and when they prescribe controlled substances together with ordinary medications during an office visit, they are prone to write paper scripts for all of them, as opposed to switching back and forth from iPad to prescription pad.

"I still think it's a major challenge for practices that do a lot of pain medication," said Patricia Hale, MD, PhD, an associate medical director for informatics at Albany Medical Center in New York, who participated in yesterday's briefing.

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