Rising tide could lift e-prescribing boat

WASHINGTON —Like rising floodwaters behind a weakening dam, a barrage of activity on Capitol Hill and elsewhere by pharmacy leaders, congressional lawmakers, technology vendors and other healthcare stakeholders could overwhelm the resistance of the nation’s physicians to paperless prescriptions and accelerate the shift to electronic prescribing.

Many forces suddenly are at work in the push for nationwide adoption of e-prescribing and health information technology. Among them: new proposals in Congress to lure or even force doctors into the new electronic era—and to eliminate federal restrictions on e-prescribing of controlled substances, a new advocacy campaign from the pharmacy benefit management industry, stepped-up lobbying efforts by pharmacy leaders and rising awareness of the benefits of paperless prescriptions among House and Senate lawmakers.

The final weeks of 2007 saw a slew of activity. On Dec. 18, 19 U.S. senators co-signed a letter to Attorney General Michael Mukasey in support of e-prescribing—urging an end to a Drug Enforcement Administration ban on the electronic transmission of prescriptions for controlled substances. “DEA regulations permitting [electronic prescription of controlled substances] have been delayed for years, inhibiting wider uptake of e-prescribing, and postponing the realization of this technology’s benefits,” the letter stated. “It is our belief that both the healthcare and law enforcement communities would benefit greatly from a secure EPCS system, and that technological solutions are at hand.”

That action came two weeks after a hearing before the Senate Judiciary Committee in which the National Association of Chain Drug Stores, Rite Aid vice president of pharmacy services Mike Podgurski and SureScripts chief executive Kevin Hutchinson asked Congress to help overturn the DEA restrictions.

“E-prescribing is safe and secure,” NACDS testified. It is an effective tool that is saving lives, improving the quality of health care and reducing the costs of care. The inability to e-prescribe controlled substances is preventing patients, prescribers and payers from taking advantage of these benefits.

“Moreover,” the group added, “the current federal roadblock is also depriving law enforcement of a tool that could help stop illicit prescribing and doctor-shopping and assist with diversion control.”

Podgurski told the Senate panel, Allowing controlled substance prescriptions to also be sent electronically is an important step in accelerating the rate of growth in e-prescribing in general.

“Currently, about 13 percent of all prescriptions written are for controlled substances. We believe that prescribers would be more willing to make the necessary technology infrastructure changes in their practices if all prescriptions, including controlled substance prescriptions, were able to be sent to pharmacists electronically,” he said.

Podgurski said Rite Aid has been involved for many years in the development of the current e-prescribing infrastructure—and that he was involved in the development of Rite Aid’s own e-prescribing system in 1998. “Our company has also been very actively involved in the development of the Pharmacy Health Information Exchange operated by Sure-Scripts,” he testified. “Rite Aid strongly supports the ability of prescribers to send and retail pharmacies to receive e-prescriptions for controlled substances.”

The chairman of the Senate Judiciary Committee, Sheldon Whitehouse, D-R.I., already has indicated his support for lifting the ban. “While e-prescribing could reduce adverse drug events, increase adherence to prescription regimens and save billions of dollars each year, federal regulations still require paper prescriptions for controlled substances often used to treat attention-deficit disorder, anxiety, pain and other ailments,” White-house said. “This requirement means that many doctors default to writing all prescriptions by hand rather than maintaining two systems.”

During his testimony, Hutchinson disclosed the results of the first National Progress Report on E-Prescribing. Published by SureScripts and based on data derived from the operations of the Pharmacy Health Information Exchange, the report features statistics measuring the current status of e-prescribing in the United States.

Among its findings:

There were more electronic prescriptions in the first three quarters of 2007 than in 2004, 2005 and 2006 combined, and the 2007 total will reach 35 million—or 2 percent of the estimated 1.47 billion new prescriptions and renewals eligible for electronic routing in the United States.

Of the 563,000 office-based physicians in the United States, 6 percent now are e-prescribing. SureScripts estimates the number of electronic prescribers will grow to approximately 85,000 next year.

More than 40,000 pharmacies now are accepting e-scripts, and that total should grow to 45,000 in 2008, according to the e-prescribing platform provider.

“There is a fully operational, nationwide infrastructure that closely adheres to all industry and government-approved standards for e-prescribing,” Hutchinson testified. He added, however, “Despite strong momentum and growth, this national asset is grossly underused. Every time a paper prescription is written, it is a lost opportunity to improve patient care.”

The push to convert physicians and federal lawmakers to an e-prescribing platform has drawn adversaries into a broad and unusual alliance—encompassing both retail pharmacy and the pharmacy benefit management industry. This is one campaign in which the Pharmacy Care Management Association—the nation’s chief PBM advocacy organization and a frequent critic of independent pharmacy—and the National Community Pharmacists Association find themselves on the same side.

PCMA, for its part, has stepped up its drive for e-prescribing with a new TV and print advertising campaign aimed at federal policymakers. To drive home its point, the PBM umbrella group has enlisted the support of well-known pharmacy advocate L. Lyle Bootman, dean of the College of Pharmacy at the University of Arizona.

Bootman is a vocal advocate of linking physicians and pharmacists through electronic data communications and health information technology, and last year co-chaired an Institute of Medicine committee that recommended that all physicians begin using e-prescribing by 2010 to help reduce the estimated 1.5 million preventable medication errors that occur in the United States annually. “However, fewer than 1-in-10 physicians currently use e-prescribing technology,” PCMA noted.

“Thousands of people die every year because of preventable medication errors,” Bootman said in the PCMA ad spot. “Many of them are America’s seniors.”

According to the IOM, about 7,000 people die from medication errors each year.

Along with the TV ad, PCMA also is running a print ad in Roll Call and other inside-the-Beltway publications with the headline: “While You Wait.” The print advertisement urges Congress to require e-prescribing in Medicare as a solution to the medication-error death rate.