E-prescribing may give way to universal adoption

WHAT IT MEANS AND WHY IT'S IMPORTANT Now, it’s up to the doctors.

(THE NEWS: DEA allows controlled drug e-prescribing, handing pharmacy advocates a key victory. For the full story, click here)

In a dramatic if long anticipated break with its own regulatory past, the Drug Enforcement Administration earlier this week agreed to sweep away its longstanding rule preventing doctors from electronically prescribing controlled substances. The capitulation came with the release of the DEA’s interim final rule for 2010, and it clears away the last big legal roadblock to nationwide, universal electronic prescribing of commonly dispensed medications.

That doesn’t mean the floodgates to universal adoption of electronic patient records and paperless prescribing have suddenly opened. A large majority of family physicians and their practices -- roughly 3-out-of-4 of them -- still hand-write prescriptions, and rely on their patients to carry them to the pharmacy for dispensing.

Although “electronic health record adoption is picking up rapidly, with an estimated 27% of physicians using some kind of EHR, the vast majority of medical records in the U.S. are still on paper, with the average appointment taking 13 pages to document,” confirmed Karen Riley, a spokesperson for the New York eHealth Collaborative and the NYC Regional Electronic Adoption Center for Health.

And, as study after study of patient adherence rates confirms, between the point of prescribing and the local pharmacy yawns a vast gulf that swallows many written scripts. In one recent study, researchers at Harvard Medical School found the problem of  “primary nonadherence” is rampant. Tracking 75,000 patient visits, they found that 22% of first-time patient prescriptions were never filled.

Allowing e-prescribing of potent and tightly restricted pain relievers and other medications won’t bridge most of that gap. But it will help close the loop between physician, patient and pharmacist for several large classes of medicines, and it will simplify the prescribing process for family docs and specialists.

Opening controlled substances to the world of electronic data storage and communications has long been a top priority for Surescripts, the e-prescribing network set up nine years ago by the National Association of Chain Drug Stores and its independent pharmacy counterpart, the National Community Pharmacists Association. “There’s a high demand for it, both at the state level -- where they want to track the use of controlled substances -- as well as at the federal level,” former Surescripts CEO Kevin Hutchinson told Drug Store News in one interview.

“That will help tremendously,” Hutchinson went on in that 2008 interview. “It’s a roadblock for us today, because physicians have to think about when to write scripts electronically, and when to pick up the paper pad. That’s difficult, and that is one final hurdle we need to get over.”

Now that hurdle has been vaulted. The real transformation of the nation’s healthcare system -- away from outmoded paper records and handwritten scripts to electronic data storage and transmission -- will depend on how quickly doctors embrace health information technology.