Health IT, e-Rx tsunami awaits physician adoption

NEW YORK

By now, there’s no doubt that health information technology and electronic communications will drive a seismic shift in the way doctors, diagnostic labs, pharmacists, health plan payers and patients themselves interact, share information and diagnoses, promote healthier behavior and generate prescriptions. The support of key policymakers and healthcare stakeholders for that change also is clear: the Bush administration, Congress, pharmacy leaders, technology vendors and other groups all are pushing for the rapid and universal adoption of both e-prescribing and health IT as a more efficient and effective way to gather, store and transmit privacy-protected patient records.

No one disputes the obvious benefits. “If appropriately used, e-prescribing can open up better lines of communication between all members of the healthcare team,” said Allen Vaida, Pharm.D., executive vice president of the Institute for Safe Medication Practices. “It also can provide vital drug and patient-specific information during prescribing and ultimately help reduce the risk of adverse drug events.”

For community pharmacies, the chance to link up directly with prescribing physicians, electronically and in real time, is a win-win opportunity for patients, pharmacies and doctors. The switch to paperless prescriptions not only reduces errors and puts doctors and pharmacists in closer touch with one another; it also leads to higher prescription volumes.

A recent study from Walgreen Co. and SureScripts supports that finding. Using prescriber data from IMS Health, the study tracked the number of prescriptions received by pharmacies before and after physicians began using electronic prescribing—and showed an 11 percent increase in new prescriptions filled after physicians began prescribing electronically. One major reason: more of those physicians’ scripts actually made it to the pharmacy.

“E-Prescribing is finally becoming mainstream and clearly benefits pharmacies in so many ways: safety, quality, productivity and efficiency to name a few,” said Brian Morris, director of product management at McKesson Pharmacy Systems.

“The opportunity to get more prescriptions into the hands of patients is a benefit to us all,” said Bruce Roberts, executive vice president and chief execuitve officer of the National Community Pharmacists Association. “Electronic prescribing has long been viewed as a means of improving prescribing safety, but this research sheds new light on the additional clinical and economic benefits.”

The shift from paper to electronic prescribing also could have a dramatic impact on patient compliance, researchers suggest. According to studies cited in a recent report by the National Council on Patient Information and Education, only about 50 percent of American patients typically take their medicines as prescribed, resulting in approximately $177 billion annually in direct and indirect costs to the U.S. economy.

“A common hurdle to adherence improvement has been the drop-off that occurs at the handoff of the prescription from consumers to the pharmacy,” said Ray Bullman, NCPIE executive vice president. “E-prescribing ameliorates myriad factors that challenge consumers’ getting their prescriptions to the pharmacy. That’s an important contribution.”

Added David Bernauer, recently retired chairman of Walgreen Co. and current chairman of the National Association of Chain Drug Stores, “Electronic medical records will give pharmacists, doctors and payers clear visibility into adherence. Doctors will finally know what their patients are taking. Pharmacists will know the outcomes doctors are seeking. And payers will have better outcome evidence.”

Despite the many benefits that could accrue to e-prescribing, however—and despite the inevitability of its adoption—the nation’s more than 550,000 office-based physicians remain a powerful breakwater slowing the health IT tsunami. But given the costs and time involved in making the transition, their resistance should come as no real surprise.

It sounds simple enough. E-prescribing occurs when a physician uses a computer or handheld device to electronically generate and transmit a prescription to a pharmacist’s computer, rather than sending a handwritten, printed, faxed or telephoned script to the pharmacy. Nevertheless, only about 10 percent of doctors in solo or small-group practices are storing, generating and transmitting patient records and/or prescriptions electronically.

One big hurdle is the cost, which can be up to $40,000 for adoption of electronic record keeping, e-prescribing and health IT, according to estimates. Another is the time involved in changing routine practices: doctors are used to the simplicity of simply scribbling down a prescription and handing it to a patient.

Indeed, said Health & Human Services Secretary Michael Leavitt in a report from the Associated Press, doctors tend to view electronic patient record keeping as a boon to insurers and patients, but a big out-of-pocket investment that may not be worth the cost for physicians themselves—at least in the near term.

A handful of technology vendors are working to overcome that resistance by putting hand-held devices and other data storage and communications hardware into the hands of physicians for little or no up-front costs. Meanwhile, both the White House and Congress are working to implement the Bush administration’s previously announced plan to encourage the nationwide adoption of electronic health records by 2014.

For its part, the administration is launching a pilot program in Medicare that will provide physicians with a monetary incentive for shifting to an online system for e-prescribing and patient record keeping.

In Congress, such legislators as Sens. Debbie Stabenow, D-Mich., Sheldon Whitehouse, D-R.I., and Olympia Snowe, R-Maine, have joined with such House members as Rep. Patrick Kennedy, D-R.I., and Tim Murphy, R-Pa., to introduce bipartisan legislation promoting health IT through tax incentives and federal grants.

“Our healthcare system must and will change,” Kennedy said. “Moving health care into the information age is the critical first step to building a sustainable, high-performing 21st century healthcare system.”