Adoption of e-Prescribing

March 29, 2013 11:56 pm
Posted By: Anant Bhatia

Despite having to forfeit 1.5% of total Medicare reimbursements due to a penalty for non-compliance with the ePrescribing mandate for Medicare Health Care Providers (HCPs), 40% of HCPs have yet to comply with the mandate. Even an incentive program (Medicare’s Electronic Prescribing Program) that pays 0.5% to HCPs that have implemented an e-Prescription (eRx) system has failed to boost compliance.

Besides benefits such as lowering of risks due to illegible handwriting, limiting Adverse Drug Effects (ADEs) and easier transmission of drugs to the pharmacy, eRx systems are indispensable if Electronic Health Records (EHRs) systems are to have a meaningful implementation. In fact, data has shown that integrated eRx-EHR systems have a higher utilization at 53% compared to standalone eRx systems. Surprisingly, EHR systems have become a major barrier to the adoption of eRx systems.

EHR systems are expensive investments both in terms of money and time to be implemented. There is a substantial implementation cost to the provider, but there is perhaps a more fundamental reason that could explain the slow adoption: resistance to change and comfort with the conventional system of writing prescriptions. The workflow impact is two-fold because of the employee learning curve and the task of inputting demographic, allergy and medication information for each existing patient. Another issue with eRx systems is their limited interoperability with other clinical IT systems; it will be extremely important to have interoperability especially with the EHR systems to fully utilize the benefits of the EHR incentive program. Also, for security reasons, e-prescription of certain controlled drugs is limited, although this barrier is being overcome through improvements in system security.

91% of the nation’s pharmacies accept eRx while 58% of office-based physicians use eRx; the existence of barriers to adoption for physicians is evident through such numbers. Some states namely Rhode Island (where 97% pharmacies that accept eRx), Minnesota with its strict compliance laws and Delaware (that ranks #1 in Surescripts safe Rx rankings) have been distinctly active at incentivizing and promoting eRx. Some of the larger states have been slow at adoption and that includes the nation’s capital. Minnesota is an eRx leader; a Surescripts ranking of states’ adoption rates can be found here.

The rate of adoption by bigger practices is slow and needs to catch up with pharmacies. According the National Progress Report, the adoption rate is a mere 27% for practices with 100 or more providers compared to 55% for a 6-10 practice size. The data suggests that it is easier for smaller practices to adopt eRx compared to bigger practices such as hospitals. This is surprising given that economies of scale could be expected at bigger practices. Perhaps the need of the hour is to look beyond incentives and penalties structure to understand their slow adoption rate. Perhaps they are looking for integrated solutions or are on a wait and watch mode to understand how the market shapes and find integrated solutions rather than buying piecemeal solutions before committing to a huge investment. At present, the top 3 eRx vendors ranked according to the satisfaction index are Practice Fusion, DrFirst and Advanced MD (ADP).