Advice for physicians on e-prescribing

The Institute of Medicine has called for all prescriptions to be written and received electronically by 2010. Yet only 6% of office-based physicians currently e-prescribe, according to William Jessee, MD, head of the Medical Group Management Association (MGMA). But the adoption rate is accelerating: More physicians e-prescribed in 2007 than 2004, 2005, and 2006 combined.

According to a recent report from SureScripts, 97% of chain pharmacies and 27% of independent pharmacies currently handle prescriptions electronically. MGMA says that "administrative complexity" of paper prescriptions costs a practice about $15,700 for each full-time physician. E-prescribing could help by reducing, say, the phone time spent in clarifying prescriptions.

There are even some national programs where the e-prescribing cost is zero. Last year, for example, a number of well-known companies, including Dell and Google, set up the "National ePrescribing Patient Safety Initiative" to offer free e-prescribing.

The pharmacy coalition recognizes that switching over affects workflow and information technology support. For instance, some patients can't immediately remember their pharmacy's address or telephone number. One suggestion from the crowd was for that information to be gathered at the front desk.

One development that may push pediatricians toward e-prescribing, said Robert Hall, an American Association of Pediatrics (AAP) assistant director, is the new requirement that all prescriptions for Medicaid be on tamper-resistant prescription pads. All state Medicaid programs now require pads to have at least one industry-recognized "tamper resistant" feature, such as a design to prevent unauthorized copying. Doctors can avoid that requirement by e-prescribing.

There also is a discussion in Washington about whether e-prescribing will be allowed for controlled substances. The idea has met with resistance from the Drug Enforcement Administration, according to news reports.

At the pharmacy coalition event, organizers said Massachusetts is the state with the highest proportion of prescriptions e-prescribed, at 13%.

Former Speaker of the House Newt Gingrich spoke at the news conference. "Because in a paper-based system you have no capacity for expert analysis to automatically find out whether something is contraindicated, or whether the person is already taking another drug or the person has an allergy, the objective reality is that a paper-based system has dramatically less effective information flow, is dramatically more unsafe: It literally kills people," he said.

Gingrich also told the audience, "The odds are overwhelming by the end of this year ... the federal government will be firmly on course to get to an all-electronic prescribing regime across all of the health activities paid for by the federal government. That is an extraordinary step in the right direction."

Nevertheless, he suggested, "A doctor in a single practice needs to talk to a doctor in a single practice ... I'm hoping we can build a national doctor inventory where a doctor who wants to learn can actually be talking to a doctor who is doing it. Because you can talk to vendors all you want to. The vendor does not live the life. They don't have the same problems."

KATHRYN FOXHALL is a contributing editor to Contemporary Pediatrics.