E-Prescribing Systems Still Finding Their Mojo

6 Top-Notch E-Prescribing Options

The latest figures from Surescripts, the nation's largest e-prescription network, show that at the end of last year, 58% (or 317,000) of office-based physicians were using e-prescribing tools to fill prescriptions, versus only 36% (190,000) in 2010. Even more encouraging is the fact that smaller practices are finally getting into the act.

Among practices with six to ten physicians, 55% adopted the technology, as did 53% of practices with two to five physicians. Similarly, solo practitioners also experienced significant growth, with 31% adopting e-prescriptions in 2010 and 46% in 2011.

It's hard to see a downside to this trend. A recent RAND study predicts that when electronic medication ordering reaches the 60% threshold, it will lower the death rate from acute myocardial infarction and heart failure by 2.1%, which researchers considered significant.

Similarly, during a recent webcast, Harry Totonis, president and Surescripts CEO, pointed out that when physicians e-prescribe, they gain access to a patient's benefit information and medication history--information that helps them select the best medication for the patient.

Most e-prescribing systems also check for patient allergies and drug-drug interactions, two more safeguards to ensure patient safety.

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Also, there's the fact that many physicians have notoriously poor handwriting, so switching to an electronic system reduces the number of phone calls pharmacists must make to clarify illegible prescriptions.

Additionally, studies have shown that e-prescribing can increase medication adherence and reduce healthcare costs. Patients who lose paper prescriptions, for example, may delay going back for a new one or not take their medications on time, which can lead to more health problems.

Certainly financial incentives are a driving force behind physicians' increasingly use of e-prescriptions. The 2008 Medicare Improvements for Patients and Providers Act (MIPPA) instituted a Medicare e-prescribing program that pays small incentives to doctors who write at least 10% of their prescriptions electronically, with some exceptions. The bonus was 2% of eligible Medicare Part B charges in 2009-10, 1% in 2011-12, and it will be 0.5% in 2013.

Clearly there are significant financial and clinical benefits to e-prescribing, but there's still plenty of room for improvement. For example, deficiencies in an e-prescribing program or in the CPOE platform that houses it can sometimes cause major problems. Last year, for instance, investigators from the University of Wisconsin-Madison and Geisinger Health System in Pennsylvania reported that e-prescribing actually increased medication errors rather than reduce them.

Their review of two intensive care units at a 400-bed rural teaching hospital in the Northeast before and after CPOE implementation revealed a higher rate of duplicate medication orders with the technology in place. Identical electronic orders jumped from 0.36 to 1.72 incidents per 100 patient days, while same-medication errors increased from 0.31 to 1.87 per 100 patient days. They also found a slight uptick in the rate of medication orders in the same therapeutic class.

In some cases, the clinical decision support algorithms used by the CPOE system overlooked true duplicates, according to investigators. And the medication database used by the system didn't recognize oral and intravenous forms of a single medication as the same drug.

Another study suggests that just because an e-prescribing system is integrated into an EHR doesn't mean it will perform any better than a stand-alone e-prescribing program. Researchers from Weill Cornell Medical College and New York-Presbyterian Hospital found that after adjusting for baseline differences, clinicians who used the stand-alone program had four times a lower rate of errors at one year compared to those using the integrated system.

It turns out the stand-alone program had a more mature clinical decision support system, and users were better trained and given stronger technical support than the physicians using the integrated system.

The bottom line is clear: While the increased use of e-prescribing systems is good news for doctors and patients, without a sophisticated clinical decision system and a fully staffed technical support staff, providers won't see the benefits they're hoping for--and patients could be put at increased risk.

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