History's answer to increasing the use of computerized diagnostics

The year the dot-com bubble burst, 2001, the three largest pharmacy benefit management companies launched RxHub, an electronic prescribing network, and the two main pharmacy associations created its rival, Surescripts.

While the two exchanges battled for supremacy, both promoted the common cause, e-prescribing, as a patient-safety issue and funded a grind-it-out marketing campaign that cost millions of dollars to sustain.

I had lunch the other day with physician information technology leader Dr. Harry Greenspun, who recalled those days, saying, for years "you couldn't swing a dead cat" in health IT circles without hitting Kevin Hutchinson, Surescripts' then-omnipresent CEO.

And yet, despite five years of campaigning, by 2006, there were just 16,000 e-prescribers in the whole country, according to Superscripts' data.

In 2007, some technological progress was made. The majority of e-prescribers shifted from using stand-alone e-Rx systems to e-Rx technology built into electronic health-record systems. That meant physicians didn't have to jump between computer systems to write a script.

By 2008, the number of e-prescribers had increased to 76,000. RxHub and Surescripts merged. Of more importance, the feds joined the e-Rx campaign with a program to first incentivize e-prescribers and then penalize those who aren't under the Medicare Improvements for Patients and Providers Act.

In 2009, e-prescribing was one of three "must-haves" required by Congress in the meaningful-use criteria under the American Recovery and Reinvestment Act's EHR incentive payment program.

Since then, e-Rx has exploded. By the end of 2011, there were 390,000 e-prescribers—58% of the total prescriber population—and 82% of them were writing their scripts on an EHR, according to Surescripts.

Behold the powers of persistence, marketing, the federal government, the right thing to do and, oh yes, self-interest.

Pharmacies estimated they would net labor savings of $1 per e-prescription. Pharmacies and pharmacy benefits managers figured they'd gain from substitutions to higher-profit generics, which the electronic tools could remind physicians to consider.

Why rehash all this?

We have a story in this week's magazine about the limited use of computerized diagnostic support applications.

Several of these applications have been around for decades. Two were developed by the legendary healthcare computing pioneers Drs. G. Octo Barnett and Lawrence Weed.

Unlike e-prescribing systems, however, computerized diagnostic support tools don't have a lobby with a business case behind them—at least not yet. Several experts I interviewed for this story suggested that, maybe with the advent of accountable care organizations, the tools will be better incentivized. Another medical informaticist I spoke with, Dr. William Bria, predicts that patients soon will be armed with these systems on their mobile devices, and that could force the issue.

But for now, they seem to be caught in the same limbo—the right thing to do, but kind of clunky and no government mandate to use them—that e-prescribing tools were stuck in until just six years ago.

My take on this is that widespread adoption and use of these tools is inevitable.

Absent a lobby, though, I just hope I live so long.

Follow Joseph Conn on Twitter: @MHJConn.