October and November of 2003 could prove to be watershed months in the history of e-prescribing. Although the final version of Medicare legislation passed by Congress late last month no longer carried earlier language mandating the adoption of electronic prescribing technology, it does call on CMS to set standards for e-prescribing by 2008.
The new law also allows HHS to provide grants for e-prescribing systems. And it authorizes bonus payments to physicians who reduce drug interactions and improve formulary compliance for Medicare patients.
"People have been talking about electronic prescribing for a while, but I think we are fast approaching the time when widespread adoption can be a reality," FDA Administrator Mark McClellan, M.D., said in a Nov. 12 speech.
"It's frequently used in hospitals already," McClellan says. "And even though well under 10% of prescriptions in doctors' offices are electronic, a multitude of powerful forces--such as the emergence of low-cost Web technologies and the increasing popularity of palm-sized devices amongst physicians--are converging to modernize ambulatory prescribing as well."
Peter Kaufman, CMO of DrFirst, the Rockville, Md., firm that produces Rcopia e-prescribing software, says the No. 1 factor in the rise of e-prescribing is the work that companies like SureScripts, ProxyMed and NDCHealth are doing toward building electronic "backbones" for direct connectivity on the pharmacy end.
SureScripts, a joint venture of retail pharmacy organizations, automatically contacts the physician's office if a patient does not pick up a prescription as ordered.
"The pharmacy can request electronic renewal on SureScripts even if the script came in on paper," Kaufman says. He also says that the applications have gotten better and easier to use.
"Doctors are now seeing the drive toward e-health," Kaufman says.
In the 2003 Modern Physician/PricewaterhouseCoopers technology survey, 27.8% of respondents say that at least some of their physicians write electronic scripts, up from 23.2% last year and 11.8% in 2001.
In just the last two months:
- Blue Cross Blue Shield of Massachusetts and Tufts Health Plan, Waltham, Mass., reached agreements with Dallas-based Zix Corp. to provide $3 million worth of PocketScript e-prescribing software and service to 3,400 physicians.
- Zix also made a deal with Group Health, a health insurer in New York state, to bring the technology to 5,000 physicians, and it began a pilot test with Grove Hill Medical Center, a 70-physician multispecialty clinic in New Britain, Conn., in conjunction with payer ConnectiCare.
- ePocrates, best known for its drug reference tools, last month launched its own Web-based formulary service in partnership with the American Society of Health-System Pharmacists to put hospital-specific formularies and interaction testing on desktop computers and personal digital assistants.
- The Massachusetts Medical Society became the first statewide physician organization to endorse an e-prescribing product. The society will offer its members discounted access to Rcopia service.
- InstantDx, Gaithersburg, Md., expanded its e-prescribing partnership with CVS by achieving full electronic connectivity with the Woonsocket, R.I.-based pharmacy chain's stores in Maryland and Virginia.
- Massachusetts and New Jersey took steps to legalize and regulate digital physician signatures on electronically transmitted prescriptions.
"By enrolling the 3,400 physicians who write the highest volume of prescriptions for our members, we expect to improve prescription drug safety, convenience and costs for the maximum number of our members," explains Robert Mandel, M.D., vice president of provider enrollment and services for the Massachusetts Blues. "The technology has the potential to revolutionize one of the most basic parts of the medical process."
E-prescribing has its skeptics. The AMA and the American College of Physicians both argue that e-prescribing technology remains largely unproven. And a controversial study, published in October, suggests e-prescribing has little effect on formulary compliance and generic drug utilization.
Still, Alan Weinstein, M.D., InstantDx co-chairman and CEO, says even incremental improvements are good for medicine.
"We shouldn't wait until we have all the bells and whistles for communication. I think we should start right away," Weinstein says. "We need to get docs, pharmacists and nurses off the phone."
Indeed, the October study by Aetna and Advanced Concepts USP, a business unit of Philadelphia pharmacy school University of the Sciences, finds that that e-prescribing technology reduces the number of staff calls to pharmacies by 62% and cuts incoming pharmacy call volume by 53%.
Caroline Samuels, M.D., can vouch for the efficiency gains. "We hardly ever get calls back from pharmacies," says Samuels, who uses Rcopia at Dimensions Medical Associates, a Lanham, Md., internal medicine teaching program affiliated with Prince George's Hospital Center in Cheverly, Md. "Problems are picked up by staff that used to be brought back to us. Integration into the flow of the clinic has allowed us to eliminate redundant work of the staff."