The expanding universe of information technology coalitions grew even larger last week as a group formed to promote electronic prescribing by physicians.
The new coalition, called Cafe Rx, will tackle the thorny problems of practice change, industry collaboration and medication politics that could keep the e-prescription movement stalled long after initial questions of standards adoption are resolved. Fewer than 5% of the nation's doctors are prescribing electronically, according to one industry study, and experts say the pace of adoption won't budge much until problems of workflow interruption, start-up expenses and control of the prescribing process are ironed out.
Driven by the Medicare Modernization Act, a flurry of activity already is under way to forge a standard e-prescribing format for sending prescriptions to pharmacies or mail-order businesses, examining them for clinical appropriateness and insurance considerations, and fulfilling the orders for patients.
But unless the computer systems and electronic routines mesh with busy physician practices, all that advance work may not push the industry to widespread adoption, said Robert Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians.
In addition to technology factors, physicians continue to be concerned that such systems could be manipulated by health plans and pharmacy benefit managers with a stake in steering physicians to choices based purely on economics, he said.
Creating the right conditions for physicians to use such technology will take the coordinated efforts and consensus of crucial participants ranging from IT vendors and data-exchange middlemen to health plans, drugstore outlets and pharmacy benefit managers, said Donald Gravlin, a Capgemini consultant helping to launch the new coalition.
Cafe Rx arose out of discussions hosted by the National Council for Prescription Drug Programs, or NCPDP, a standards development organization promoting transfer of data to and from the pharmacy services sector of healthcare. An NCPDP electronic standard for retail pharmacy claims is among the transactions adopted in the Health Insurance Portability and Accountability Act of 1996.
The standards group also has a nonbinding industry blessing for its standard on transmitting prescription details electronically between prescribers and pharmacies.
Last month CMS Administrator Mark McClellan announced that the federal government expects to require "an initial set of well-established standards" for e-prescribing by January 2006 for drug plans participating in the new Medicare prescription drug benefit. Originally the Medicare Modernization Act had called only for pilot projects by that time. National standards weren't required until 2009, and they applied only to drug plan sponsors-physician adoption is voluntary.
The charter companies of Cafe Rx, in addition to the NCPDP and Capgemini, include IT giants Microsoft Corp., Hewlett-Packard Co. and Cisco Systems; NDCHealth, which connects pharmacies and payers with providers; RxHub, which provides eligibility, formulary and medical-history data; SureScripts, which connects physician offices and retail pharmacies; and Allscripts Healthcare Solutions, a vendor of e-prescribing and electronic record systems.
Initial funding for the Cafe Rx coalition is coming from "charitable contributions" from the founding companies and dues money from an NCPDP work group on
e-prescribing, Gravlin said. Beyond that, the coalition has been approached by health plans to be part of the initiative, but "the crystal ball's still cloudy" about how they'll contribute to the costs of operation, he said.