Software vendor Allscripts Healthcare Solutions assembled a coalition of healthcare plans, technology companies and provider organizations to back an offer to provide a free, Web-based electronic prescribing service to allU.S. physicians in an effort to boost what so far has been lackluster use of the technology.
Members of the coalition, called the National E-Prescribing Patient Safety Initiative, announced the strategy last week during a media event at the National Press Club in Washington , and introduced the eRx Now service. Others who have signed on as corporate sponsors are computer makers Dell and Fujitsu Computer Products of America; software developer Microsoft Corp.; network equipment maker Cisco Systems; data-miner Wolters Kluwer Health; telecommunications provider Sprint Nextel Corp.; and SureScripts, the for-profit consortium formed by two leading pharmacy trade groups that provides an e-prescribing technology platform connecting doctors’ offices with retail pharmacies and pharmacy benefit managers.
Health plan sponsors include Aetna , Horizon Blue Cross and Blue Shield of New Jersey and WellPoint. There also are a host of providers acting as "regional supporters" of the free e-prescription offering, including Brown & Toland Medical Group, San Francisco , and the University of South Florida Physicians Group, Tampa .
But it’s uncertain that the effort will have any effect. Other groups previously have given away e-prescribing technology in the hopes of enticing doctors to put away their prescription pads—something they’ve been reluctant to do. According to a report on information technology usage by the Robert Wood Johnson Foundation released in October 2006 that cites data from multiple surveys as of 2005—the most recent year available—while 24% of physicians used an electronic health record, only 9% used a system that had advanced functions such as e-prescribing.
"There have been any number of these things that have not succeeded," said Rick Spurr, chief executive officer of Allscripts’ competitor Zix Corp. "This is an extremely complex area, and it’s highly, highly sensitive. You can kill people. So your quality control has to be off the charts and so does your reliability. If it doesn’t work every time, the doctors won’t use it."
Healthcare payers have much to gain from use of the systems. Avoiding adverse drug reactions will save plans money, but that’s just one of "a number of benefits to the plans" from e-prescribing, Spurr said. "But the most tangible benefit to them is on drug (spending), most notably through increase in generic substitution," Spurr said. "We’ve seen in our data that customers see a 5% increase in generic substitution."
But it’s those side benefits that have privacy experts worried. According to Deborah Peel, an Austin , Texas , psychiatrist and founder of the Patient Privacy Rights Foundation, in a written response to the eRx Now proposal, the effort to boost e-prescribing without adequate patient privacy protections is a bad idea. "If doctors e-prescribe, they will violate the laws and ethics they are required to uphold by disclosing sensitive patient records into electronic systems that allow e-prescriptions to be reused for purposes other than filling prescriptions," Peel said. "It is bad medicine to use the current e-prescription system, which was not engineered to obtain patient consent before secondary uses or to segment access to sensitive prescriptions."
Nevertheless, proponents say the data also can be used to improve quality. "This is an idea that really surfaced a little over six months ago," said Glen Tullman, Allscripts’ CEO. "What really triggered the idea was the (July 2006) release of the Institute of Medicine report, saying 1.5 million Americans are injured from preventable medication errors and 7,000 die. We realized we can do better." Tullman said e-prescribing can reduce those errors, but low physician adoption of the systems is the problem. Tullman said the coalition attempts to address the key barriers to IT adoption, including the cost of the systems and the technological problems of system installation and maintenance.
Tullman said Allscripts can offer the eRx Now service anywhere because it is Web-based and since payers are not funding the service directly, it is not limited to any one supporting payer’s market area. "We don’t need any payers to support this from a coverage standpoint. It’s not limited to any geographical area," Tullman said. "What the payers are adding is incentives (paid directly to physicians for using the service). We want the payers, because they have a huge interest in going electronic. That’s icing on the cake," he said.