The not-for-profit e-Health Initiative released A Clinicians Guide to Electronic Prescribing at a Boston e-prescribing conference sponsored by the CMS with the clear aim of boosting the use of e-prescribing. But the guide points to a number of obstacles the industry faces before e-prescribing takes hold.
Introduced Oct. 7 at the daylong conference, the guide notes that e-prescribing systems are offered in a variety of forms and costs. Stand-alone e-prescribing software systems can either be purchased and loaded onto and then run off a prescribers own computer system or can be accessed through a Web browser and the service is paid for through monthly fees.
Another route to e-prescribing is through the purchase of a comprehensive electronic health-record system equipped with electronic prescription functionality. These types are harder to implement and more costly, with large practices achieving a positive return on investment in a year or two, but for smaller practices it may take longer, according to the guide.
Despite some encouraging words, the report offers a sobering cost analysis, particularly for EHR-based e-prescribing. The price of stand-alone systems runs between free and $2,500 per physician per year, according to the guide. The guide notes that a Congressional Budget Office study pegged EHR costs at between $25,000 to $45,000 per physician, with $3,000 to $9,000 per doctor per year thereafter for software licensing fees, technical support and updating and replacing used equipment. And these numbers do not include initial hardware costs nor do they account for the inevitable decline in revenue from the loss of productivity while climbing the electronic learning curve.
One other oft-cited barrier to e-prescribing was noted in the guidea Drug Enforcement Administration ban on the use of electronic transmission of prescriptions for controlled substances. This adds complexity to the prescribing process and is a barrier to adoption and use of e-prescribing, given that, according to (American Medical Association) estimates, about 20% of all prescriptions are for controlled substances. In those cases, the system sends the prescription to a printer in the office, instead of transmitting it electronically to the patients pharmacy or pharmacy benefit manager. A public comment period on a DEA proposed rule to allow e-prescribing for so-called scheduled drugs closed Sept. 28, the guide notes, but thus far, no final decision has been reached and no timetable set to allow DEA-regulated drugs to be prescribed electronically.
Another barrier is that some pharmacies simply arent ready for e-prescribing. While only about 3% of chain drugstores are not connected to the SureScripts-RxHub e-prescribing network, about 73% of independent drugstores arent connected, the report stated. SureScripts-RxHub is the name of the for-profit company created by the recent merger of SureScripts, which was launched by the two drugstore trade associations, and RxHub, which was founded by three large PBMs.
In 2007, about 35 million prescriptions were filled electronically, a tiny fraction of the 1.47 billion prescriptions and prescription renewals that were eligible for electronic routing, according to the guide, but those e-Rx numbers are expected to triple this year. According to the guide, starting next year, physicians using qualified e-prescribing tools can accrue Medicare payment incentives of up to 2%.
The e-Health Initiative developed the guide in cooperation with the AMA, American Academy of Family Physicians, American College of Physicians, Center for Improving Medication Management and Medical Group Management Association and .
The centers board of directors includes members from the AAFP, Blue Cross and Blue Shield Association, Humana, Intel Corp., the MGMA, SureScripts-RxHub and Walgreen Co. Kate Berry, senior vice president of business development for SureScripts-RxHub, is listed as the centers executive director.
The guide comes as the federal government intensifies its efforts to promote e-prescribing. Apart from the Boston conference, the CMS this spring issued its final rules on a Medicare e-prescribing program.
The final e-prescribing rule was published in the Federal Register on April 2. The rule requires three electronic tools for use in e-prescribing: formulary and benefit transactions, which give prescribers information about which drugs are covered by a Medicare beneficiarys prescription drug-benefit plan; medication history, which electronically transmits to a prescriber a list of the medications the patient is already taking, including those prescribed by another provider; and status notifications, which tell the prescriber if the prescriptions the doctor has written are being filled by the patient.