Tipping point beckons for e-prescriptions
By Dr. Sumit Dutta
Senior Vice President, Physician Advocacy & Strategy,
Medco Health Solutions Inc.

Guided by a combination of incentives, doctors are near the tipping point for making electronic prescribing ("e-prescribing") part of standard medical practice in the United States. Recent initiatives promoting the use of e-prescribing by clinicians are achieving significant results, and Medicare's financial incentives for doctors to incorporate the technology should accelerate its adoption. The merger between the SureScripts and RxHub networks has aligned the technology for e-prescribing standards at both mail and retail pharmacies. As a result of these and other efforts, an estimated 100 million e-prescriptions were "written" in 2008, a 300 percent increase over 2007.

Strong leadership is needed to fully integrate e-prescribing to handle the 4 billion prescriptions written annually in the United States. The Institute of Medicine (IOM), reports preventable medication errors result in 7,000 deaths and 1.5 million injuries each year. By converting to e-prescribing, the nation could eliminate many preventable medication errors.

E-prescribing in practice
Through e-prescribing, doctors are alerted when a prescribed medication may cause a potential interaction with another drug the patient is taking, if a patient has a known allergy to the medication or if the FDA has issued any black box warnings for the drug. E-prescribing eliminates the problem of illegible handwriting and makes physicians immediately aware of the patient's prescription drug coverage. Doctors receive fewer phone calls and faxes.

One successful program that deserves mention is the Southeast Michigan e-prescribing Initiative (SEMI), which began in and around Detroit in 2005. To date, more than 3,000 physicians have elected to participate in SEMI. In 2005, the number of e-prescriptions issued to retail pharmacies in the Detroit area was 130,000; by 2007, that number had skyrocketed to almost 2.2 million. Since the launch of the program, 1.28 million drug safety alerts have been sent to physicians and 40 percent of those prescriptions were changed.

Medicare costs and e-prescribing
E-prescribing can also generate essential improvements for the Medicare Part D Program. During the 2008-2017 budget cycle, e-prescribing is expected to reduce federal health expenditures by as much as $29 billion. Given that American senior citizens account for 42 cents of every dollar spent on drugs, measures taken to reduce medication costs would have a substantial impact on the nation's healthcare spending. The Medicare program is increasing reimbursements to doctors using the technology and will start reducing pay to physicians who have not adopted e-prescribing by 2012.

The bottom line
In its 2006 Preventing Medication Errors report, the IOM recommended that to reduce errors, improve patient safety and decrease health care costs, clinicians should be "writing" prescriptions electronically by 2010. E-prescribing can save money. More important, it strengthens the No. 1 rule of medicine: Do no harm to the patient.

Note: Doctors should ensure that any e-prescribing system they choose is compliant with all Medicare Part D standards in effect as of April 1, 2009. These standards can be found online at www.cms.hhs.gov/EPrescribing.

____________________________________

¹ http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf.
² Gorman Health Group, "Options to Increase E-Prescribing in Medicare: Reducing Medication Errors and Generating Up to $29 billion in Savings for the Federal Government," July 2008, http://www.pcmanet.org/assets/2008-03-25_Research_GHG-PCMA%20Options%20to%20Increase%20E-prescribing%20in%20Medicare%20July%2007%20FINAL.pdf.