E-prescribing mixes policy, politics to create better healthcare

September 1, 2007

Preventable medication errors are resulting in $3.5 billion in drug-injury related healthcare costs. To address this crisis, the IoM recommends that the entire system move to electronic prescribing (e-prescribing) by 2010.

One year ago, the Institute of Medicine (IoM) made national headlines when it estimated that 1.5 million preventable medication errors are occurring annually throughout our nation's health system and are resulting in $3.5 billion in drug-injury related healthcare costs. To address this crisis, the IoM recommended that the entire system move to electronic prescribing (e-prescribing) by 2010.

Leading policymakers from both sides, including then-Senate Finance Committee Chair Charles Grassley, rushed to announce support for the IoM's recommendations and reiterated the need for Congress to act. Senator Hillary Clinton immediately called for a national, uniform e-prescribing standard to replace a patchwork of conflicting and duplicative state laws. Indicative of the broad support that e-prescribing enjoys, AARP, AFL-CIO, Consumers Union, Pharmaceutical Care Management Association, and the U.S. Chamber of Commerce jointly signed a letter supporting the effort, noting that "widespread adoption of e-prescribing will save lives, improve quality, and reduce healthcare costs." Yet, for various reasons, Congress has not acted.

Despite real barriers to systemwide adoption, the marketplace is working hard to make e-prescribing a reality. A number of competing e-prescribing initiatives are under way at the behest of retail pharmacies, payors, and pharmacy benefit managers (PBMs), including SureScripts and RxHub. While having different business models and degrees of sophistication, they share a common goal: to use cutting-edge technology to provide patients, physicians, pharmacists, and payors with better data and to improve quality by reducing adverse drug interactions and providing real-time safety checks.

Private and public payors are racing to implement e-prescribing because the benefits are so apparent. E-prescribing can:

Despite the clear benefits, physicians have failed to embrace available e-prescribing technology. According to a new poll of 400 physicians conducted by Ayres McHenry & Associates, only one in 10 physicians uses e-prescribing technology on a regular basis. Almost two of three physicians report implementing e-prescribing is not a priority. In 2003, Congress attempted to require physicians participating in Medicare Part D to use e-prescribing technology, but the requirement was dropped in the face of fierce opposition by the American Medical Association primarily because of physicians' cost concerns.

As consumers, payors, and policymakers are demanding greater value for their health care dollars, e-prescribing is a logical place to start. E-prescribing will only happen with the support of physicians, who have thus far stalled progress. With a new Congress in place, now may be the time for a fresh start.

Phil Blando is a Partner with AB+M Partners, a health care consulting firm in Washington.