E-prescribing update for health execs: Where are we now?

Barriers persist though adoption continues to grow

Though most physicians are using e-prescribing, significant opportunities to expand and maximize e-prescribing services remain. In 2014, 90% of U.S. pharmacies could accept electronic prescriptions, 70% of physicians used e-prescribing via an electronic health record (EHR), and each state had an e-prescribing rate of 41% or above, according to the Office of the National Coordinator for Health Information Technology. While these numbers are likely even higher today, healthcare analysts say that cost, implementation, and security issues associated with e-prescribing must be addressed.


The global e-prescribing market was valued at more than $250 million in 2013, and is estimated to grow to $887.8 million by 2019, according to a 2014 study by Persistence Market Research.

When e-prescribing is used accurately and efficiently it reduces prescribing errors and saves patients-and the healthcare system-time and money. In late 2012, Surescripts, one of the largest e-prescribing networks in the U.S., estimated that an increase in first-fill medication adherence combined with other e-prescribing benefits could save the U.S. between $140 billion and $240 billion in healthcare costs over the next 10 years.

“Payers know that healthier patients cost less money, says Linda Stotsky, director of Business Development, North American Healthcare in the U.S. market for LogicNets, Inc. "E-prescribing drives down drug costs by including decision support, formulary information, medical history and drug history. This helps physicians make decisions that lead to a lower expenditure on drugs and a decrease in adverse drug events.”

E-prescribing also increases patient adherence, which leads to fewer hospital readmissions and promotes better health outcomes. A Surescripts study found that e-prescribing increased patient adherence by 10% compared to written prescriptions between 2008 and 2010. With the help of e-prescribing, patients no longer have to spend time taking prescriptions to a pharmacy, waiting for them to be filled and picking them up-all factors that decrease the chances of patients taking their medication.




BedfordThough e-prescribing can save time and money, the monetary incentives associated with e-prescribing are sometimes not enough to offset the costs of implementing and maintaining the technology. “Some of the biggest barriers for clinics and hospitals to implement e-prescribing are implementation costs and prescriber adoption,” says Jim Bedford, director of Healthcare, Pharmaceuticals, Medical Devices & Life Sciences at West Monroe Partners, a management and technology firm.

Though the electronic health record (EHR) incentive programs offers incentives to clinicians to adopt several technology initiatives associated with EHR use (including e-prescribing), many organizations struggle with training and upkeep of these systems, says Stotsky. “Roughly 70% of hospitals are using electronic health records technology to send electronic prescriptions to pharmacies, thanks in large part to the Medicare improvements to Patients and Providers Act of 2008, and meaningful use,” she says.

Rural areas that lack information technology professionals and high-speed broadband services face more challenges implementing e-prescribing services. West Virginia, Hawaii and Kansas have the lowest number of hospitals using EHR and e-prescribing technology, while Massachusetts is the leading state for e-prescribing, with its academic centers, doctors, and Blue Cross Blue Shield leading the charge, says Stotsky.




Security is another issue that many clinicians face when e-prescribing. Because many systems are web-based with multiple users, e-prescribing can be vulnerable to security breaches.

“E-prescribing transactions contain protected health information data that can be exposed if proper security protocols are not followed,” Bedford says.

Communication related to prescriptions-between physicians, pharmacists, and payers-also raises problems. Physicians report issues with having the ability to cancel e-prescribed orders, while some pharmacies still insist on faxing refill orders to avoid technology glitches.

“Using e-prescribing to request new and refill prescriptions has improved some of the communication, however there is still much more that can be done to facilitate better communication between providers, payers and pharmacists," says Bedford.

Though the majority of e-prescriptions are made through Surescripts, physicians who use other services integrated into their EHRs and physicians who use standalone e-prescribing systems may encounter more problems, says Bedford. “Some policies and incentives already exist, however it would be easier if all drugs could be prescribed using the same format to all providers and pharmacies,” he says. “Today, a provider and pharmacy must be part of the same e-prescribing network in order to be able to use e-prescribing for the pharmacy the patient would like to use.”