Despite widespread enthusiasm for establishing interoperative electronic health records, progress has been slow in developing the standards, protocols and rules needed to move from small initiatives to a national e-health system. To stimulate action, the Bush administration and major players in the e-health community are promoting electronic prescribing systems as an achievable step toward broader interconnectivity. Health plans and insurers are backing these efforts as a way to prevent medication errors and improve quality of care.
MEDICARE IN FRONT
Health and Human Services (HHS) Secretary Mike Leavitt is leading the charge with a call for mandatory electronic prescribing for drugs provided to Medicare beneficiaries. Such a policy would be implemented under proposed Senate legislation that requires all physicians to use e-prescribing for Medicare patients by 2011. To get there, the bill offers grants to help physicians obtain e-prescribing software and bonuses on Medicare reimbursement for physicians that transmit prescriptions electronically.
The January 2009 deadline for Medicare e-prescribing aims to spur more physicians to adopt health IT. Some 35,000 healthcare providers are now transmitting prescriptions to pharmacists electronically, but this represents only 6% of office-based physicians. In fact, a large number of providers use electronic medical record systems to fax prescriptions to pharmacies.
"Many physicians that use EHR systems don't realize that the actual prescription is sent by fax," explained Robert Kolodner, MD, HHS national coordinator for health IT. The Center for Improving Medication Management and several leading medical associations have established the http://GetRxConnected.com/ Web site to guide an estimated 150,000 prescribers who utilize computer-generated faxing to shift to real electronic prescribing in order to meet the Medicare e-Rx criteria.
STATES MAKE PROGRESS
Pharmacy organizations also are encouraging e-prescribing by recognizing those states with the highest e-prescribing volume. Data from pharmacy transactions compiled by SureScripts continues to place Massachusetts at the top of the list with 13% electronic prescribing-more than 4 million electronic prescriptions last year.
Other states receiving Safe-Rx awards include Rhode Island, Nevada, Delaware and Michigan. But even some high e-Rx states have less than 5% of prescriptions transmitted electronically, and many states have just a handful of prescribers actually operating online. About 70% of pharmacies have e-prescribing capability but cannot benefit from the efficiencies of the system unless physicians are willing and able to transmit information electronically.
One critical issue blocking expansion of e-prescribing is the Justice Department's insistence that prescriptions for controlled substances must be written on paper. Many physicians fear that e-prescribing could raise problems and decide to stick with paper to avoid violations.