Electronic Efficiency: Are E-Prescriptions the Future?

More US doctors are expected to throw away their paper pads and begin to prescribe drugs electronically under a new Medicare measure offering them financial incentives to go high-tech, according to experts.

Only about 6% of US doctors currently "e-prescribe", even though doing so may improve efficiency and curb errors, and more than 70% of retail and mail order pharmacies are able to handle e-prescriptions.

"We hope it will be like going from a horse and buggy to a bullet train, making patient safety and the efficiency of the system enormously improved," says Dr Steven Stack, a board member of the American Medical Association.

"Prescriptions will be instantly transmitted to the pharmacist, hopefully ready when the patient arrives," says Stack. "Technology will hopefully help to avoid unintended consequences from drug-to-drug interactions or allergies. It also definitely eliminates physician handwriting as a problem."

INCENTIVES AND PENALTIES

President Bush vetoed the legislation on the government's Medicare health insurance programme that contained the e-prescribing incentives, but the House and Senate immediately voted to override his veto and enact the measure.

It raises Medicare payments for doctors who e-prescribe, with a 2% bonus in 2009 and 2010, a 1% bonus in 2011 and 2012 and a 0.5% bonus in 2013.

The measure would penalise doctors who do not e-prescribe, with a 1% Medicare payment penalty in 2012, a 1.5% penalty in 2013, and 2% in 2014 and thereafter.

Medicare is the federal health insurance programme covering people aged 65 and over and the disabled.

Dr Steven Waldren, who focuses on health information technology for the American Academy of Family Physicians, adds, "I definitely think it will have an impact and increase the number of physicians (doing e-prescribing). To what degree is the real question."

One issue is whether the incentives are sufficient for doctors to assume the cost of software and training.

"In and of itself, an increase to the fee schedule that results in perhaps a $1,000 or a $2,000 increase in revenue for the physician's office will just about offset the cost of deployment," says Dr Charles Kennedy, vice president of health information technology for WellPoint Inc.

"So they (bonuses) will allow the physicians to probably break even, which may not be an incredibly strong incentive."

WellPoint, the largest US health insurer by membership, provides its own incentives to encourage doctors to e-prescribe, making it more attractive, he says.

SUPPORT FOR E-PRESCRIBING

Safety is seen as a major benefit. Proponents think electronic prescription would minimise the risk of a pharmacy misreading a doctor's sloppy handwriting or dispensing a different medication with a similar name.

Healthcare experts, politicians and advisers to Republican presidential candidate John McCain and Democrat Barack Obama promote e-prescribing as a part of healthcare reform. There are 4.4 billion prescriptions written annually in the US.

The National ePrescribing Patient Safety Initiative, a coalition of healthcare and technology companies including Dell, Aetna, Microsoft, Google and WellPoint, has offered to provide e-prescribing software from Allscripts to any doctor for free.

On 1 July 2008, the two biggest e-prescribing networks announced that they were merging to form a single, secure, nationwide network for e-prescriptions and exchanging health data.

RxHub, a joint venture of pharmacy-benefit managers CVS Caremark, Express Scripts and Medco Health Solutions, joined forces with SureScripts, a private company formed by the National Association of Chain Drug Stores and the National Community Pharmacists Association.

"We're really focused on seeing how we can help the market get to the elimination of the paper prescription pad," says Rick Ratliff, co-CEO of the new SureScripts-RxHub.