e-Prescribing Adoption Lags

Grossman: The major issues are having the resources to set up the technology and incorporate it into workflow and then make it part of the practice culture. The large practices with employed physicians are more likely to have EMRs. Then, they have staff that is responsible for setting up the EMR and testing it. And often in those types of practices, when they bring physicians on board, they may get rid of prescription pads. The workflow is there. Then physicians have the expectation that their colleagues are going to use the systems in larger practices, so there’s an expectation that everyone is putting information in the medication lists and using the tool.

You certainly have examples in the smaller practices of the super user. It’s not to say that physicians in smaller practices can’t do that; it’s just the resources they need to set it up, test it, and the troubleshooting to make sure all the functionality works, there’s a huge resource investment that goes into that. Many of the standalone systems are Web based so all the upgrading is invisible to the physician because that’s all being done by the vendor. Some of that is mitigated by some of the vendors to use some of those ASP [application service provider] systems, but there are still challenges to use all the new functionality.

HCI: How much do you think meaningful use will incentivize physicians to use advanced e-prescribing features?

Grossman: Clearly with respect to transmission electronically, meaningful use is likely to have a direct impact on the use of that functionality for physicians that have that IT. So, right now they say 40 percent of prescriptions that are allowed, so the scheduled drugs the DEA allows, are to be sent electronically. I think this will definitely have an impact for those physicians who are responding to the incentives. Once physicians get that functionality in place and working, they’re going to use it frequently for all their prescriptions because it can be actually much easier.

I think for the other types of functionality right now, the requirements for the drug to drug interaction functionality has to be there and the drug formulary functionality is an option under that menu. There is also medication history that we didn’t talk about in this study, that’s a functionality provided by vendors like SureScripts that [allows] access to adjudicated claims data from health plans that patients are covered under. It shows what drugs they’ve bought under insurance plans. So that was actually not included in meaningful use, although it’s included under the MIPPA [Medicare Improvements for Patients and Providers Act] requirements as a functionality.

HCI: What do you think CIOs can do to encourage usage of e-prescribing?

Grossman: One thing is training, and that means making sure the physicians are aware of the functionality, and as systems get upgraded and changed, if access to that functionality changes, the physicians are made aware of that and don’t assume that they know.

The second thing is being able to work with the IT staff and the practice administrators to make sure the functionality is working well—testing to make sure the patient match is working, and that the formulary information is actually available to physicians at the point of prescribing. Also, that it’s up to date so that if there’s a major local health plan missing, that they’re going back to their vendor. Also, having someone troubleshooting across the practice. While incentives are useful , I think that when physicians find this functionality useful, it’s a kind of cost-benefit. If they find it valuable, and the value is worth the time it takes them to do it, they will do it. But if it turns out that it’s not worth the time to them, they’re not going to use it. For example, with formularies if that does it make it easier to make a decision with patients upfront and improve efficiency [they will use it].

There are a lot issues outside of the scope of the practice itself. There’s getting good formulary information and making it available. Getting all the local pharmacies onboard and having them send all their prescriptions electronically and making sure the connectivity works smoothly between them. EMR designers [need] to design systems that trigger alerts in a way that’s helpful to the practice and make it easy for physicians to set up. So there are a lot of other entities that need to be engaged, so its health plans, mail order, retail pharmacies, pharmacy benefit managers, and EMR vendors. So the point that we ended with in the issue brief was that in many ways e-prescribing is a more advanced IT functionality in terms of interoperability and in terms of health information exchange of data. There are still many challenges. It’s a complex task to setting up that connectivity and that interoperability and the exchange of that data and the quality of that data. It’s sort of a harbinger for the challenges that people face in implementing EHRs more fully because they’re much more complex.