As the volume of electronic prescribing begins to grow dramatically, what challenges and opportunities face hospital and health system CIOs? Many, say those in the trenches. Indeed, as CIOs and industry observers look out at a rapidly changing landscape, they say the time is now to prepare on a detailed, practical level to support enterprise-wide e-prescribing solutions for all affiliated physicians.

How fast is the landscape changing? Statistics bear out an environment of rapid change. According to a report recently released by the St. Paul, Minn.-based Surescripts entitled “The 2009 National Progress Report on E-Prescribing” ( http://www.surescripts.com/container_pdf.aspx?name=downloads/Surescripts_Releases_2009_National_Progress_Report.pdf), electronic prescribing nearly tripled in 2009 over 2008. Indeed, by the end of 2009, the report found, about 18 percent of eligible prescriptions were routed electronically, up from 6.6 percent at the end of 2008, according to the company's 2009 National Progress Report on E-Prescribing. The number of physicians and other prescribers using electronic prescribing more than doubled to 156,000 from 74,000, the number of electronic requests for prescription benefit information increased to 303 million from 79 million, and the number of prescription histories delivered to prescribers grew to 81 million from 16 million.

And the coming federal subsidies (see sidebar) tied to e-prescribing are only going to drive this growth even further, industry observers agree. But how is this e-prescribing boom affecting the relationship between CIOs and IT on the one hand, and the physicians who submit prescriptions electronically? CIOs say it is having a major impact already.

“Just having that information available on a give-and-take basis is huge,” says Carol Steltenkamp, M.D, CMIO of University of Kentucky HealthCare (UK HealthCare), a 600-bed Level 1 trauma center in Lexington. “As an academic medical center, it is our job to be teaching the physicians of the future and they need to be doing this.”

Steltenkamp cites the improved safety and access of e-prescribing as a principal reason why. Her concerns about patient safety and prescribing errors are echoed in a recent study in The Journal of General Internal Medicine. The study, funded by the Washington-based Agency for Healthcare Research and Quality, found that a group of primary care practices in New York reduced their prescribing error rate from 42.5 percent to 6.6 percent over a one year period using e-prescribing.

Steltenkamp goes further when she notes that e-prescribing alone, even when not accompanied by full EMR adoption on the part of individual physicians, is proving its merit. Though the EMR adoption rate among physicians in her community remains at around 30 to 40 percent, she sees e-prescribing alone as improving the quality of care, simply based on the fact that community physicians logging onto the hospital's physician portal are able to check the prescription information that the hospital has on their patients. In addition, the hospital can always fax a clear print out of the prescription to the physician office.

U Kentucky uses the Atlanta-based Eclipsys Sunrise Clinicals for its EMR, including e-prescribing, and that prescribing information can be accessed by its community physicians using a portal into Eclipsys. It doesn't matter what EHR the physicians are using in their offices-or even if they have one. And that, according to Todd Shores, senior manager in the Health Care Providers practice at New York City -based Deloitte Consulting, is part of the evolving relationship between the hospitals and the physician practices. “You have to phase any e-prescribing project to meet the initiatives of your organization,” he says. Safety and quality are first.”

Shores says that e-prescribing is part of an organizational approach between the community physicians and the healthcare system as a whole.

And Steltenkamp agrees that it is an organizational approach. “Our challenge as a hospital is to bring value to the community physicians,” she says. The relationship will surely only continue to grow: in March, Surescripts announced an agreement with Quest Diagnostics to form an integrated services arrangement to make lab information available along with prescription information, electronically.

Expect to see more growth in this area as the Medicare Improvement for Patients and Providers Act (MIPPA) penalties coming out of the Centers for Medicare and Medicaid Services (CMS, Baltimore) begin to take effect in 20112. For prescribers that do not adopt e-prescribing, penalties of 1.0 percent decrease in allowed charges will begin, rising to 2.0 percent in 2014. In 2009, MIPPA already began paying out incentives of 2 percent for e-prescribing.

“As an academic medical center, it is our job to be teaching the physicians of the future, and they need to be doing this.” - Carol Steltenkamp, M.C., CMIO, University of Kentucky HealthCare

One challenge that remains is that though 85 percent of the pharmacies in the country can receive electronic prescriptions, there are still remain independent pharmacies in small communities that are not in the Surescipts Rx hub. Those pharmacies, however, can still receive a fax printed from an EHR that adds legibility.

So what can CIOs do to ensure their physicians are in the loop? “The CIOs need to primarily focus on solutions in their current EHR provider, make sure it has those e-prescribing capabilities,” says Shores. “They need to also make sure they have relationships with the intermediaries like Surescripts to be able to transmit to those local pharmacies in their communities.”

Steltenkamp says she believes e-prescribing is at the tipping point, because as more and more people use it, it truly becomes patient-centric, and everyone benefits. “Our challenge is to bring value to our community physicians,” she adds. “We want to hold out the carrot, not the stick.” She compares its similarities to the impetus of the stimulus dollars. “The message needs to be that you really need to work with the providers and e-prescribing is a way to facilitate the good care that they're giving, not hinder it.”

Takeaways

E-prescribing is reaching a tipping point health system-wide.

Hospitals and health systems are helping physicians to benefit from e-prescribing, even in cases where full EMR has not yet taken place.

e-prescribing and lab information will soon available in the same place.

Providers who do not use e-prescribing will begin to see penalties in 2012.

Healthcare Informatics 2010 May;27(5):24-26