E-prescribing: Time to put away the pen and the prescription pad

Key Points

Traditional prescribing is widely acknowledged to be an error-prone activity involving excess paper, multiple parties, and opportunities for miscommunication. The process is also inefficient: by one estimate, 3 person hours per physician per day are spent dealing exclusively with prescription drug management. It is also expensive: drug management costs $28 billion per year.

E-prescribing generally refers to a process initiated by a physician to transmit patient and medication information through electronic media to a destination, resulting in the delivery of medication to a patient. This includes creating the prescription; receiving automated decision support, including drug and allergy information, medication history, and eligibility; sending the prescription electronically to the pharmacy; and receiving medication renewal requests from the pharmacy. Faxing a prescription, even through computer software (a function included in many early EMR products), does not meet the current definition of e-prescribing.

In the U.S., the e-prescribing process is facilitated by SureScripts ( http://www.surescripts.com/), which specializes in gathering, coordinating, analyzing, and routing the stream of information involved in making a prescription. E-prescribing can be deployed as a Web-based, hosted application, a stand-alone application, or a component in an electronic health record system.

What are the advantages?

E-prescribing offers many advantages to physicians and their practices, including these:

Patient safety. The Institute of Medicine has estimated that 7,000 Americans die and 1.5 million are injured each year by preventable medication errors. These include transcription errors because of illegible handwriting, drug-drug interactions, allergic reactions, and duplicate prescriptions by different providers. It is estimated that e-prescribing, when implemented, can prevent over 60% of these mistakes.

Patient satisfaction. Results of a 2008 Medical Group Management Association survey support the contention that patients prefer e-prescribing in an age of consumer-driven health care. Patients believe that it is more reliable, reduces waiting time at the pharmacy, and even allows them to get their prescription filled at one of several pharmacies because e-prescribing is not location specific.

Quality of care. Decision support tools inherent in e-prescribing assist physicians in reconciling medications, keeping accurate records of medicines, and updating allergy information.

Efficiency. A 2006 study at Brown University, Providence, RI, estimated that office staff and physicians reduced the time spent on prescriptions every day by 50% after adoption of e-prescribing, from 120 minutes to 60 minutes. These efficiencies came in the form of reduced callbacks from pharmacies prompted by illegible or incomplete information, reduced callbacks from patients prompted by insurance eligibility or "fax not going through," and reduced requests for renewals from pharmacy benefit managers and mail order houses.

A recent study from the Mayo Clinic in Phoenix indicates that e-prescribing may also lead to greater efficiency in hospitals. In the study, the time it took a provider to place an order dropped from 41.2 minutes to 27 seconds using e-prescribing (J Am Coll Surg 2009; 208:960-7).

Regulatory. It is clear that the Centers for Medicare & Medicaid Services believes there is a business case for adopting e-prescribing. The Medicare e-prescribing initiative calls for a 2% bonus payment to physicians who successfully submit a reporting measure regarding e-prescribing in 2009. This will be gradually phased into a 2% penalty for physicians who do not comply with the measure by 2014.

Getting started

Good resources exist for the physician who is ready to start e-prescribing. Quick guides for physicians are available from SureScripts. Detailed instructions on participating in a free subscription to a stand-alone e-prescribing solution can be found at http://www.nationalerx.com/. The CMS web site on e-prescribing ( http://www.cms.hhs.gov/eprescribing/) contains details on the final rules and reimbursement methodology. Finally, a presentation at the National E-prescribing Conference in October 2008, which served as the source of some of the material in this article, can be found at http://www.epsilonregistration.com/er/EventHomePage/CustomPage.jsp?ActivityID=378&ItemID=1117/.

Bottom line: E-prescribing is yet another innovation in safety and technology that is good for patients, good for physicians, and good for the bottom line.