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5/6/2011
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E-Prescribing Not Meeting Expectations

Physicians say systems are often too difficult to use and don't provide useful data, diminishing potential safety and cost-savings benefits.

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While office-based medical practices are increasingly turning to electronic prescribing, two important shortcomings with e-prescribing technology are holding back wider adoption and preventing physicians from achieving many of the touted safety and cost-saving benefits, a new survey suggests.

In many cases, it's difficult to import prescription data, including medication history and insurance information, into patient records, and the data available aren't always useful enough for physicians to take time to review during typical office visits, according to the Center for Studying Health System Change (HSC), a Washington-based healthcare research organization.

In a research brief released Thursday, HSC said that just one-sixth of practices interviewed regularly reviewed patient medication history from a third party--usually insurance or pharmacy records--when writing electronic prescriptions.

About a third of practices said their e-prescribing systems didn't offer such capability, while 38% had the feature but their physicians chose not to use it because the information wasn't easily accessible, the doctors didn't see much value in it, or the technology simply was too difficult to navigate.

A complete medication history helps prevent duplicate prescriptions and avoid any potentially harmful interactions between incompatible medications, and it also stops physicians from prescribing something a patient is allergic to.

Likewise, many physicians did not bother to consult patient-specific formularies--lists of medications that insurance companies will cover--to help patients determine how much they will owe at the pharmacy. This step is supposed to check whether lower-cost generic alternatives to name-brand drugs are available.

"These potential gains assume that physicians who e-prescribe have access to these features and use them. However, not all e-prescribing systems have these features, and even when the features are available, physician practices may not implement them or individual physicians may not use them," said the study, which was funded by a grant from the federal Agency for Healthcare Research and Quality (AHRQ).

"Available research suggests that missing, incomplete, and inaccurate data limit the value to physicians of using e-prescribing systems to access medication histories and formulary information," the report added. "Consistent with earlier research, this study's findings suggest that barriers still impede physicians' use of these data in making prescribing decisions."

In at least one case, HSC found that the software displayed "preferred" drugs as advertised, but forced doctors to manually replace the drug name in the system when making a substitution to satisfy the formulary.

The study is based on 114 telephone interviews last year with 24 physician practices and 48 community pharmacies that were active users of the Surescripts prescription information network, as well as with IT vendors, chain pharmacies, and e-prescribing intermediaries. HSC selected two practices and four pharmacies in each of the 12 geographic areas the center follows. The survey pool represents a mix of physicians, e-prescribing system managers, pharmacists, IT vendors, and representatives of mail-order pharmacies, HSC said.

About 70% used e-prescribing as part of electronic medical records (EMRs), while the rest had standalone e-prescribing systems, according to HSC. That, the report suggests, could be a negative factor. "One problem is that the EMR is such a huge product and there's so much going on with the patient that for the doctors to pull up one more thing, especially if it’s not utterly relevant or they don’t have a question, they won’t do it," the IT manager at an unidentified practice is quoted as saying.

The current, first stage of the federal program that pays Medicare and Medicaid bonuses for "meaningful use" of EMRs includes five requirements related to e-prescribing, while some functions of e-prescribing could support two additional measures, HSC said. However, physicians are not required to review medication histories and formularies when writing electronic prescriptions.

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