latest annual report from Surescripts, a company that electronically connects physician offices with pharmacies.
The big increase appears to be related to two factors: First, the government's Meaningful Use incentive program has spurred massive growth in the adoption of electronic health record (EHR) systems, most of which include e-prescribing modules. Surescripts data shows that in 2012, 87% of e-prescribers used an EHR, rather than a standalone e-prescribing application, to write prescriptions.
Second, the Centers for Medicare and Medicaid Services (CMS) has had a separate e-prescribing incentive/penalty program since 2009. Now in the penalty phase, the program will reduce 2014 Medicare payments by 2% for physicians who do not meet requirements for being a successful e-prescriber by June 30 of this year.
David Yakimischak, executive VP and general manager, e-prescribing, for Surescripts agrees that these factors have promoted adoption of e-prescribing. But he told InformationWeek Healthcare that physicians are continuing to use the technology in ever-greater numbers because it provides real value to them.
"E-prescribing is adding value and helping them practice medicine better," he said. "That's what's necessary for them to continue to use it."
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Despite this rapid growth, Surescripts' report also showed that the number of prescription renewals routed electronically dropped 15% to 82 million in 2012 from 96 million in the previous year. Up to that point, the number of electronic refills had increased every year since 2008.
The reason for this anomaly, Yakimischak said, is that Surescripts changed how it measured renewals. Before this year, the company counted any request for a renewal, whether it was approved or denied; but in 2012, it included only approved requests in its refill figure. Under the old methodology, he said, the number of renewals would have exceeded 100 million last year.
Another major report finding is that 47% of patient visits generated an electronically delivered medication history. That represented a growth rate of 48% in this component of e-prescribing over the previous year.
Community medication histories show what other providers prescribed for patients. They come from available prescribing data, which in past years had some fairly big holes in it, making some doctors reluctant to bother with these histories. According to a 2011 research brief by the Center for Studying Health System Change (HSC), medication histories were available from Surescripts for about 50% of patients, although the percentage varied from region to region.
The use of electronic eligibility and benefit information also jumped by a third in 2012, according to Surescripts. The HSC survey showed that this kind of information was available for 50%-80% of patients, but was often out of date or had other limitations.
Yakimischak believes that other factors besides the overall growth in e-prescribing account for the rise in the use of medication histories and benefit information. Health plans and pharmacy benefit managers (PBMs) have raised the percentage of patients for whom this data is available, he said, and have greatly reduced the time it takes to deliver the information to the point of care. Also, he noted, software vendors have started to integrate data from medication histories in decision support tools such as drug interaction checkers. These and other advances have encouraged more providers to use these added-value features of e-prescribing, he said.
The number of prescribers (not all of them doctors) who sent prescriptions electronically jumped 25% to 489,000 in 2012 from 390,000 a year earlier. This included 69% of office-based physicians, according to Surescripts.
The biggest growth in this category occurred among solo practitioners. Fifty-eight percent of these doctors prescribed electronically in 2012, vs. 46% in 2011. The second largest increase was in practices of two to five doctors, 64% of which included e-prescribers, compared to 53% a year earlier. And the highest percentage of e-prescribers (65%) was found in practices of six to 10 doctors, up 18% from 2011.
Strangely enough, the Surescripts report shows a higher percentage of doctors in groups of 10 or fewer practitioners were e-prescribing than in larger groups. Yakimischak admits that this seems counterintuitive, since other studies show that more large practices have adopted e-prescribing. However, he said, big groups and hospital systems tend to have fewer individual physicians who write prescriptions than small practices do. So the individual adoption is higher in the small groups.
The top 10 states in 2012 for utilization of electronic prescription routing, prescription benefit and medication history services were: Delaware, Minnesota, Ohio, New Hampshire, Massachusetts, North Carolina, Vermont, Missouri, Maine and South Dakota. Overall, physician adoption of e-prescribing was greater than 70% in 24 states, and no state had a rate below 40% in 2012.
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