State and federal health IT mandates credited with the double-digit increase in electronic prescribing from 2010 to 2011.
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Minnesota knocked Massachusetts out of the top slot it has held for five years in Surescripts' annual Safe-Rx awards. Surescripts, which connects physician offices to pharmacies online, ranks the states by the percentage of prescriptions routed electronically to pharmacies, the percentage of providers who e-prescribe, and other statistics.
In 2011, 61% of prescriptions in Minnesota were sent to drugstores electronically--the most in any state. In terms of e-prescribing adoption, Massachusetts and New Hampshire topped the list, with 86% of physicians in those states sending prescriptions electronically, versus 82% of doctors in Minnesota.
At a press conference announcing the awards, Patrick Miller, a professor at the Hampshire Institute for Health Policy & Practice, credited the federal electronic health record (EHR) incentive program for part of New Hampshire's success in e-prescribing.
Marty LaVenture, director of health information and e-health for the Minnesota Department of Health, said that two Minnesota laws had accelerated his state's progress on e-prescribing. The first law, which required all prescribers to use e-prescribing by 2011, coincided with the big jump in the percentage of doctors and nurses writing e-scripts, from 49% in 2010 to 82% last year. In addition, he cited Minnesota's requirement that all providers have interoperable EHRs by 2015.
LaVenture also praised the Minnesota e-Health Initiative, a private-public collaborative, for helping to boost e-prescribing. The collaborative, which has helped lay the groundwork for e-health activities in the state, has created a guide to e-prescribing and has gotten its members to promote its use among providers, LaVenture told InformationWeek Healthcare in an interview.
In addition, he said, the state health department has collected data on adoption of e-prescribing and EHRs. That helped state officials allocate resources to areas where e-prescribing was low. Minnesota has provided grants and loans to rural and underserved providers and pharmacies to help them get involved in e-prescribing.
Across the country, the federal Meaningful Use incentive program had a major impact on e-prescribing. According to Surescripts, 82% of e-prescribers used EHRs in 2011. And when the company released its 2011 National Progress Report in May, Surescripts president and CEO Harry Totonis attributed the increased use of e-prescribing partly to the Meaningful Use criteria for EHR incentives. The progress report found that 58% of office-based physicians were using e-prescribing tools, compared to only 36% in 2010.
The Meaningful Use program helped increase e-prescribing in Minnesota, LaVenture said. But he noted that the state has been near the top in EHR adoption for the past few years. "Once providers had EHRs, that allowed us to go fairly rapidly on e-prescribing."
In other states, the federal e-prescribing program, which began with incentives and is now in the penalty phase, has also had a significant impact. But in Minnesota, LaVenture said, the train was already moving down the tracks at a good clip before that program began. The state mandate, which was passed in 2008, "got the attention of folks," he said, even though it didn't carry penalties for non-compliance.
Minnesota has taken advantage of another federal program to gain some traction on e-prescribing outside of hospitals and physician practices. The state health department has access to the $9.6 million in funds provided to Minnesota to promote health information exchange, and it has directed some of that money to help independent pharmacies gear up for e-prescribing, LaVenture said.
The state has also provided grants to nursing homes for health information exchange, and he believes that some of that has been spent on enabling providers in those facilities to prescribe electronically. But much more remains to be done, he added, in settings like home health, public health, and mental health.
The other states in Surescripts' top 10, in terms of the percentage of prescriptions transmitted electronically, for 2011 are Massachusetts, South Dakota, Delaware, New Hampshire, Iowa, North Carolina, Maine, Vermont, and Michigan. North Dakota, while not in the top 10, saw the largest increase in e-prescribing, moving from 46% to 18% in the nationwide ranking.
Surescripts noted that the use of community medication histories had increased markedly in some top 10 states. For example, it grew by 50% in North Carolina and was used in 60% of visits in Delaware.
In Minnesota, while prescribers requested insurance benefit information online in 88% of patient visits, only 25% of those visits involved medication history requests. While this is a growing category, LaVenture explained, the large groups that dominate healthcare in Minnesota mainly check these histories when a doctor sees a new patient, because their EHRs contain most patient medications. Independent practices, he said, are more likely to consult the community drug histories.