Rapid growth in online prescribing relates to accelerated adoption of electronic health records.
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More than half of U.S. physicians now prescribe electronically, according to the latest statistics from Surescripts, the largest network connecting physician offices to pharmacies in this country. As of September, Surescripts said 52 percent of office-based doctors--totaling 291,000 physicians--were sending prescriptions online to pharmacies, compared to fewer than 10% just three years ago.
Overall, there are now 357,000 e-prescribers on the Surescripts network, including doctors, nurse practitioners, and physician assistants. Ninety-four of retail pharmacies nationwide are using the network to receive electronic prescriptions.
The pace of change has been very rapid: At the end of 2009, only 156,000 office-based prescribers were sending electronic prescriptions to pharmacies. A year ago, that number had increased to 234,000--or 34 percent of the total.
Three factors have been primarily responsible for the accelerated adoption of e-prescribing: the e-prescribing incentive program of the Centers for Medicare and Medicaid Services (CMS); the rapid growth in electronic health record systems, many of which include e-prescribing; and the active support of health plans, employers, vendors, provider organizations, and government agencies.
The first shot in the arm for e-prescribing was Medicare's program of carrots and sticks. Physicians who e-prescribe have been receiving incentives that began at 2% of their Medicare revenues in 2009 and will taper off to 0.5% in 2013. Doctors who failed to prescribe electronically in the first half of 2011 will lose 1% of their Medicare reimbursement in 2012 if they do not qualify for a hardship exemption. The penalty will rise to 1.5% in 2013 and 2% in 2014.
The EHR buildup, which has been propelled by the government's Meaningful Use incentives, has also had a marked impact on e-prescribing adoption. According to a Surescripts spokesman, the percentage of e-scripts generated by EHR users has risen to 80%, compared to 63% in 2008.
At a Surescripts press conference announcing the latest figures, Mary Martin, the nonprofit organization's senior vice president, customers and markets, confirmed the relationship between e-prescribing and EHR adoption. "Surescripts connects to over 200 EHRs, allowing easy movement of electronic prescriptions," she noted.
Insurance companies have long championed e-prescribing because it helps them get formulary and benefit data in front of physicians at the point of care, which encourages the prescribing of generic drugs. At the Surescripts conference, health plans in North Carolina, Michigan, Delaware and Massachusetts were all cited as contributors to the growth of e-prescribing in their states. This trend was especially significant in Michigan, where Health Alliance Plan collaborated with automakers and Detroit's Henry Ford Health System to jump-start e-prescribing.
Health IT vendors have also played an important role. Allscripts and several other technology vendors, for example, launched the National ePrescribing Patient Safety Initiative (NEPSI) in 2007. Allscripts donated e-prescribing software that was offered as a free download to physicians.
Surescripts said e-prescribing growth occurred in every state in 2010--the index year for state breakouts--but was more concentrated in some states than in others. For example, in Massachusetts, the top-ranked state, nearly 70 percent of physicians used e-prescribing; 43 percent of all prescriptions were electronic scripts; and online medication histories were used in 41 percent of patient visits.
The top 10 states with the highest rates of e-prescribing, in order, were Massachusetts, Delaware, Michigan, Connecticut, Rhode Island, Pennsylvania, South Dakota, Iowa, Oregon, and North Carolina. These states also saw big increases in subcategories of e-prescribing, such as the use of community medication histories and the use of online benefit and formulary data.
John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston and, until recently, CIO of Harvard Medical School, received Surescripts' annual SafeRX Evangelist Award for his tireless promotion of e-prescribing. After describing the benefits of the technology for patients, providers, and health plans, he said, "I look forward to the future where safe, accurate medication delivery is going to be a part of Meaningful Use stage 2 to a greater and greater extent."