E-Prescribing Reaches Tipping Point

Surescripts survey finds 58% of office-based physicians now issue prescriptions electronically. Meaningful Use e-prescribing requirements have played a large role in the technology's adoption.
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New figures from Surescripts reveal that at the end of 2011, 58% (or 317,000) of office-based physicians were using e-prescribing tools to fill prescriptions, versus only 36% (190,000) in 2010.

"The National Progress Report on E-Prescribing and Interoperable Healthcare, Year 2011," which examined actual adoption and use of e-prescribing nationwide, also found that smaller practices led the way. Among practices with six to 10 physicians, 55% adopted the technology, as did 53% of practices with two to five physicians. The most significant growth in physician adoption of e-prescribing occurred among solo practitioners: from 31% in 2010 to 46% in 2011.

Among specialty groups, e-prescribing adoption rates were highest among internists (81%), endocrinologists (78%), cardiologists (76%), and family practitioners (75%).

During a May 17 webcast, Harry Totonis, president and CEO of Surescripts, linked the increased adoption of e-prescribing to Meaningful Use stage 1 and the proposed Meaningful Use stage 2 e-prescription requirements.

"Physicians who began using e-prescribing in 2008 are also tracking towards meeting Meaningful Use measures at significant levels. A good amount of the early adopters, 60%, reached the Meaningful Use stage 1 measures at the end of 2011, and 38% reached the proposed stage 2 measures for the same period," Totonis said.

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Surescripts' CEO also noted that when physicians e-prescribe, they gain access to a patient's benefit information and medication history--information that allows them to enter safer prescriptions into the system.

Additionally, studies have shown that e-prescribing can increase medication adherence and reduce costly mistakes. Patients who lose their paper prescriptions, for example, may delay going back for a new one, not take their medications on time, and as a result see their illness deteriorate.

"We all know that about 30% of paper prescriptions never get filled; by contrast all electronic prescriptions make it to the pharmacy," Totonis said. "This is good for patients and healthcare overall. We estimate that over the next 10 years this will yield [up to] $240 billion in healthcare savings."

Other highlights from the report:

-- The number of electronic prescriptions routed in 2011 grew to 570 million, up from 326 million e-prescriptions in 2010. By the end of 2011, an estimated 36% of prescriptions dispensed were routed electronically, up from 22% at the end of 2010.

-- E-prescriptions per active e-prescriber increased over time. In the first quarter of 2008, the average was 49 per month. By fourth quarter 2011, the study group averaged 213 per month.

--Eighty-two percent of active prescribers used electronic health records systems for e-prescribing in 2011, compared to 79% in 2010.

-- In 2011, Surescripts partnered with pharmacy benefit managers and retail pharmacies to compare the effectiveness of e-prescriptions and paper prescriptions on first-fill medication adherence. The data showed a consistent 10% increase in patient first-fill medication adherence (i.e., new prescriptions that were picked up by the patient) among physicians who adopted e-prescribing technology. The analysis suggests that the increase in first-fill medication adherence combined with other e-prescribing benefits could lead to $140 billion to $240 billion in healthcare cost savings and improved health outcomes over the next 10 years.

However, while some studies show the benefits of e-prescribing, others have noted the technology's limits. Last year, a study published by the Journal of the American Medical Informatics Association indicated that about 10% of computer-generated prescriptions included at least one error, of which a third had the potential to harm a patient.

Nevertheless, in his assessment of the latest Surescripts' report, Dr. Michael Fischer, assistant professor of Medicine at Harvard Medical School, said e-prescribing is making a big difference by collecting data that allows physicians and pharmacists to identify non-adherence.

"We can see prescriptions ... that were sent to the pharmacy and never picked up, where before, paper prescriptions [could not be tracked] in any practical way. We actually know the scope of the problem in a way that was not possible before," Fischer said during the webcast.

With more prescriptions in the system, it should follow that doctors and pharmacists have an opportunity to find out why patients don't collect and take their medications. With that knowledge, Fischer anticipates that healthcare organizations will introduce new models to ensure medication adherence.

"In the future we are going to see the tremendous potential that e-prescribing offers to drive interventions to improve medication adherence. This really can be an important area for innovation and research in the next few years to identify approaches that can dramatically improve the health of the population," Fischer said.

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