New Hampshire Has The Right Goal For Its E-Prescription Plan: Perfection

Finally, there's an e-health initiative that goes all the way.

New Hampshire is pushing to be the first state to have every one of its doctors, clinics, and hospitals using electronic prescription systems, and to do so by 2008. Leading the charge is Gov. John Lynch's Citizens Health Initiative, an alliance of doctors, hospitals, and insurers. E-prescriptions replace handwritten paper orders by doctors, so when an electronic order is placed, the systems query pharmacy and health plan databases to check for drug allergies, interactions with other prescriptions, the dosage based on age, and whether the drug is covered by the patient's insurance.

The program doesn't depend on direct state or federal government funding. Insurers are developing incentive plans--so-called pay-for-performance--that reward doctors for using the e-prescribing systems and meeting other goals that could improve patient care.

Electronic prescriptions should be an easy sell. They don't require the heavy up-front tech investment or process changes that electronic medical records do, and they offer clear returns. In July, the Institute of Medicine released a report estimating that 1.5 million patients each year are harmed by drug errors that could be avoided through health IT such as e-prescription systems, which can red-flag dosage mistakes, allergies, and drug interactions. The institute recommended in its report that all U.S. doctors and pharmacies use e-prescribing by 2010.

Most states have some kind of health IT push on right now, says Kate Berry, senior VP of business development and alliances at SureScripts, a provider of e-prescribing technology and services. "But this move by New Hampshire is the boldest I've seen," she says.

New Hampshire has a good shot at pulling this off. Not only is it a smaller state--it has 2,800 doctors--but it's unusual in that the majority of its primary care physicians are employed by hospitals and health care systems. "The majority of primary care physicians are already using EMR systems that have e-prescribing capabilities because their health system [employer] is using those systems," says Dr. Gary Sobelson, the past president of the New Hampshire Medical Society. Sobelson estimates up to 75% of primary care doctors in New Hampshire already use e-health record systems that have e-prescribing capabilities. Sobelson's group in Concord, N.H., has been using GE Centricity e-health record software for about nine years.

However, many of the EMR systems currently being used by New Hampshire's physicians aren't providing "closed-loop" functionality, says Dr. Phil Boulter, who's heading up the Citizens Health Initiative's quality programs. Many of those systems let a doctor write a prescription electronically, but once it's transmitted, the pharmacy receives a fax order that then needs to be entered into its systems manually. Part of the state's goal is to "close that loop, make it seamless," he says. Boulter estimates 80% of the pharmacies in New Hampshire have the infrastructures in place to accept e-prescriptions.

Citizens Health Initiative is working with vendors such as SureScripts that offer technology that can close those loops through modules added to EMR packages and by providing the infrastructure products and services needed by pharmacies to accept the e-prescriptions directly into their systems, he says.

As for the estimated 30% or so of doctors in the state who haven't yet begun using any e-health record systems, Boulter thinks standalone e-prescribing products like handheld systems from Zix might offer viable alternatives to get those physicians onboard. Before joining the New Hampshire effort, Boulter was senior VP and chief medical officer at Tufts Health Plan in Massachusetts, where he lead an initiative that provided doctors in that state with Zix e-prescribing devices. Zix doesn't yet have any initiatives under way to work with health plans in New Hampshire, says Kirk Paul Kirkman, Zix's VP of physician recruitment and retention. Doctors can purchase the Zix systems on their own, though typically it sells through alliances with health plans and insurers who encourage their member doctors to use the technology, he says. There are about 2,500 doctors in seven states using Zix's systems, he adds.

While many states have e-health initiatives, they could learn from New Hampshire's uncompromising goal. "As a profession, doctors are 20 years behind in using electronic tools," Sobelson says. "The time has come."