The last several issues of Risk Review have focused on the coming push for more use of electronic health or medical records and other related health information technologies. To date, none of these technologies has been mandated in any real sense of that term. Rather, the emphasis has been on encouraging their use as a means to streamline practice management, improve efficiency, and decrease the probability of medical errors.
There is now building a broad coalition of corporations, consumer groups, and even pharmaceutical providers that is moving closer to compelling physicians to file prescriptions electronically. Although physicians likely do not need to worry in the short term about forced compliance, over the next few years the federal government is planning on making it less and less desirable to stick with the old pen and pad.
This article is intended to provide an up-to-date summary of electronic prescribing, its challenges and potential liability risks for physicians to overcome in the months and years to come.
Federal electronic prescribing legislation
According to the provisions of legislation which passed both houses of the U.S. Congress as of July 9, physicians treating Medicare patients will begin to see two percent increases in the next federal fiscal year (FY 2009, beginning this October 1) when they use online prescribing software.
Alternatively, those who don’t have that software installed by FY 2011 (October 1, 2010) will see their Medicare pay cut by one percent, on top of whatever other reimbursement decreases might be in place by then. The disincentive would change to a two percent drop by FY 2013.
There has been strong bipartisan support for this approach of tying electronic prescribing to the passage of broad-based Medicare legislation, which could prevent the otherwise draconian reimbursement cuts to physicians scheduled to begin on July 1.
“E-prescribing remains the only health IT proposal that can generate short-term savings for the federal government, and, as a result, is the only one we think can get passed for the foreseeable future,” wrote Lehman Brothers analyst Tony Clapsis, in a recent note to investors.
The relatively slow adoption of electronic prescribing to date
“Today, only about 20 percent of doctors use either stand-alone e-prescribing programs or e-RX modules in electronic health record systems. And until recently, most e-prescribing physicians either computer-faxed their prescriptions to drugstores or printed them out for patients.”
The latter methods essentially eliminate the adverse drug reaction, detection and prevention capabilities of electronic prescribing software. These preventive benefits are often touted as the rationale to justify the added expense of the software, especially when purchased as a modular component of an electronic health record system (which may cost $40,000 or more per physician).
A just-released report issued jointly by the e-Health Initiative, and the Center for Improving Medication indicated that more than 35 million prescription transactions were sent electronically in 2007, a 170 percent increase over 2006.
Despite this great an increase, the report indicated that only one percent of all prescriptions which were eligible for electronic routing in 2007 were actually transmitted electronically. So even though 35 million prescriptions were sent electronically last year, almost 3.5 billion still were not.
Reasons for the still low use of electronic prescribing include:
- Financial burdens, including implementation, training and maintenance costs;
- Workflow changes and change management, meaning that despite the longer term efficiencies and time savings, the planning, training and support as well as changes in clinical process workflow required, especially at the beginning of installation can be significant;
- Continued needs for greater connectivity, since some pharmacies, payers and pharmaceutical benefits managers and mail order pharmacies are still not connected;
- Medication history, which is still not sufficient from all sources thereby requiring additional tools to reconcile medication histories from multiple sources.
So even though the vast majority of physicians do not currently prescribe electronically, efforts to shore up the Medicare Program prior to the onslaught of retiring Baby Boomers will likely compel them to do so in the near future. In addition to the challenges to e-prescribing responsible for the relatively low adoption rates to date, other obstacles also exist, including implications for physicians’ workload and potential liability risks.