Digital Prescriptions Gain Favor

Various Factors Pull

Antiquated Process
Into 21st Century
By VICTORIA E. KNIGHT
June 17, 2008 

NEW YORK -- In the age of the iPhone, you would think electronic prescriptions would be commonplace. Handwriting, however, still carries the day.

About 35,000, or fewer than 10% of U.S. physicians, prescribe drugs electronically, and about 35 million of more than 3.5 billion prescriptions dispensed by U.S. retail pharmacies were sent electronically.

The possible benefits to doctors and patients are clear: electronic-prescriptions can save a great deal of time and money for both parties. Digital technology also can alert physicians to potentially harmful drug interactions or allergies, and for pharmacists, remove the guesswork associated with deciphering nearly illegible handwriting.

Several factors are pulling this antiquated area of health care into the 21st century, although obstacles hinder widespread adoption.

Some private insurers are offering financial incentives to physicians who use electronic prescribing and are offering subsidies to help defray the technology's costs. State and national programs, meanwhile, are becoming available to ease the technical transition and lower the cost of e-prescribing for doctors.

WellPoint Inc., the largest U.S. insurer by number of health-plan members, pays 1% above the regular fee schedule to physicians in Ohio who electronically prescribe and provides payments of as much as 6% higher to physicians in the Northeast who use it and also meet certain performance metrics. Blue Cross Blue Shield of Massachusetts subsidizes electronic prescriber's costs in Massachusetts for one year through eRX Collaborative, a corporate coalition.

Rick Ratliff, acting president and chief executive of SureScripts, a private company that runs the network that routes prescriptions between physicians and pharmacies, said about 70% of pharmacies -- including all the major chains -- are connected, and more independent pharmacies are coming online each day.

A new program called Get Connected offers free clinical software evaluations and advice (www.GetRXConnected.com). The program was endorsed this week by the American Academy of Nurse Practitioners and the American Academy of Physician Assistants, which represent 162,000 prescribers.

The Westchester Medical Group, a multispecialty group practice in White Plains, N.Y., with about 140 physicians on staff, has trainers on its staff who teach physicians how to electronically prescribe and upload the medication histories of their most frequently seen patients.

Having technical support on site may not be cost-effective for most physicians, as about 60% work in solo or small practices. Louis Petrone, who describes himself as tech-savvy and works in a practice with one other physician, said it took him a couple of weeks to get up to speed and that the free telephone technical support available is adequate for his needs.

Uploading patients' medication histories, however, would have cost several thousand dollars, so he decided to add patients as he goes along instead. Initially this required him to extend his working hours, although he is back to his regular schedule.

Computer programs can flag cheaper generic alternatives to brand-name drugs, and with the most sophisticated types of software, physicians can prescribe based on the drugs covered under a patient's health plan. Blue Cross Blue Shield of Massachusetts, for instance, said members who receive electronic prescriptions on average are saving about $250 a year on maintenance medications.

Medication errors that lead to injury occur 1.5 million times a year in the U.S., according to a report released in 2006 by the Institute of Medicine of the National Academies.

"Many doctors ask their patients to bring in bags containing all their medications. Many of the drugs aren't necessary or may be interacting in harmful ways," said John Rother, director of public policy for AARP, an advocacy group for older Americans. Electronic prescribing would help to eliminate these problems by giving physicians a complete picture of a patient's medications and by alerting them to potential problems just by using a computer, laptop or cellphone that can access the Internet.

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