Paperless prescribing hits key milestones


Health technology advocates have passed a major milestone in the long campaign by pharmacies, technology vendors and health reform activists to shift the nation’s doctors beyond paper prescribing: the conversion of 100,000 physicians to the electronic transmission of prescriptions directly to dispensing pharmacies.

Surescripts, which operates the country’s largest national electronic prescribing network, announced last month that more than 100,000 doctors now are routing prescriptions electronically in the United States. “What’s more, the use of three critical components of e-prescribing—electronic prescription benefit, history and routing—jumped 61% in the first quarter of 2009,” Surescripts revealed.

That resulted in more than 134 million e-prescribing messages being exchanged among prescribers, payers and pharmacies, according to the company. “In the past two years, the United States has gone from 19,000 to 103,000 prescribers routing prescriptions electronically—punctuated by 39% sequential growth in prescriber adoption in the first quarter of this year,” said Harry Totonis, newly elected president and CEO of Surescripts. “The past two years have also witnessed a sevenfold increase in the use of e-prescribing.”

Recent trends at Walgreens bear out Surescripts’ national conclusions. In March, Walgreens recorded a tripling in the number of prescriptions filled electronically from year-earlier levels. And new government incentives to doctors will quickly push that level higher still, Walgreens predicted.

Walgreens pharmacies filled a record 3.1 million prescriptions electronically during March, marking a 211% increase compared with March of last year, the company reported. Even more striking: the total number of scripts sent via doctors’ e-prescribing systems and filled by Walgreens last month accounted for 15% of all of the chain’s eligible prescriptions.

Walgreens estimated it will fill more than 40 million e-prescriptions this year, compared with 15 million filled in 2008. The company said it expected growth to continue, as the federal government in January began providing financial incentives for doctors to transmit prescriptions electronically for Medicare patients as part of its campaign to nudge the nation’s healthcare system toward health information technology and electronic record-keeping.

Under that incentive program, doctors will earn a 2% bonus on their covered Medicare reimbursements for every Medicare script they transmit electronically instead of via a handwritten prescription handed to the patient.

Don Huonker, Walgreens SVP healthcare innovation, hailed the continued growth in e-prescriptions and said it contributes to lower health-care costs and better patient health. “Prescriptions transmitted electronically increase the likelihood that patients will get their prescriptions filled, benefit from their drug therapy and avoid more expensive medical procedures,” he said.

Despite the nationwide advances in e-prescribing tracked by Surescripts, however, Totonis urged stronger action. “While this growth shows clear evidence that the steps taken by policy-makers, prescribers, payers, pharmacies and others are having a positive impact,” he said, “swift and specific action is required for the United States to achieve mainstream adoption and use of e-prescribing.”

The advances described by Surescripts are reported in the annual National Progress Report on E-Prescribing. Among the report’s key findings:

By the end of 2008, 74,000 doctors were actively prescribing electronically, versus 36,000 at the end of 2007 and 16,000 in 2006;

Prescriber use of benefit information and prescription history grew from 37 million in 2007 to 78 million in 2008 and from 6 million in 2007 to 16 million in 2008, respectively;

Prescriptions routed electronically more than doubled from 29 million in 2007 to 68 million in 2008; and

By the end of 2008, increased participation by payers in e-prescribing enabled access to prescription benefit and history information for 65% of U.S. patients.

Seven states are connected to the Surescripts’ network through their pharmacy benefit managers to deliver prescription information for fee-for-service Medicaid patients.

At the end of 2008, approximately 76% of community pharmacies and six of the largest mail-order pharmacies in the United States were connected for prescription routing, Surescripts announced.

Three key factors helped drive the shift away from paper prescriptions last year, Surescripts reported. One of the biggest: growing attention among federal and state policy-makers to the cost and patient-safety benefits of e-prescribing. In addition, “National programs drove e-prescribing and offered practical tools to assist the industry in moving forward,” noted the company, and adoption of the new technology accelerated among public and private health-plan payers, prescribers and pharmacies.

Nevertheless, noted Surescripts, “The nationwide effort to replace paper prescriptions with more informed, paperless prescribing is far from over. Today, for example, only about 10% of eligible prescriptions are routed electronically.”

Totonis laid out an action plan for faster nationwide adoption that included several policy and business recommendations. Among them: redoubling efforts to convince the U.S. Drug Enforcement Administration “to pass regulations that allow controlled substances to be electronically prescribed in a way that is workable and scalable,” and providing “education, financial incentives and implementation assistance for all prescribers, with a particular focus on addressing the needs of small and medium-size practices.”

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