Pharmacy, politicians promote national health IT system

Despite widespread support from retail pharmacy, policymakers and other health care stakeholders, the rollout of a nationwide electronic prescribing system has been a gradual process of fits and starts. A national e-prescribing network—and its closely related larger-scale corollary, a national health information technology system—has been stymied by technology hurdles and passive resistance among the hundreds of thousands of prescribing physicians whose support is critical to its success.

Those hurdles may soon fall for good. Pharmacy leaders, lawmakers, Bush administration policymakers and technology vendors all are pushing for the rapid adoption not only of e-prescribing, but what is likely to be a sweeping transformation of the entire U.S. health care system through health IT. That system will involve the gathering, storage and transmission of privacy-protected patient records to link physicians, pharmacies, clinics, hospitals, labs, health plans and patients in an electronic web of up-to-date information about patients’ current health, current treatment, medication therapy, lab results and prescription history.

For community pharmacy, the revolution can’t come fast enough. Perhaps more than any single trend now under way in health care, e-prescribing and health IT will link pharmacists with prescribing physicians and other stake-holders as part of a truly integrated health care team on behalf of the patient.

In a recent address, former Walgreen Co. chairman David Bernauer pointed out some of the benefits that health IT could shed on pharmacy, the health care system and patients themselves. “Electronic medical records will give pharmacists, doctors and payers clear visibility into adherence,” said Bernauer, who is chairman of the National Association of Chain Drug Stores. “Doctors will finally know what their patients are taking. Pharmacists will know the outcomes doctors are seeking. And payers will have better outcome evidence.”

Another benefit for pharmacy and for the pharmaceutical industry, Bernauer said in his first address as chairman is a marked improvement in patient adherence with their drug therapy. “Very recently, IMS did a study for us on docs who switched from paper to electronic scripts,” Bernauer said. “They found that, on average, 11 percent more new scripts made it to the pharmacy after the docs switched to e-scripts.”

Other industry stakeholders agree that the shift to e-prescribing will drive patient compliance. “Today, 20 percent of prescriptions go unfilled,” said Mark Merritt, president of the Pharmaceutical Care Management Association. “E-prescribing improves medication adherence by providing physicians with information on each patient’s medication history and more affordable prescription options. This real-time information allows the physician to know which medications the patient is actually taking, counsel them on the importance of sticking with their therapies, and discuss more affordable options if cost is an issue.”

Bernauer predicted that a national e-prescribing and health IT system is “on the verge of an explosion” as the forces driving adoption of health IT come together. Indeed, pharmacy leaders in states like Rhode Island have already joined with technology vendors and e-prescribing platform providers like SureScripts in a series of successful demonstrations of paperless prescribing on a regional and local-market scale.

Also driving adoption: a new plan by the Centers for Medicare & Medicaid Services to eliminate the “fax exception” that Congress extended to doctors as part of the Medicare Modernization Act of 2003. Under that exception, Congress allowed doctors to continue to fax prescriptions to pharmacies for scripts filled under the Medicare Part D drug benefit program.

CMS’ proposed rule would require doctors to shift to a paperless system by Jan.1, 2009. The new rule also would require all electronic prescriptions to comply with the NCPDP Script Standard.

Acting CMS administrator Leslie Norwalk called the proposed rule change “an important new initiative to encourage the use of electronic prescribing to improve the speed and accuracy of care furnished to [Medicare] beneficiaries.”

SureScripts president and chief executive officer Kevin Hutchinson said of the plan, “[Health and Human Services] Secretary [Michael] Leavitt is delivering on his promise to use the federal government’s leverage as the nation’s largest health care insurer to promote health IT adoption.”

Health information technology is one of those rare public-private initiatives that draw wide support from both sides of the aisle in Congress and from the Bush White House. A broad cross-section of House and Senate lawmakers—ranging from such liberal standard bearers as Sen. Edward Kennedy, D-Mass., to conservative Republicans, such as Congressman Phil Gingrey of Georgia have co-sponsored or supported legislation to transform the U.S. health care system through electronic record-keeping and communications.

One such bipartisan bill is the Health Information Technology Act of 2007, introduced earlier this year by Sens. Debbie Stabenow, D-Mich., and Olympia Snowe, R-Maine. The bill would provide tax incentives and a five-year, $4 billion federal grant to promote investment in health IT technology.

“The result of using 19th century technology in a 21st century health care system is higher costs, increased errors and decreased quality of care,” Stabenow said.

“Our health care system must and will change. The only question is whether we change the system, or it changes us,” noted Rep. Patrick Kennedy, DRI, another vocal champion of data-driven health care who co-chairs the 21st Century Health Care Caucus in Congress. “Moving health care into the Information Age is the critical first step to building a sustainable, high-performing 21st century health care system.”

Sen. Sheldon Whitehouse, the Rhode Island Democrat who defeated long-time moderate Republican Sen. Lincoln Chafee last fall, praised efforts in his own state through the Rhode Island Quality Institute, local physicians and pharmacies, and stakeholders like SureScripts, to promote health IT. As a result, he said, Rhode Island has made “great strides in e-prescribing and intensive care unit reform.”

Nevertheless, Whitehouse said, “America is still decades behind,” and he called for “urgent federal action to support a national health information technology system.

“The savings here are enormous,” Whitehouse asserted during a rally on Capitol Hill in support of National Health IT Week in May. “[The] Rand [Corp.] estimates $81 billion. That was the low-end number for Rand; their high-end estimate was $346 billion a year.

“With savings like that around, why is it not happening? Because there are attributes of our health care system, in the way that it is structured, that disable those efforts—the way it’s reimbursed, the way people talk to each other,” Whitehouse said. “If we can cure those problems we can unleash a torrent of activity that will bring to health care the same kind of savings and efficiency that other industries have already found.”

Gingrey, a physician and cosponsor of another bill called the National Health Information Incentive Act, asserted that “the future of American health care will be determined in large part by our adoption of health information technology.” He called the current health system in the United States “woefully behind in using technology to reduce medical errors and streamline care.

“Our ATMs shouldn’t be more advanced than our medical records,” Gingrey asserted.

Rep. Charles Gonzalez, the Texas Democrat who co-sponsored the bill with Gingrey, said it would foster adoption of health IT by family physicians with its offer of grants, loans and tax incentives to offset the costs of technology.

Not to be outdone, the Bush adminis