Electronic prescribing yields a trove of benefits


Connecting all the dots in health care. That’s the ultimate goal in the health industry’s migration to an electronic platform, where doctors and other prescribers write prescriptions digitally and send them — directly and immediately — to a patient’s pharmacy for dispensing.

Key to that effort is the ongoing shift from paper prescriptions to electronic prescribing, by which prescribing doctors and other clinicians generate and transmit a new prescription electronically, direct to a patient’s pharmacy of choice. At the pharmacy, the digital prescription is automatically queued up for dispensing by the pharmacy’s computer system, simultaneously creating a record stored in that patient’s electronic medical record (EMR).

The U.S. Centers for Medicare and Medicaid Services (CMS) defines electronic prescribing as “the transmission, using electronic media, of prescription or prescription-related information between a prescriber, dispenser pharmacy benefit manager, or health plan, either directly or through an intermediary, including an e-prescribing network.” That network “includes, but it is not limited to, two-way transmissions between the point of care and the dispenser.”

Led by Delaware, Minnesota, Vermont, Wisconsin and Massachusetts — where nearly all physicians now prescribe electronically — all 50 states now embrace e-prescribing. In all, roughly three out of every four office-based physicians now prescribe electronically, generating more than 600 billion transactions a year, and 95% of pharmacies are equipped to receive and process those e-scripts.

That marks a dramatic gain from 2004, when just 4% of office-based doctors had converted to paperless prescribing, according to Surescripts, the largest health information network for connecting pharmacies with other health providers, benefit managers and health information exchanges.

Driving that rapid adoption of paperless prescriptions is a confluence of forces impacting all facets of healthcare delivery in the United States. Among the most pressing: the health system’s unsustainable rise in costs, the clear need for collaborative-care and accountable-care models integrating all members of the health delivery team, and the urgent drive to connect all of a patient’s health history with a comprehensive medical record that’s privacy protected but accessible to both the patient and to his or her health providers.

The goal for e-prescribing, said Sure-scripts CEO Tom Skelton, is “a more connected and collaborative healthcare system with a technology-neutral platform that exchanges vast amounts of data across a disparate range of health technology systems in use today.

“There is no question that health care is going digital,” said Skelton. “Providers across the country are sharing critical information to coordinate patient care. Just as we’ve witnessed continued growth in e-prescribing, so too have we seen the complexity of the healthcare system multiply, while patients and providers demand easier access to health information.”

Indeed, e-prescribing brings benefits to all participants in the care continuum — from patients and health plan payers to doctors, pharmacists, health administrators and care coordinators. By holding down prescription processing and dispensing costs and eliminating potential errors of handwritten prescriptions, it also benefits taxpayers who foot the bill for the nation’s federal and state health programs.

For patients, the e-prescription software linking their individual medication use records can catch potential problems like drug-to-drug adverse interactions, while helping patients and their healthcare team keep track of all their medications within a comprehensive, individualized medical record.

Shifting from paperless to digitized prescriptions also yields another big benefit: giving pharmacists and prescribers a powerful tool to track and improve medication adherence rates. Said Kristi Rudkin, senior director of product development and adherence for Walgreens Boots Alliance, “E-prescribing has given us more insight into the problem of primary nonadherence, where the patient doesn’t pick up that prescription.

“When scripts are handwritten, the pharmacy staff isn’t aware of scripts that never make it to the pharmacy,” said Rudkin. “But with e-prescribing, if the prescription is coming right from the prescriber to the pharmacy, the pharmacy is at least aware that the patient should be getting this medicine, and can intervene.”

Also add a safer pipeline of abuse-prone prescription drugs to the list of benefits. Electronic prescribing of controlled substances is now allowed in nearly every state and the District of Columbia, reducing fraud and diversion.

The National Association of Chain Drug Stores strongly endorses the concept. “E-prescribing holds great promise to generate a robust database of real-time information that could be used by DEA, state enforcement officers, pharmacies, insurers, wholesalers, and other partners to assist with the proactive identification of prescription drug abuse,” NACDS noted.

Among the federal agencies promoting e-prescribing and the integration of patient-centered care is the financially stressed Medicare program. “CMS promotes this patient-centered approach to care and recognizes the downstream effects of having or not having certain critical pieces of information communicated across providers and settings,” the agency has stated.

Embracing the benefits of e-prescribing, Congress in 2008 passed the Medicare Improvements for Patients and Providers Act (MIPPA), instructing CMS to promote adoption of the technology among physicians treating patients on Medicare.

“Going green with a paperless program can benefit patients [and] improve provider workflow,” the agency asserts. “Gaps and duplication in patient care delivery can be reduced or eliminated through proven technologies, such as interoperable electronic health records, e-prescribing and telemedicine.”

To encourage physicians to ditch the prescription pad and switch to prescribing electronically, the agency provided a diminishing series of payment incentives to participating prescribers, beginning in 2009 and ending last year. At the same time, CMS imposed a gradually escalating series of financial penalties, beginning in 2012, for those who refused to budge: a reduction in Medicare payments that reached 2% of a billable fee for beneficiaries receiving treatment in 2014.

“CMS encourages care coordination across the healthcare continuum and supports providers to care for patients with chronic diseases so they get seamless and effective care,” the agency explained in a memorandum to caregivers.

“We know that people and organizations working together, across silos, will make healthcare more efficient, more effective and easier to navigate,” Surescripts asserts. “We believe that healthcare is inextricably linked to technology, and if technology improves, healthcare will improve with it.”

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