e-Prescribing needs work: Are we surprised?

In the most recent Health Affairs, Grossman and colleagues discuss the limitations of e-prescribing from the perspective of the physician office practice. Two thirds of those interviewed used eRX in the context of a more comprehensive EMR.

• Follow this link to the Grossman Health Affairs article

• Follow this link to the AHRQ HIT e-RX web site

Their semi-structured interviews raised the following concerns:

First the good news:

• Practitioners uniformly believed this technology leads to better care. Although they seem to disregard the many early adopters and discarders when they say that their subjects "did not want to go back to paper."
• They relate documentation benefits and believe more legible prescriptions decrease call-backs and believe the ease of accessing lab data in the many who use integrated EMR/e-Rx decreases chart pulls.
• They believe that formularies (when available) made choices "somewhat easier." Those few who submitted electronically reported additional time savings.
• Most could not point to staff cuts but believed the technology freed staff to do other things. They believe efficiency gains were offset by costs.

Now the less positive news.

• Most were not able to availa themselves to update a medication history
• Eligibility checks were erratic because the limited number of PBMs and a conservative matching algorithm.
• Some noted that adjudicated claims data did not necessarily correspond to an active medication list.
• Clinical decision support was limited because of integration.
• Many had difficult getting formulary data. ("Over half of the practices did not have acess to the formulary data electronically....either because their systems lacked the feature or the practice had chosen not to enable it.
• Those respondends seeking formulary information found it from 25-90%.
• There was limited connectivity to pharmacies (retail and mail).
• Many believed their states precluded electronic transmission (largely, this is so only for controlled substances).
• Local pharmacies' lack of readiness was cited as a barrier to full electronic transmission.
• "Most practices using electronic fax or EDI reported spending substantial time educating local pharmacies about e-prescribing. This included both informing pharmacies that electronic transmissions were legal and making sure that pharmacies routinely checked their fax machine or computer system for the transmissions. Respondents reported that it took a couple of months of daily communication about individual patients for pharmacies to begin to treat electronic transmissions as routine. Until that point, practices reported that pharmacies regularly called when patients arrived to pick up medications because they could not find the prescriptions."
• Two industry experts "believed, however, that pharmacies typically must reach a critical mass of electronic prescriptions to successfully incorporate checking these new sources into their workflow."