E-prescribing: The "Write" Way to Go

In a 2006 report to Congress, the Institute of Medicine (IOM) estimated that preventable medication errors cost the health care system $77 billion annually and result in 7000 deaths per year. To avoid medication errors, the IOM suggested that physicians and other providers use electronic prescribing (e-prescribing).

Too often, handwritten prescriptions can be misinterpreted. The e-prescribing software would ensure that key information, such as the drug name, dose, route, and frequency of administration, includes meaningful data. Tying these data to a patient?s medical history also would allow health care providers to check for allergies, drug-drug interactions, overly high doses, and clinical conditions.

In addition, ?once an e-prescription is in the system, it would follow the patient from the hospital to the doctor?s office or from the nursing home to the pharmacy, avoiding many of the ?hand-off errors? common today,? according to the IOM report.

Saving Lives and Money

E-prescribing would save lives and save the health care system billions of dollars, which is why pharmacy groups are supportive of efforts to implement the technology. Last year, a report by the Gorman Health Group, commissioned by the Pharmaceutical Care Management Association, estimated that e-prescribing would save the federal government up to $31 billion through reductions in adverse drug events and increased formulary compliance, including higher rates of generic substitution.

Unfortunately, adoption of this important technology has been slow. First, it took states several years to enact legislation allowing e-prescribing because of privacy concerns. In 2004, roughly half of the states had laws and regulations that prohibited e-prescribing. As of August 2007, all 50 states, plus Washington, DC, allowed their physicians and pharmacists to electronically exchange prescriptions and lifesaving prescription information, according to SureScripts, a network provider of e-prescribing services.

Second, although the 2003 Medicare Modernization Act required Medicare Part D plan sponsors to accept e-prescribing and the national standards that were created for Medicare, physicians were not required to use the technology.

The Centers for Medicare & Medicaid Services (CMS) estimates that, under current law, only 5% to 18% of physicians will adopt e-prescribing. Given the potential of e-prescribing to save lives, as well as generate savings to the Medicare program, these projections are disappointing.

Legislative Incentives

The projections could change for the better, thanks to draft standards released by CMS and bipartisan legislation introduced last year. In November 2007, following several years of rigorous pilot testing involving a variety of influential health care stakeholders, CMS unveiled draft standards for e-prescribing to promote interoperability and eliminate a major barrier to implementation.

Under the Medicare Electronic Medication and Safety Protection Act of 2007, legislation introduced by Sens John Kerry (D, MA), John Ensign (R, NV), Debbie Stabenow (D, MI), and Mel Martinez (D, FL), and Reps Allyson Schwartz (D, PA) and Jon Porter (R, NV), physicians would be offered incentives to e-prescribe. Providers who do not adopt e-prescribing would face significant penalties, effective January 1, 2012.

The bill already has significant support from a broad coalition of business, labor, and consumer groups, including Consumers Union, the American Federation of Labor and Congress of Industrial Organizations, the National Association of Chain Drug Stores, and the Coalition for a Competitive Pharmaceutical Market, which have joined together to ask Congress to pass legislation this year to ensure the adoption of e-prescribing in the Medicare program.

Given the tremendous support for e-prescribing, it is time for Congress to move forward with legislation. Requiring physicians to use the technology in Medicare would be a good first step in helping to increase the adoption of e-prescribing?a step that will benefit countless patients.