It's Fast. It's Easy.

Yet fewer than 20 percent of physicians use e-prescribing. Find out why you should be one of them.

Soon after implementing an electronic prescribing system in his North Kansas City, Mo., practice, Richard Hellman proudly told a patient that he no longer had to write prescriptions. He'd put away his prescription pad forever. The patient was relieved, Hellman said, because she'd recently been the victim of a serious medical error due to a doctor's illegible handwriting. The woman had been prescribed Cytoxan, a chemotherapeutic agent, but the pharmacist interpreted the prescription as Cytomel, a drug used to treat underactive thyroid.

"She ended up with a hyperactive thyroid with the error," says Hellman, vice president of the American Association of Clinical Endocrinologists. "She was very grateful [for e-prescribing]...."

The industry group e-Health Initiative estimates only 5 percent to 18 percent of practicing physicians use e-prescribing technology, and they tend to be high-prescribers like oncologists, pain management physicians, and those in family practice or internal medicine. But it's inevitable that those ranks will rise.

Dan Michelson, chief marketing officer of Chicago-based Allscripts, a clinical software and connectivity company, says the electronic medical information marketplace continues to evolve as it develops interoperability standards and protocols for information being transmitted from one system to the next. E-prescribing is just one piece of a fully integrated electronic health record.

"If you view this just as an individual slice, you are missing the bigger story, which is what is going on with clinical automation in general. There is a significant movement that is being pushed by President Bush on down regarding physicians automating and using electronic health records. And there is a whole myriad of things on the market that support those efforts," Michelson says.

Easier All Around

E-prescribing isn't going away. It will be mandatory for drug plans participating in the new Medicare Part D prescription drug benefit by 2009, although the Centers for Medicare and Medicaid Services (CMS) is requiring an initial set of standards by January 2006, when the benefit is scheduled to begin.

Patients are playing a big part in the transition, says Carolyn Hartley, president and CEO of Physicians EHR, LLC, of Cary, N.C.

"The first audience driving it is women who are going to be registering for prescription benefits through the Medicare Modernization Act," Hartley says. "There was a Harris Interactive poll in 2004 [showing] that the largest group of people developing personal health records is women over 65. This is for a number of reasons: they need Medicare; they go to [about] 4.6 physicians a year; and [they or] their husbands are on multiple medications. They're also the people like my mom, who has to get on a bus to go to the pharmacy and pick up her prescription, and she doesn't want to have any problems by the time she gets there."

Patients aren't the only ones who benefit. Jamie Steck says e-prescribing has been the norm for more than three years at Central Utah Clinic in Provo, where he is director of information technologies. It's made the lives of physicians, physician assistants, nurse practitioners, and other staff members easier.

"Before, our nurses were spending on average about an hour and a half to two hours a day just renewing prescriptions, usually at the end of the day," he says. "Now, they are taking maybe a half-hour to do that process. We are not sitting on hold with the pharmacy and the pharmacy is not trying to reach us. It just makes it so much easier because everything is clean and done right the first time," he says.

You can print out instructions and other educational information about what you're prescribing for patients to take home. And depending on the program, you can tell on the spot if a medication is on a patient's formulary and is preferred, not preferred, or not covered.

Improved safety is a big lure, too. E-prescribing eliminates the ubiquitous problem of handwriting legibility, and adds real-time drug-to-drug interaction and drug-allergy alerts.

Chris Madden, a Tifton, Ga.-based internist, also likes the idea that his Drug Enforcement Agency number isn't floating around. "The patient never sees the prescription, so they never see our DEA number."

Saurabh Desai, MD, an internal medicine physician who practices in Douglasville, Ga., says that learning how to electronically prescribe medicines has been easy. Desai and his group of three internists and one nurse practitioner purchased the RxWriter by MicroFour, Inc. to use in conjunction with the EMR software, PracticeStudio.

"We do not order any [prescription] pads to be printed anymore," Desai says. "And if a patient wants to change medications, we don't have to look for a chart. If you prescribe some medication which does not get along well with a medication that a patient is already taking, [it] will tell you that this is not the right choice," he says.

E-prescribing helps ensure the prescribing process comes full circle. One in five patients doesn't bother to pick up their prescriptions, according to Hartley. "In the old way of doing things, there was no systematic way of recording whether the patient even picked up the medication. Now, it's in the system. But someone has to put it in the system; so it is either the physician at the point of care or the nurse at the point of faxing it to the pharmacy."

Doctors still could potentially input the wrong information, so checking and rechecking work continues to be necessary. Another drawback is simply that computers go down sometimes, according to Desai.

"[I]t is still computer-based and, sometimes, the computer acts up and you are stuck," he says. "You have to have some good computer support so [you] are never without it for a few hours."

Adding e-prescribing to your practice definitely means doing due diligence to comply with security standards. Hartley recommends doing a risk analysis and developing a risk management plan. Be able to answer questions like: What is your process if the system goes down? How are you going to be able to access health records? What is your technical support? Are there going to be audit controls to find out who has access to the patient records?

Before You Buy

Consider whether you want a stand-alone e-prescribing software or one that is part of, or can be integrated into, a full EMR. Then, think about what kinds of things you'd want the technology to include, because not all systems are alike.

"The bottom line is electronic prescribing is one part of an electronic health record. Even if you do not purchase the full electronic health record today, you can migrate there over time," Michelson says.

According to Hartley, "It will be more expensive to just buy the e-prescribing module and then move to the full-blown EMR later on. The e-prescribing module won't let you do billing and generally speaking won't let you capture patient data. All it does is it helps you meet the e-prescribing rule.

"[But] if you're timid and looking for an affordable way to test the waters in digital healthcare, go to e-prescribing first. It's like renting a car for 30 days to find out whether or not you like that model so that you can buy it later on."

Look for the important basics to e-prescribing systems, including a current medication list, dosing levels, and allergies for specific patients, as well as alerts to drug-drug interactions, and drug allergy errors.

Bells and whistles might include the ability to track levels of payer reimbursement, or the ability to call up all patients taking a certain medication in case there is a recall.

"You should be able to figure out how to call or send an e-mail to all the people who need to come in ... . This is where the e-prescribing alone does not work well. If you have an e-prescribing database that is tied to your practice management software, then you can get all of those telephone numbers ... " says Hartley.

Share and Save

She also suggests that physicians look into sharing costs of the total EHR, with a group of other practices, a hospital, or other healthcare facilities.

"EHR software is still pretty unaffordable, although prices are coming down. Physicians that form a loosely held collaboration can have a stronger seat at the table if they go together into buying EHR software. [It gives them] an ad hoc user group; they have a support center and they can share the cost of training and implementation," Hartley says. "It is a much smarter way ... than trying to do everything in isolation."

Physicians should also carefully select the companies they choose to do business with. According to Hartley, there are about 1,000 vendors and about 250 are considered "top flight." Already, many companies selling the software have gone out of business or into bankruptcy. Experts predict an industrywide consolidation still to come.

And the technology will continue to evolve. One new development to look for: full electronic transmission to pharmacy systems (meaning no faxes or e-mails; instead, the prescription would go right into the pharmacy database). That could further reduce errors - there's no keying in information and there's nothing left to interpretation.

The bottom line: if you're not among the ranks of the e-prescribing, think about signing on soon, before it's mandated - and patients no longer know what to do with that little slip of paper you've just scribbled on.

Lisette Hilton can be reached via editor@physicianspractice.com.

This article originally appeared in the November/December 2005 issue of Physicians Practice.