Trendspotter: E-prescribing is becoming mainstream, even without EHRs

Electronic prescribing is well on its way to becoming mainstream, and new DEA regulations allowing electronic prescriptions of controlled substances should accelerate that movement.

Last year, the number of e-prescribing physicians and midlevel practitioners jumped to nearly 156,000 from 74,000 in 2008. That’s about 25 percent of these providers, and it’s possible that the total could hit 50 percent within three years.

The DEA’sproposed rules, announced March 31, would remove a longstanding obstacle to electronic prescribing: dual workflows. Particularly in practices that prescribe a fair amount of pain medications, it’s difficult to have two different systems for prescribing, one electronic and the other paper. The ability to send every prescription online to pharmacies and to build a single electronic medication list that includes controlled substances will undoubtedly induce more doctors to try e-prescribing.

The fact that physicians couldn’t prescribe controlled substances online last year makes the 2009 surge in adoption all the more remarkable. Medicare played a role by offering a 2 percent incentive for e-prescribing, starting Jan. 1, 2009. (The bonus drops to 1 percent in 2011 and 2012.) Physicians who don’t prescribe electronically by Jan. 1, 2012, will forfeit 1 percent of their Medicare payments; the penalty will later rise to 2 percent.

 The government’s ARRA incentives for EHR adoption will eventually have some effect on e-prescribing, which is one of the criteria for “meaningful use.” But even today, many physicians are waiting to see the final version of the ARRA regulations before they plunk down their money for an EHR. And in 2009, the incentive program had little effect on EHR adoption. So it appears that a large part of the surge-if not most of it--involved standalone e-prescribing programs, most of them designed for handhold devices.

Another factor that has contributed to the growing adoption rate is the increasing number of pharmacies ready and willing to accept electronic prescriptions. Surescripts, the company that connects physician offices online with drugstores, says about 85 percent of the nation’s pharmacies and six big mail order houses now participate in its network.

To be sure, online connectivity is still limited in some rural areas: One multispecialty group in Tennessee reports, for example, that less than a third of the pharmacies in its area are accepting online scripts. But in metropolitan areas, physicians can prescribe online to most pharmacies with a high degree of confidence.

Surescripts also reports that in 2009, the number of prescriptions and renewals routed electronically zoomed to more than 190 million from 68 million in 2008. Physicians used Surescripts in 2009 to access 81 million prescription histories, a five-fold increase from the prior year. The number of requests for electronic formulary and drug benefit information soared from 79 million to 303 million.

All of this is good news for physicians and patients. Electronic prescribing improves patient safety because of increased legibility and decision support features, including information about a patient’s community medication history. When physicians can see whether a drug is on a health plan’s formulary before they prescribe it, they and their patients are less likely to suffer the inconvenience of having to switch drugs after playing phone tag with a pharmacist.

However, to put the progress on e-prescribing in perspective, it’s important to remember that roughly 2 billion prescriptions a year are written in the U.S. For all of 2009, Surescripts estimates, 12 percent of eligible prescriptions (excluding controlled substances) were sent electronically, versus 4 percent in 2008. That’s a big jump, but it’s still a small percentage of all prescriptions.

If adoption continues to accelerate, however, a majority of prescriptions could well be written electronically within five years. That would be a win for everybody, from doctors and patients to pharmacists and payers. And incidentally, the wide-scale use of e-prescribing will help set the stage for EHR adoption, as physicians become more accustomed to using computers in their everyday work.

What all of this shows is that, despite the naysayers, health IT is starting to have a big impact on clinical practice. Whatever the outcome of the ARRA incentive program, this is a major trend that will continue to gather momentum, just as it has in every other sphere of American life.