Poised for Broad Adoption With pilots aplenty behind it, e-prescribing is a technology on the verge of widespread adoption.

By Kirk Paul Kirkman

It has come time in the healthcare industry to take stock and examine where e-prescribing has been, where it is headed and, more importantly, how all industry players can come together to make it a success. Over the past few years, several large, statewide e-prescribing programs have been launched and are in various stages of deployment and optimization. The programs often have been referred to as “pilots.” To date, the results have been uniformly positive, in a variety of markets, so much so that one can comfortably reach the following conclusion: The industry’s pilot has been completed, and e-prescribing improves patient care, adds efficiency to practices and pharmacies, and reduces overall pharmacy costs by encouraging on-formulary and generic script writing where appropriate.

Additionally, the legislative activity surrounding e-prescribing at the state level continues to be encouraging with recent activity demonstrating an increasing pace of state support for e-prescribing. We are entering the next phase of this technology as we move beyond pilots into widespread adoption. As with any initiative, it is important to weigh the pros and cons and learn from these pilots about best practices in adoption.

State Legislature Support The industry’s pharmacy backbone, Surescripts, recently pointed out that during the past 18 months, we have witnessed an impressive 51 percent improvement in the number of states that have adopted favorable e-prescribing laws. The fact that these 22 states have introduced eRx-friendly legislation is impressive in and of itself and should serve as a precursor to extensive provider adoption.

The most recent state to launch an e-prescribing initiative is New Hampshire. This state’s level of commitment to improving safety, quality and efficiency through e-prescribing is, currently, unrivaled in the country. New Hampshire Governor John Lynch and the Citizen’s Health Initiative have stepped forward and pushed for 100 percent e-prescribing capability by 2008. The plan is refreshingly aggressive, requiring all primary care physicians to be e-prescribing capable by October 2007 and all clinicians by 2008.

With mandates like this on the horizon, healthcare professionals are standing up and taking notice. Salvatore Volpe, M.D., a solo primary care practitioner in Staten Island,

Kirk Paul Kirkman is vice president of physician recruitment and retention at ZixCorp, headquartered in Dallas. Contact him at kkirkman @zixcorp.com.

N.Y., commented, “Recently, there have been an impressive number of states announcing e-prescribing initiatives. I expect in the next few years, the majority of doctors will be e-prescribing instead of using paper prescriptions, if there is

adequate financial support from government and healthcare insurance companies. This technology has finally been proven to provide invaluable benefits by improving patient care and patient safety. Fortunately, the evolution of hardware and software continues to make e-prescribing easier to use and more intuitive.”

Learning From the Best States such as New Hampshire should turn to proven statewide e-prescribing initiatives for guidance and best practices. There are metrics that need to be put in place when adopting any new technology or overhauling any process. Success in e-prescribing needs to be measured in a variety of ways for each of the stakeholders involved in the service continuum.

For health plans, better care should be measured, in part, by lower adverse drug events, lower drug costs witnessed by an increase in on-formulary scripts and an increase in generic script writing. Recently, the eRx Collaborative in Massachusetts announced that in June, nearly 8,000 electronic prescriptions changed as a result of drug-to-drug or drug-to-allergy alerts (which is approximately 2 percent of electronic prescriptions written by Collaborative prescribers). Further, eRx Collaborative participant Blue Cross Blue Shield of Massachusetts has found that high electronic prescribers’ pharmacy costs went down as much as 3.5 percent due to improved utilization of preferred brands and lower-cost generics.

The eRx Collaborative is not alone in its successes; strong results also have been enjoyed by Aetna, a national heath plan who recently sponsored an e-prescribing program across New Jersey. “The initial phase of e-prescribing was a success. Across the board we have seen greater-than-anticipated increases in formulary compliance and generic prescribing,” said Thomas Howe, M.D., Aetna’s New Jersey medical director. “We believe that e-prescribing leads to patient safety and quality improvements as well. We are looking forward to expanding into new markets and bringing the value of e-prescribing to additional members and health care providers.”

For practices, physicians continue to feel positively about point-of-care decision support tools such as drug-to-drug, drug-to-allergy and dispensed drug history. “e-Prescribing technology has reduced the need for phone calls, faxes and paper prescriptions from the prescribing process making the procedure extremely effective,” said Dr. Nandini Chitre of Boulevard Medical Group. “The technology allows me to spend more time with my patients and provides me access to their prescription history, which saves a lot of time and money for the patient, the pharmacist and our practice.”

Value Across the Service Chain The confluence of consistent, positive results across multiple e-prescribing programs, along with federal and state initiatives and added to existing and additional health plan sponsorships, have all served to position e-prescribing for broad adoption in 2007 and beyond.

From a patient perspective, one can expect to enjoy improved care, increased efficiency in prescription fulfillment and point-of-care information important for good, collaborative decision making with their physicians. Patients have assumed a greater role in the decisions surrounding their potential medications, namely higher copay participation and direct-to-consumer pharmaceutical advertising. e-Prescribing facilitates this dialogue and choice at the point of care, helping to fuel patient-driven healthcare.

From a practice perspective, physicians care deeply about providing better patient care and bringing increased efficiency to the practice. At the same time, physicians feel that learning to use digital tools at point of care can be an important, affordable first step in the march towards an electronic health record.

Finally, as health plans seek to gain share in an increasingly competitive marketplace, reducing “over drug spend” allows them to control costs and more effectively compete for additional insured lives. Ultimately, these savings will translate into improved efficiency and savings for all in the service continuum.

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