Terry Hashey, a family physician in Jacksonville, Fla., remembers how the e-prescribing application in his electronic health record helped him when a new patient presented at his office with an acute problem. She had just flown in from out of state to visit her daughter, and he knew nothing about her medical history. But by the time she'd filled out her registration form, he'd pulled up her complete prescription drug list by using the medication history feature of Surescripts, a company that connects his e-prescribing application online with pharmacies and pharmaceutical benefit management firms.
A patient's medication history, which shows which prescriptions were filled at area pharmacies as well, helps Hashey in a number of ways. He can use it to check on patient compliance, to see what prescriptions other physicians have written for his patients, and to detect "shoppers" who are after controlled substances. And when he writes an electronic prescription, the medication history operates in the background to alert him to potential drug interactions.
Hashey also likes his ability to do rapid refills and to obtain formulary information through his e-prescribing software. Overall, Hashey says, electronic prescribing is "the best part of the EHR for efficiency, work flow, and error prevention."
Al Juocys, who practices family medicine in Rochester, Mich., also loves his e-prescribing application, which is separate from his EHR. Juocys's e-prescribing application can be used with a patient portal that allows patients to view their medications and request refills online. The program also notifies patients when prescriptions are sent to pharmacies so that they can go pick them up.
Neither of these features is available within his current EHR, Juocys points out. Also, he was reluctant to use the EHR's e-prescribing module because his EHR vendor would have charged him a hefty fee for connecting with pharmacies through Surescripts. That link is included in his e-prescribing application's cost.
The downside of not using an e-prescriber integrated with his EHR is that every time Juocys writes a new prescription or a refill, he has to re-enter the information into his EHR's medication list. (He doesn't consider that a bother, however.) If you're considering getting into e-prescribing, a standalone application or one that's part of a bundle of connectivity services might be a good choice. The cost is substantially less than that of an EHR; it can help your office gain efficiency; and it can prepare you for the work flow changes that a full EHR will entail.
On the other hand, if you're going to get an EHR eventually, there are numerous advantages to using e-prescribing as part of an integrated system, including the automatic transfer of patient demographic data from your practice management system and the ability to view lab results when you're prescribing. The key is to make sure that the EHR you buy has a robust e-prescribing application. Here's a brief sketch of the landscape and some factors to consider in your decision.
Rapid adoption of e-prescribing
By the end of this year, according to Surescripts, about 200,000 physicians, physician assistants, and nurse practitioners will be prescribing electronically. That number represents nearly a 25 percent increase from the 156,000 clinicians who were e-prescribing at the end of 2009. The number of electronic prescriptions written this year is expected to hit 300 million, compared to 190 million in 2009.
Of the clinicians who prescribe electronically, 77 percent do so within EHRs, up from 70 percent in 2009. The high percentage of EHR use for e-prescribing can be ascribed partly to vendors' upgrades of existing customers so that they can send their prescriptions online to pharmacies, says Kevin Hutchinson, the former president of Surescripts. Hutchinson, who is currently CEO of Prematics, a vendor of standalone e-prescribing software, also notes that many standalone products that connect with Surescripts have either been broadened into "lite" EHRs or incorporated into some of the leading full-featured EHRs.
On the other hand, 80,000 prescribers, including 50,000 doctors, have downloaded a free standalone e-prescribing product, sponsored by the National ePrescribing Safety Initiative (NEPSI). That's according to Lee Shapiro, president of Allscripts, which makes the software. In addition, he notes, many hospitals and integrated delivery systems are sponsoring a slightly different Allscripts e-prescriber for their staff doctors. Some health plans are sponsoring other e-prescribing solutions, including Prematics. So there are inexpensive choices out there that don't require you to get an EHR.
Another advantage of a standalone product is that Medicare is now offering an incentive for e-prescribing. Nevertheless, fewer physicians are now considering standalone e-prescribing applications, practice management consultants say. Most doctors are more interested in the government incentives for showing meaningful use of qualified EHRs, which begin next year. With $44,000 to $64,000 per physician on the table for achieving meaningful use, Medicare's 2 percent bonus for physicians who prescribe electronically — which turns into a penalty in 2012 if you don't e-prescribe — looks like chump change.
"It's good if doctors are thinking about getting an EHR, because it will prevent that penalty for not e-prescribing," says Rosemarie Nelson, an MGMA consultant. "But they're focused on the $44,000."