Meaningful use counting
To show meaningful use, physicians will have to attest that they're sending at least 40 percent of their "permissible" (non-controlled substance) prescriptions electronically. Nelson suggests that doctors look for EHRs or standalone applications that will automatically count qualified prescriptions for them and create a report. Referring to the 90-day period in 2011 in which physicians must demonstrate meaningful use, she says, "You don't want to wait the 90 days and find out that you didn't qualify for the incentive."
Shapiro says it's no big deal if your EHR doesn't count electronic prescriptions. If doctors e-prescribe routinely, he says, they'll easily surpass the minimum. "Providers aren't going to count patients and decide that since they already met that level today, they are not going to e-prescribe for the rest of the day."
Controlled-substance app coming
Physicians have long groused about the legal ban on prescribing controlled substances electronically, which creates a dual work flow for them. In June, the federal Drug Enforcement Administration (DEA) adopted new rules that permit the process, but pharmacy groups have requested clarifications.
The sticking point in the addition of controlled substances to e-prescribing is the lack of a standardized protocol for authentication. DEA has specified the general requirements, but Surescripts is working out the details in conjunction with pharmacies and the leading EHR and e-prescribing vendors. Once that's done — assuming that certain states don't throw up additional roadblocks — the vendors should be able to quickly add the necessary fields to their applications, and physicians could prescribe controlled substances online. Shapiro thinks that this will happen sometime in 2011.
How to get started
Let's say you've decided you want to prescribe electronically, but you're not ready to make the leap to an EHR. Where do you begin?
The first step, according to Cindy Dunn, a senior MGMA consultant, is to understand what's involved. "Whether you buy the e-prescribing software or get it for free, you still have to put a computer network in your practice," she points out. "You have to get computers and you have to create a work flow to utilize this electronic piece. It's more than just purchasing the software. You're going to have to change what you do within your practice."
Installing a computer network and wiring offices can be costly, Dunn notes. Also, she says, outside IT support can run $150 to $200 an hour. Free e-prescribing software might entail extra charges for a Surescripts connection or upgrades. In a small practice, however, e-prescribing need not cost a fortune, Nelson says. The license fee for standalone e-prescribing software isn't expensive — for example, she points out, an average vendor charges roughly $600 per provider per year for its program and a Surescripts connection.
A small office can set up the required gear fairly easily, according to Nelson. If your nurse already uses a desktop PC, she says, you just need a portable device that you can carry from one exam room to another. A computer tablet or laptop will set you back about $1,000, and you can buy a business-grade wireless network and have it installed for under $1,000. If you have two nurses who share a computer, you might have to spend $600 on a second PC. An average vendor might charge about $500 for a one-time download of patient demographic data from a practice management system. So, if you don't mind entering the demographic and insurance data for new patients into the e-prescribing application, you can put together an e-prescribing system for around $3,000.
MGMA estimates manual prescribing costs are about $15,000 per provider per year, including the labor expense of office staff fielding calls from pharmacies. By shifting staff around or even reducing the number of FTEs, Nelson says, a practice can recoup the initial cost of e-prescribing within six months.
Brave new world of iPads
More and more doctors are using iPads and smart phones in their clinical work. These devices, which have plenty of computing power for e-prescribing, can connect with the Internet via either Wi-Fi or a cellular network. That means that a doctor could prescribe electronically without access to a wireless network.