The Writing’s On the Web
Edition: April 2006 - Vol 14 Number 04
The state-of-the-art of prescribing medications isn’t very state-of-the-art. In fact, most medical groups still write – or scribble – prescriptions on paper.
One professional group – the Medical Group Management Association – is trying to get its members on board with electronic prescribing. The Englewood, Colo.-based association hosted a Web cast on the subject in January, during Medical Group Practice Week (Jan. 23-27). E-prescribing is, simply, a method of communicating prescriptions to pharmacies or caregivers via some method of electronic communications.
MGMA President and CEO William Jessee, M.D., rolled out some sobering statistics: Of the medical groups surveyed last summer by the association in conjunction with the Agency for Healthcare Research and Quality, 74 percent still use manual systems for prescribing. Only about 9 percent use computerized systems.
Perhaps not surprisingly, groups implementing e-prescribing were much more likely to have electronic medical records systems than those that were not. Ninety percent of those without electronic medical records were using paper for prescribing, while 29 percent of those with automated medical records systems were using those systems for e-prescribing.
The problem with paper
What’s wrong with the old-fashioned method of prescribing? Plenty, according to Maria Friedman, senior advisor, and Andrew Morgan, insurance specialist, with the Centers for Medicare and Medicaid Services, the federal agency that oversees the Medicare program. In fact, more than 8.8 million adverse drug events occur nationwide in the ambulatory care setting, they said.
It is estimated that nationwide adoption of e-prescribing could eliminate 2.1 million of those adverse events per year in the United States, and prevent 1.3 million provider visits, more than 190,000 hospitalizations, and more than 136,000 life-threatening adverse drug events, they continued.
With projections like that, it’s no surprise that the feds began a pilot project on e-prescribing in January 2006, and plan to issue a report to Congress in April 2007. The project will attempt to answer such questions as: How does e-prescribing affect the quality of care? What’s the return-on-investment for the physician? What are the barriers to implementation? What’s more, the Medicare Modernization Act of 2003 provided for a voluntary ambulatory prescribing program under Part D to demonstrate the benefits of the technology.
Benefits to the patient
“For most of us, the big push of e-prescribing is to enhance patient safety,” said Charles Lathram, president and CEO of Advanced Physicians Solutions, a medical-practice consulting firm based in Florence, Ala. With e-prescribing, handwriting errors are avoided; and prescriptions can be electronically screened to ensure that the newly prescribed medication doesn’t interfere with meds that the patient is already taking.
Convenience for the patient, office and insurer is a benefit, too. E-prescriptions are transmitted to the pharmacy during or immediately following the patient’s office visit. In most cases, the medication is on hand at the pharmacy when the patient arrives to pick it up.
For the pharmacist, e-prescriptions can be interfaced with the formulary of the patient’s insurer, so that the patient and pharmacist know immediately whether or not the prescribed drug is covered by the plan. What’s more, renewals for maintenance drugs (e.g., medications for birth control or hypertension) can be easily – and automatically – renewed.
The physician practice benefits too, according to Lathram. For starters, some health plans subsidize the cost of e-prescribing technology, he said. “And as we get ready for pay-for-performance, any time we can automate our processes – increase our efficiencies and capture data – we will position the practice for increased benefits.”
Physicians may be able to negotiate lower malpractice rates due to the reduced risks associated with e-prescribing, he continued. And e-prescribing allows physicians to remotely access patient medication records after clinic hours or when he is at the hospital.
A huge benefit of e-prescribing is the amount of time it can free up among office staff and physicians, added Rosemarie Nelson, principal, MGMA Health Care Consulting Group. The typical practice can lose $20,000 or more in time due to inefficiencies in the prescribing process.
Other factors that physicians should consider when implementing an e-prescribing system include:
• Does the system offer a networking solution, so that information on patients’ meds is available on desktop PCs, mobile units, etc.?
• Does it allow for wireless access via PDA or tablet computer?
• Does it maintain existing medications for each patient?
• Does the vendor offer support and training?
Physician groups should understand that an e-prescribing system may seem cumbersome at first, as patient information is being loaded, said Nelson. In fact, doctors should be allotted some “buffer time,” in which they can continue to write paper-based prescriptions.
But if the early frustrations seem overwhelming, chances are they will recede when the practice sees the payback, which will begin when the patient returns in six or 12 months, and all the medication is already in the system.