Automakers try to jump-start e-prescribing

Advocates of electronic prescribing are hoping that the Big Three automakers can do what others have not -- get physicians to put down the prescription pad and adopt electronic prescribing.

On Feb. 9, General Motors Corp., Ford Motor Co. and DaimlerChrysler Corp., along with the United Auto Workers union and two insurers, launched the multimillion-dollar Southeast Michigan e-Prescribing Initiative to help up to 17,000 physicians in Michigan implement such systems in their offices.

Because of the companies' huge size and the billions they spend annually on health care for workers, retirees and their families, the automakers' initiative will be watched closely by other large employers, potentially giving e-prescribing a shot in the arm.

Before the Big Three's announcement, the Wayne County Medical Society, the Tri-County Osteopathic Assn. and the Detroit Medical Society were scheduled to sponsor an April 20 meeting to educate and encourage physicians to prescribe electronically. About 200 physicians are expected to attend the meeting. The societies would not comment on the Big Three's plan but did say they were supportive of e-prescribing.

"It's something we've been looking at for a while," said Adam Jablonowski, Wayne County's executive director. "I think we all recognize that there are benefits to be gained by the use of electronic prescribing."

For years, many have advocated e-prescribing to reduce medication errors and costs and as a key step in helping doctors transition to full-fledged electronic medical records. But many physicians have resisted prescribing electronically for various reasons. These include concerns about cost, the quality of technology, workflow issues, and a belief that employers, insurers and patients reap most of the benefits at physicians' expense. According to the Centers for Medicare & Medicaid Services, fewer than 10% of doctors prescribe electronically.

The automakers' initiative could help boost electronic prescribing, but "I wouldn't say that it's any silver bullet," said Kevin Hutchinson, CEO of SureScript Systems, which is developing a national network connecting doctors and pharmacies, and is participating in the automakers' initiative.

Pushing the momentum forward

Initially, the automakers plan to recruit 6,500 doctors in Michigan to participate in their e-prescribing initiative, with plans to expand it to 17,000.

Participation is voluntary, and the Big Three and their partners are still working out the details about incentives for physicians, said Sharon Baldwin, a spokeswoman for General Motors. Doctors will have to pay for hardware and software but will be offered incentives "to help offset their technology investment," she said.

Hutchinson said the automakers' plan can make e-prescribing more of a reality for doctors. Momentum is already swinging toward e-prescribing, he said, including more pharmacies being connected to e-prescribing systems. One out of every three pharmacies in the United States now can accept electronic prescriptions, and half will be able to do so next year, he said.

Also, e-prescribing got a push on Feb. 4, when CMS published a proposed rule to establish electronic prescribing standards under the Medicare Part D prescription drug plan, which is scheduled to take effect in 2006. In a letter dated Oct. 4, 2004, addressed to CMS, the American Medical Association supported the creation of uniform national standards for e-prescribing but expressed serious concerns because "current technology is still in its infancy and remains unproven."

The AMA said the proposed standards must be flexible and scalable for health care entities of all sizes. "Core standards must allow for basic stand-alone electronic prescribing platforms that permit solo physicians or small practices to meet the regulatory requirements without an undue financial burden," the AMA wrote.

A skeptical audience

But Gregg Malkary, founder and managing director of Spyglass Consulting Group, a Menlo Park, Calif., health care consultancy, is skeptical about the Big Three's effort, given that past e-prescribing programs showed physicians to be resistant to the technology.

"There's no incentive for a doctor to utilize [e-prescribing]," Malkary said. "If you're a doctor, your income has gone down 50% in the past 10 years. Reimbursement has gone down significantly, so you have to see twice as many patients, and now you're also asking them to use e-prescribing systems? Some actually are faster to utilize than paper, but others are slower."

Malkary points to Indianapolis-based WellPoint as an example of how e-prescribing pushes don't always work. In 2004, 19,000 doctors in four states participated in the plan's $42-million program that gave doctors a choice of either a handheld-based e-prescribing system or a desktop-based practice-management system. The majority -- 16,700 -- spurned the e-prescribing system in favor of the management system.

Success for the automakers' initiative will depend on whether they offer the "right" incentives to physicians, Malkary said. These include paying doctors a certain amount per electronic prescription or prescriptions, discounts on liability insurance, and incentives based on the number of generics versus brand-name drugs they prescribe. "If the right incentives aren't in place, this thing will fail miserably," Malkary predicted.

Recruiting doctors, particularly those in private practice, will be challenging, some experts say. That's a lesson that sponsors of other e-prescribing initiatives already have learned.

In Washington, D.C., for example, the Council for Affordable Quality Healthcare, a nonprofit coalition of the nation's major insurers, and Columbia, Md.-based MedStar Health, among others, planned to hand out 200 free software subscriptions for a one-year test that ended in April 2004. But only 100 practices signed up.

"We saw that stand-alone e-prescribing is still pretty difficult to sell to physicians, even when it's free," said internist Peter Basch, MD, MedStar's medical director of e-health initiatives. "I think the message is that e-prescribing works, but that broad adoption will probably take a combination of mandates and incentives."