E-prescribing reduces errors, cost for large group practice

The Henry Ford Health Clinic, a 900-member multispecialty practice in Detroit, says it has saved money and prevented tens of thousands of medication errors after a year of testing an electronic prescribing system with its 300 primary care physicians.

As a result, the clinic plans to roll out the technology across the entire group with the goal of writing all prescriptions electronically by the end of the year, said Mark A. Kelley, MD, executive Vice President of Henry Ford Health System and CEO of the Henry Ford Medical Group.

The group does not track how many prescriptions doctors in the group write annually, but it estimates the 300 doctors in the pilot are issuing more than 20,000 electronic prescriptions weekly.

Since launching the pilot in February 2003, more than 50,000 out of more than 500,000 electronic prescriptions were changed because of drug formulary alerts. The changes helped boost generic use to 7.3% and resulted in cost savings of $3.1 million over a one-year period, said Matt Walsh, associate vice president of purchaser initiatives at Health Alliance Plan, Michigan's second-largest HMO, which is owned by Henry Ford Health System.

The clinic could not say how much of the increase in generic drugs was the result of e-prescribing, but physicians who used the electronic system increased their generic rate by 1.25% more than those who did not, spokesman Dwight Angell said. "If this spread is realized over the entire [group], it would translate into over $1 million in yearly drug cost savings."

The health care organization did not track how many generic alerts the system issued or how many of those times physicians failed to switch to a generic, Walsh said. Doctors were not required to prescribe generics but had to explain why they stuck by the brand name to avoid a call from the pharmacist, Walsh said.

In addition to boosting use of generics, e-prescribing also led physicians to change more than 80,000 prescriptions because of potential drug-to-drug interactions and another 6,500 prescriptions because of potential allergic reactions.

Doctors probably would have caught most of the potential drug allergies and "a good portion" of the adverse drug events at the point of care and pharmacy, Dr. Kelley said.

"Would we have picked all of these things up? Absolutely not," Dr. Kelley said. "Would we have picked up the important ones? Perhaps, but now we have a pretty full system that ... helps every physician get the same information, so it's got to be better [than handwriting prescriptions].

The electronic prescribing system, which also sharply reduced phone calls from pharmacists who now had no difficulty deciphering what the doctor had ordered, has been well-received by physicians.

"Doctors are demanding this," Dr. Kelley said. A key reason is the information technology staff worked with testing physicians to deliver a product that would enable them to write an electronic prescription as fast as it would take to write it on paper, he said.

"Once it became clear by word of mouth that this actually worked and was pretty slick, our other physicians wanted to try it," Dr. Kelley said. "One of the challenges we found out ... is even though the system works, it takes a couple of weeks of hard work to learn how to use it. It does slow you down when you first try it, because you're doing something you've never done before."