New Hampshire wants everyone to e-prescribe

If New Hampshire Gov. John Lynch has his way, in two years the paper prescription pad will be a thing of the past.

In October, Lynch announced his goal of New Hampshire becoming the first state to have all its doctors prescribing electronically. Lynch wants primary care physicians to be compliant by October 2007 and all others by October 2008.

The New Hampshire Medical Society, along with the state hospital association and a group of pharmacists and insurers, helped develop the plan under the leadership of the New Hampshire Citizens Health Initiative, which Lynch created in January to promote quality of care and use of health care technology.

The electronic prescribing goal is the first phase of a wider initiative to equip every doctor with an electronic medical record system, said Palmer P. Jones, executive vice president of the New Hampshire Medical Society.

But some of the plan's supporters aren't sure the e-prescribing goal will be met. Physicians aren't required to participate, and the state is putting no money toward assisting doctors to buy the technology.

"I would call it an optimistic goal. I wouldn't call it a realistic goal," Jones said.

The governor is expecting widespread compliance, said spokeswoman Pamela Walsh, because of planned pay-for-performance incentives the Citizens Health Initiative is developing with the state's insurers.

Gary Sobelson, MD, a family physician in Concord, N.H., and past president of the state medical society, said even without incentives, e-prescribing is "on every doctor's want-to-do list." The real issue, he said, is promotion of patient safety, and having complete medication histories on one database would be a boon for physicians.

Kristina E. Lunner, acting vice president of policy and communication for the American Pharmacists Assn., said that although she was not familiar with New Hampshire's plans, e-prescribing is definitely something the organization supports. "But the devil is in the details," she said. And so far, it's considered an unfunded mandate in many states.

Rhode Island is one state that has pledged money for electronic prescribing. With a $20 million bond pledge from Gov. Donald Carcieri, Rhode Island's goal is to have two-thirds of that state's physicians prescribing electronically by the end of 2007.

Lack of funding has stalled efforts in other states.

In Wyoming, for example, proposed legislation that would have created a statewide health information system that included electronic prescribing failed because of its $58 million price tag.

But Jones said 75% of New Hampshire's doctors are hospital-employed, and about 50% already have electronic prescribing capabilities.

So the campaign is really focused on a small number of private practices, he said.

"It's a good goal, and I think physicians are willing to work toward that," Jones said. Unfortunately, "no one has the money to help them."

On the most basic level, an electronic prescribing system can be obtained with a personal digital assistant with entry software, which costs between $2,000 and $3,000 per year, according to Anthony Schueth, managing partner at Point-of-Care Partners, a health care consulting group based in Coral Springs, Fla. Most of these software packages have the capability of cross-checking a database of patient medication history to help prevent prescription errors or dangerous drug interactions.

Dr. Sobelson thinks those systems may be within reach for most practices. And even though the level of communication between the physician and pharmacist could greatly improve through a more complicated -- and expensive -- system, the cross-checking feature, as well as a legible prescription that will cut down on misinterpretation, are really the most important aspects of the technology, he said.

"That's really where the rubber meets the road in prescribing," Dr. Sobelson said.