Consider e-prescribing as one step in climb to health IT

E-prescribing is an issue that is really getting charged-up. Pardon the pun. It is an issue that has gained an increasingly high profile in state and national circles.

The rhetoric surrounding the utility, possible ease of use and support for physician adoption continues to accelerate. Many voices are actively working within medical groups, organizations, and thought and policy circles along with legislative exploration in support of electronic prescribing by physicians.

The American Medical Association House of Delegates has developed policy touching this issue since 2005: D-120.972; D-478.994; D-478.996. Some of these policies speak to Internet prescribing rather than directly to electronic prescribing for a known patient or a patient who is part of an established medical group.

Notwithstanding, the policies can be summarized:

1. Integrity and security issues for patients must be guaranteed.

2. The AMA will work with Congress and the administration to establish standards for health information technology and e-prescribing.

3. Incentives rather than mandates must be pursued that can achieve e-prescribing objectives.

4. Interoperability among e-prescribing systems must be achieved.

5. Interoperability among e-prescribing systems and electronic medical record systems must be achieved.

Physicians continually have said they are interested in achieving e-prescribing status and are seeking the ways and means to facilitate its use. There are benefits once the system is operational -- systematic records of prescribed medication, the opportunity for a conveniently accessible medication review, documented drug allergies, accessible patient information, perhaps accessible clinical support tools and readable prescriptions with attendant patient safety implications.

Physicians write more than 1.5 billion prescriptions annually, and pharmacies fill more than 4 billion yearly, which include refills, hospital prescriptions and nursing home orders. Only 35 million prescriptions were written electronically in 2007.

In the March 10 AMNews, a front-page article reported that the Massachusetts Blues had changed its policy and will not require physicians to install electronic medical record systems to participate in its bonus program. They apparently recognize that the financial issues associated with installing EMRs are cause for pause by many physicians in the current environment. Why is this important? Many physicians see EMR adoption tied to the e-prescribing issue.

Let's explore that idea. The environment is changing. There are now stand-alone e-prescribing models in the marketplace.

Physicians now have the opportunity to explore the e-prescribing model without the larger financial commitment to an EMR system. There are growing examples of more affordable e-prescribing programs that exist outside of a full EMR system. This is in spite of not having full regulatory/standard issues addressed on the federal level that the AMA believes would facilitate earlier adoption.

The worst-case scenario is for an office to invest in electronic hardware/software/training and then have federal standards negate that effort from a regulatory perspective.

There are opportunities for physicians in all strata of practice models to consider engaging in e-prescribing as a first step to embracing EMRs. The AMA is working diligently to provide tools for physicians to achieve e-prescribing and EMR capability. There are some Web-based e-prescribing programs that provide excellent technology tools. Some "systems" are even interested in supplying this technology to physicians. As a thought for consideration, physicians should be cautious not to become prisoners of whoever is supplying the technology.

Congress also is looking at ways to facilitate adoption. One current bill would provide physicians a $2,000 initial bonus to adopt the e-prescribing technology with a phase-down of $1,000 decreasing over three years, with a 1% bonus on E&M codes that are linked to or involve a prescription. After three years, payments would be reduced by 10% if physicians were not engaged in e-prescribing. This would be far too punitive.

Other considerations would tie e-prescribing into payment updates. Some legislative proposals would mandate e-prescribing adoption. Interesting. Where this goes is undecided, but there is change in the air.

Therefore, as physicians we can and should have a powerful impact on the use of e-prescribing if we engage in the discussions. Mandating is problematic because there are operational and functional barriers to overcome.

But those barriers can be overcome. Experience has demonstrated that making technology operational is not always as easy as it is sounds. For all the reasons listed earlier, however, there is benefit to explore facilitating some "low-hanging technology fruit."

One example is to go to the National ePrescribing Patient Safety Initiative Web site and explore some options for consideration (link). This could be the first real foray for many physicians into the electronic prescribing world that may have positive implications for EMR adoption.

The challenge is to progress from "No, but ..." to "Yes, if ... ."

Let's lead on this issue and work with others who look to physicians to shape the discussion and become involved in the electronic age. Food for thought. Time for action.