E-prescribing up, but progress by states is uneven

Minnesota has passed Massachusetts to become the state with the highest rate of electronic prescribing. Massachusetts held the top ranking for five years.

Credit for Minnesota’s rise to the heights of Surescripts’ annual Safe-Rx Awards is being given to the public-private collaborative efforts to promote e-prescribing in the state. That collaboration led to an e-prescribing mandate that passed in 2008 and took effect in 2011.

Eighty-two percent of prescribers in Minnesota have adopted e-prescribing, up from 49% in 2010, according to e-prescribing network Surescripts. Prescribers there routed 61% of prescriptions electronically last year, surpassing Massachusetts, which has an 86% adoption rate but had 57% of eligible prescriptions sent electronically. (See correction)

Nationally, 58% of office-based prescribers sent prescriptions electronically in 2011. Incentives, such as Medicare’s electronic prescribing incentive program and the Medicare and Medicaid meaningful use incentive programs for electronic health record use, have proven successful in promoting e-prescribing. Yet only nine states have at least 70% of physicians electronically submitting prescriptions. Minnesota was the first state to adopt a legislative mandate.

It’s unclear whether other states will follow Minnesota’s lead in making e-prescribing a legislative requirement.

“It appears that a mandate can be an effective strategy, depending on the environment in a state and if combined with public-private initiatives designed to facilitate collaboration,” said Paul Uhrig, chief administrative officer at Surescripts.

A public-private partnership called the Minnesota eHealth Initiative was established in 2004 to provide advice and feedback on policymaking related to health information technology, including the e-prescribing mandate. The law required all prescribers, pharmacists, pharmacies and pharmacy benefit managers to participate in e-prescribing by Jan. 1, 2011.

The Minnesota Dept. of Health said in a statement that the state has made significant progress, but “gaps still remain.”

In 2011, 91% of pharmacies, 68% of clinics, 39% of hospitals and 3% of nursing homes were e-prescribing, according to the state health department. The state’s mandate includes no enforcement penalties for noncompliance, but several state programs were put in place to raise awareness and provide help to those implementing the technology.

Lyle Swenson, MD, president of the Minnesota Medical Assn., said the MMA was “generally supportive of e-prescribing” and was not opposed to the mandate. But, he said, physicians are still waiting for evidence that shows e-prescribing improves efficiencies and reduces costs.

“We are scientifically based. Show us the data,” said Dr. Swenson, a cardiologist in St. Paul, Minn. “I know for my practice, it makes me less efficient.”

Minnesota officials say more needs to be done to persuade all doctors in the state to give up the prescription pad.

“Though the trends are heading in the right direction and it is nice to receive a No. 1 ranking, we are not resting on our laurels,” Marty LaVenture, director of the Office of Health Information Technology at the Minnesota Dept. of Health, said in a statement. “There is still a lot of work to be done to completely eliminate a reliance on paper prescriptions in Minnesota.”