Have America's Physicians Embraced e-Prescribing?

Surescripts 2009 Progress Report Shows Real Gains

March 15, 2010 04:35 pm Sheri Porter

Electronic prescribing is catching on with America's physicians. According to a new report released by Surescripts, operator of the country's largest electronic prescribing network, the number of e-prescribers was close to 156,000 at the end of 2009, up from around 74,000 at the end of 2008.

Surescripts' 2009 National Progress Report on e-Prescribing(www.surescripts.com) is the third in as many years. It tracks the status of e-prescribing adoption and use in the United States.

That's important, said Kate Berry, senior VP of business development at Surescripts, because "prescribing is the most common practice in medicine." Berry told AAFP News Now that a paper prescription process is "inherently challenging" because the physician is dependent on the patient's memory and sometimes partial pieces of a prescription history.

She called e-prescribing "one of the more mature and successful examples of health information technology." It can be incorporated into a medical practice and "benefit everyone who's touched by the medication management process," she said.

Report Details

As further evidence of the medical community's growing appreciation for the technology, the 2009 report concludes that

  • the number of prescriptions routed electronically increased 181 percent between 2008 and 2009, or from 68 million to nearly 191 million;
  • the number of prescription histories delivered electronically (with patients' consent) grew five-fold between 2008 and 2009 or from 16 million to 81 million; and
  • electronic requests for prescription benefit information grew 284 percent between 2008 and 2009, or from 79 million to 303 million.

The report defines office-based prescribers as physicians, nurse practitioners and physician assistants. E-prescribing is described as a process that occurs when a prescriber uses software to perform any of three electronic functions: to access a patient's prescription benefit, access a patient's prescription history, or route a prescription to the patient's choice of pharmacy.

According to the report, at the close of 2009, the Surescripts network provided access to prescription benefit and history information for more than 65 percent of U.S. patients, allowed prescribers to access more than 230 million member records from participating health plans, and provided access to more than 20,000 formulary files maintained by health plans.

The report also notes an uptick in pharmacy participation. At the end of 2009, about 85 percent of 62,000 community pharmacies (including both chain and independently owned businesses) in the United States were connected for prescription routing. In addition, six of the country's largest mail-order pharmacies could receive prescriptions electronically.

Berry said the industry's growth spurt caught even some its biggest supporters off guard. "I'd say the biggest surprise was the continued dramatic growth despite an environment with some uncertainty," she said. Berry noted that some electronic health record, or EHR, vendors were reporting that customers were delaying their purchases pending the release of federal regulations that define the use of EHRs.

"There was a sense that it might slow down while people waited for more clarity, but we saw no slowing down," said Berry.

E-Prescribing Drivers

According to the report, the federal government can claim a good deal of credit for the growth of e-prescribing by virtue of congressional passage of legislation that strongly encourages physicians to implement and use EHRs. Physicians who do so will reap cash incentives for their efforts.

That legislation, the Health Information Technology for Economic and Clinical Health, or HITECH, Act, was embedded in the American Recovery and Reinvestment Act of 2009.

Congress also passed the Medicare Improvements for Patients and Providers Act, legislation that went into effect on Jan. 1, 2009. According to those regulations, e-prescribers can increase their Medicare payments through 2013. Notably, physicians who aren't e-prescribing by 2012 will see a 1 percent decrease in their Medicare income.

Berry was quick to laud the efforts of other players with skin in the e-prescribing game. "I wouldn't downplay some of those private sector initiatives," she said. "The government is playing a really important role both with incentives and standards … but every stakeholder, private and public, has stepped up to make this as successful as it is."

Future Growth

In its report, Surescripts also makes recommendations for ensuring the continued growth of the e-prescribing phenomenon.

For example, the report points to the DEA's restriction on the electronic transmission of prescriptions for controlled substances, calling the issue a significant barrier.

The DEA's inaction on this issue "has forced prescribers to adopt a dual workflow for prescriptions -- maintaining a paper-based process for scheduled medications and an electronic one for all others," say the report authors. And that "adds time and hassle to a process that is still new for many doctors."

The report also points out gaps in adoption in certain key sectors, such as independently owned pharmacies, state Medicaid programs and small physician practices.

The authors note that practices with five or fewer prescribers often don't have the time or the money to move forward with an e-prescribing program. And the report urges the creation of initiatives to support small practices with training and post-implementation help. "This need has already been recognized through the Regional Extension Center program established under HITECH. Smaller practices will be a focus of these centers," says the report.

The report also encourages development of regional health information exchanges as a way of "driving the meaningful use of (EHR) technologies." It urges physicians to shop for EHR systems that have been "certified for the full suite of e-prescribing services." Doing so will ensure that physicians get all the benefits of the technology and will help them achieve eligibility for federal incentive dollars, says the report.

Berry predicted that the percentage of America's e-prescribers would continue to grow beyond the report's 25 percent mark. "Certainly I would expect 50 percent in three years. I think 75 percent within five years is actually very, very reasonable."

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