E-Prescribing Mandate Premature, Says HHS Advisory Group

The American Health Information Community, or AHIC, recently submitted a list of recommendations regarding mandatory electronic prescribing, known as e-prescribing, in Medicare to HHS Secretary Michael Leavitt. AHIC was acting in its role as a federal advisory body tasked with advising HHS on health information technology, or health IT.

The Nov. 28 letter detailing the recommendations was a direct result of the group's mid-November meeting in Chicago, during which some members of the group pushed for forward movement on the e-prescribing issue.

AHIC is specifically charged with finding ways to accelerate the development and adoption of health IT. Academy EVP Douglas Henley, M.D., is the sole physician representative serving on the advisory group.

AHIC pointed out in its letter that e-prescribing holds much potential as a means to deliver safe, efficient and effective health care to patients. Despite that, "e-prescribing has not been widely adopted by the delivery system," the letter noted. Recent advances in standards and e-prescribing regulation "show that there is growing opportunity to move decisively in support of widespread adoption of e-prescribing," said AHIC.

At the top of AHIC's list was a recommendation that the secretary "seek specific authority from Congress to mandate e-prescribing." Yet AHIC also stressed that certain conditions should be met before Leavitt could exercise any such congressionally granted authority to mandate e-prescribing.

"As a representative of the physician community (on AHIC), I wasn't willing to support a mandate or even talk about a mandate unless AHIC and Secretary Leavitt understood and agreed that certain other conditions must be met first," said Henley in an interview. "I think the final recommendations reflect that."

"It might make sense at some future date to make e-prescribing mandatory, but there are a lot of other parts of the equation that need to be dealt with before that happens," added Henley, referring to specific recommendations outlined in AHIC's letter, such as

CCHIT should develop criteria designed to assess and certify the safety of e-prescribing systems, AHIC's letter noted.

Henley said that currently, up to 30 percent of outpatient pharmacies don't accept electronic prescriptions and that the DEA prohibits electronic transmission of prescriptions for controlled substances. Furthermore, "many states, through their medical boards or their state legislatures, currently require triplicate print copies of narcotic prescriptions," and those issues would need to be resolved before telling all physicians they must prescribe electronically, he said.

AHIC also recommended that a certain amount of flexibility be maintained in any e-prescribing mandate. "That flexibility could give special consideration to small- and medium-size physician practices," said Henley.

Lastly, AHIC recommended that Leavitt ask the Agency for Healthcare Research and Quality to designate patient safety organizations to monitor and address patient safety issues that might arise as a result of e-prescribing.

"The Academy is in favor of our members adopting e-prescribing technology because it's been shown time and time again that e-prescribing has the potential to improve patient safety," said Henley. For instance, e-prescribing software eliminates illegible handwriting and can alert physicians to patient drug allergies and potential adverse drug interactions.

"AAFP will continue to work with Congress and HHS to ensure that any e-prescribing mandate considered two or three years down the road is done so with the appropriate prerequisites in place," he added.