I read the article by Kenneth G. Adler, MD, MMM, “E-prescribing: Why the Fuss?” with interest. While e-prescribing has many apparent advantages, most benefiting payers and pharmacies, as a physician user I have encountered multiple disadvantages that are not adequately addressed in this article and others.
First and foremost, as Dr. Adler points out, “Writing an e-script can take a little longer than scribbling one on a prescription pad.” This is especially true if the doctor has to input the script into a stand-alone program such as Allscripts eprescribe at a computer outside of the exam room. Allscripts is the free program I used for six weeks before giving up on the whole endeavor. The average script took one to two minutes to complete, which stretched into five to 10 minutes of computer time for a patient visit requiring three or four prescriptions. I could write the same scripts in two minutes or less while sitting in the room facing the patient and answering other questions.
Second, much of the data entry that had previously been the pharmacy’s responsibility had to be done by my nursing staff. This meant they were less available for patient care, telephone calls and other tasks. As the volume of e-scripts increased, it was obvious that I would have to hire another MA to perform the required data entry.
As a solo FP, I cannot afford a fully integrated electronic medical record (EMR) system, which would offer a more efficient means of e-prescribing. I know many physicians in solo practice and small groups share my concern.
The 2-percent Medicare incentive payment for e-prescribing would produce an additional $1,300 in revenue for my practice. This hardly justifies the purchase of a $100,000 EMR or the additional staff needed to make stand-alone e-prescribing work. My biggest concern is that Medicare is going to penalize doctors who don’t eprescribe by cutting our reimbursement rates beginning in 2012.
I would ask that the AAFP not become so enamored of technology that it neglects to support what makes family medicine unique – the personal doctorpatient relationship.
Dr. Snyder’s concerns are common for physicians who are adopting e-prescribing or EMRs. They say: “Adoption will make me less productive.” “It will interfere with the efficient operation of my office.” “The cost won’t be justified.” “It will interfere with my relationships with patients.”
I’d like to be able to state that all of these are unfounded concerns of technophobes. Doesn’t health information technology always make things better? Well, my parents told me to always tell the truth. The reality is that simply purchasing the technology isn’t enough. It has to be chosen and implemented thoughtfully and carefully.
I suspect that stand-alone e-prescribing would have worked out significantly better both for Dr. Snyder and his staff if he had invested money in two things. One, I don’t recommend leaving the exam room to write a prescription. You can use a personal digital assistant with a wireless connection to the Internet, a smart phone or a tablet/notebook computer that you carry with you. Or, for more money, you can put a desktop computer with an Internet connection in every exam room. Second, it is typically worth the expense to invest in an interface between the e-prescribing system and your practice management system so your staff doesn’t have to manually enter patient demographics.
So after you invest that extra money, how will you be made economically whole on Medicare’s paltry 2-percent incentive? You won’t. Other realities of e-prescribing will make you whole. Once you build a favorites list of scripts, writing an e-script will likely take only seconds longer than a paper script. However, the amount of time it takes to do refills will be markedly reduced. Also, if you pay attention to the cost and formulary information in the computer, the time-consuming calls from pharmacies stating that a medication isn’t on the formulary and calls from patients stating they want a cheaper medication will also be markedly reduced. Typically, eprescribers find that total staff time related to medication management decreases. These are the savings that pay for the system.
Whether EMRs pay for themselves is another legitimate concern. My experience is that they do. That topic could take a whole article. In fact, well, I wrote one. See “Why It’s Time to Purchase an Electronic Health Record System,” FPM, November/December 2004 (https://www.aafp.org/fpm/20041100/43whyi.html).
Finally, as a practicing family physician, I totally agree with Dr. Snyder. The personal doctorpatient relationship is what we do best. In my view, health information technology is simply a tool to enhance that relationship and to provide better care to patients than we ever have before.