Electronic Prescribing Gathers Momentum

(MoneyWatch)  By the end of this year, more than 140,000 doctors, nurse practitioners and physician assistants will be using e-prescribing software to send prescriptions online to pharmacies--double the number that were using this technology at the end of 2008. That forecast comes from Surescripts, the company that created the network that connects physician offices to drug stores. Formed several years ago by the trade associations of the chain and independent pharmacies, Surescripts later merged with RxHub, another e-prescribing network created by three of the largest pharmacy benefit managers (PBMs).

Using data from the PBMs, which administer pharmacy benefits for health plans and employers, as well as health plan claims data, Surescripts provides benefit, formulary, and medication history information to physicians on its network. This data covers about 200 million people, roughly two-thirds of the population. Any physician who has Surescripts-certified electronic prescribing software, either standalone or included in EHRs, can access these services. And they can send prescriptions to 84 percent of retail pharmacies, as well as the six largest mail order pharmacies.

Assuming the Surescripts prediction comes true, only 23 percent of office-based doctors and midlevel practitioners will be e-prescribing online by December, and just 12 to 15 percent of all prescriptions will reach pharmacies that way. Yet the growth in the number of e-prescribing clinicians has been exponential in recent years. From 2007 to 2008, the number of prescribers routing prescriptions online grew from 36,000 to 74,000, and now it's doubling again.

Rick Ratliff, executive vice president of customers and markets for Surescripts, attributes much of the rapid growth to healthcare payers. First, employers and health plans in some states, such as Michigan and Massachusetts, actively encouraged e-prescribing among physicians. Then Medicare announced that, starting Jan. 1, 2009, physicians who prescribed electronically would get a 2 percent bonus and that later on, there would be penalties for doctors who stuck to their prescription pads. In addition, the "meaningful use" provision of the HITECH Act, part of last spring's stimulus legislation, requires that prescriptions be sent to pharmacies online. As a result, says Ratliff, more physicians who already had e-prescribing modules in their EHRs got them upgraded so they could send prescriptions online, instead of printing them out for patients.

The uptake of medication history information has been slower. In 2008, for example, while the number of prescriptions sent online jumped to 68 million, the number of prescription histories delivered to providers rose to only 16 million. But requests for electronic benefit information doubled to 78 million, probably reflecting the fact that the use of that data decreases callbacks from pharmacies.

All of this bodes well for the widespread adoption of e-prescribing-a cornerstone of health information exchange-within the next few years. Once the percentage of prescribers approaches the 50 percent mark, it should reach a tipping point, and even the most Luddite doctors will eventually abandon their unsafe, paper-based prescribing habits.