E-prescribing: Benefits & Drawbacks of Digitalized Health IT Systems

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An estimated 1.5 million medication errors occur each year and according to the Institute of Medicine (IOM), e-prescribing may be the key to reducing these risks.

To ward off errors, IOM has recommended that all medications be prescribed electronically by 2010; however, the current situation indicates the initiative has fallen short of its goal.

While the number of U.S. facilities and practices adopting some type of e-prescribing has grown swiftly, those utilizing a full-fledged e-prescribing system are few. In fact, a report by Gorman Health Group in July 2007 showed that less than 30,000 of the more than 900,000 medication prescribers in the U.S. were aggressively utilizing e-prescribing solutions within their practices. Facilities using e-prescribing, however, have reported the technology has saved time, allows doctors to spend more time with their patients, averts lost prescriptions and can save a patient money by its ability to check for cheaper medication alternatives.

While there are other obvious benefits to e-prescribing, including reductions in drug interactions and transcription errors, aligning with CMS' e-prescribing guidelines for meaningful use can be challenging. Meaningful use objectives include having at least 75 percent of all prescriptions written and transmitted electronically. To help meet this goal, CMS has drawn up an incentive program that awards early adopters and penalizes those that do not take on the initiative by 2012, with penalties increasing until 2014 (see table).

For Associated Cardiovascular Consultants, a 34-cardiologist practice that deployed e-prescribing earlier this year, a decline in the amount of errors has already been attributed to the system’s ability to double check drug interactions and obtain patient history, says Donald W. Orth, MD, a cardiologist at its Voorhees, N.J., site. However, e-prescribing also may introduce new problems and give physicians the added possibility to enter the wrong drug, Orth says. “With handwritten prescriptions, it was very easy to write exactly what drug you want,” he says. “Now, health IT gives multiple drug formulas and depending on how big the formulary is and how many drugs are listed in your EMR, if you push the wrong button and don’t recognize a problem, there could be a significant error.”

To gain CMS’ e-prescribing incentives, a facility must “effectively” perform e-prescribing for 25 Medicare-aged patients over a six-month period, says Orth. “The nice thing about CMS is that it encourages e-prescribing use and until this motivation, physicians weren’t really excited about making the switch.”

Even though the practice operates e-prescribing through a qualified EMR and cardiologists prescribe with Express Scripts, a web-based application accessible through mobile devices, the facility still has yet to reap its highly anticipated 2 percent reimbursement from CMS.

Fully connected

Some parts of the nine-hospital MedStar Health System in the Maryland-Washington, D.C., area have been using various aspects of e-prescribing for 13 years. The facility finally connected all the parts with a seamless e-prescribing feature in the EMR to avoid separate web-based applications or standalone e-prescribing systems that have the potential to lead to duplicate medication ordering. “Physicians prefer technologies that are easy and intuitive and the way that this system presents itself is both,” says Peter Basch, MD, medical director of ambulatory EHR and health IT policy at MedStar.

Currently, the system undertakes three levels of e-prescribing: The electronic creation of prescriptions, transmitting prescriptions electronically to the pharmacy and combing pharmacy benefit plans for patient history and prescription coverage. While the facility has reaped benefits from e-prescribing, Basch says meeting CMS’ requirements