HIMSS webinar: E-prescribing has come a long way; needs to go further

Work toward widespread use of e-prescribing has come a long way in a short period of time, but there’s still a long way to go before it is completely accepted and its flaws are fixed, according to the presenters of a Nov. 16 webinar cosponsored by Healthcare Information and Management Systems Society (HIMSS) and the National Conference of State Legislatures.

“We’re challenged by variations across our country -- in practice sizes, in practice locations, among insurance companies, and in state and federal regulations,” Patricia L. Hale, MD, said.

Hale, associate medical director of informatics at the Albany Medical Center in New York, added that “we still have challenges with the standard communication methods that we use to send information from place to place. There are drug terminologies, coding instructions and the actual language used in prescriptions – [e-prescribing systems] don’t all talk in exactly the same way, and that makes it challenging when you’re trying to get information from one system to another.”

Despite the ongoing interoperability issues, Hale believes that the large volume of prescriptions circulating through the healthcare system necessitates e-prescribing. According to Hale, four out of five patients receive prescriptions during physician appointments, 65 percent of the national population takes at least one prescription medicine per year and up to 4 percent of handwritten prescriptions are flawed.

If participation in e-prescribing systems is any indication of physicians’ belief in the benefits, then there appears to be a general consensus among providers with Hale.

Lee Stevens, manager of the State HIE Program at the Office of the National Coordinator for Health IT (ONC), said that thousands of providers have enrolled in EHR-based e-prescribing systems over the past few years.

“It’s been less than five years and we’ve gone from about 4,600 physicians to almost a quarter-million e-prescribing with EHRs,” Stevens said. “That’s really the ultimate goal for us.”

Displaying a map that showed states with high levels of e-prescribing participation in dark blue, Stevens said, “What we really look forward to doing with the state HIE program is having our grantees do the appropriate outreach and combining our resources here at ONC with our other programs like the regional extension center program to encourage every state to show up navy blue next year."

According to Hale, large-scale providers and chain pharmacies quickly adopted e-prescribing capabilities because they possessed the capital to do so and benefits to efficiency appeared obvious to do them. However, other healthcare organizations, such as independently-owned pharmacies have taken longer to catch on.

“When we look at independent pharmacies, there are some relatively simple barriers,” Stevens said. “There are implementation costs, of course, and they may be hurt by transaction fees. In those cases, incentives are incredibly helpful to getting them started and incorporating e-prescribing into their workflow.”

Stevens discussed several state initiatives aimed at increasing e-prescribing participation even further, focusing on efforts that don’t involve cash incentives, such as California’s attempt to train last-year pharmacy students in the applications of e-prescribing systems.

David Blumenthal, MD, the previous ONC coordinator who currently works with Massachusetts General Hospital and the Harvard Medical School, both located in Boston, concluded by reminding listeners that the true value of e-prescribing would be realized when combined with other health IT.

“E-prescribing has value, but that value is enhanced enormously when it is combined with other electronic capabilities and information,” Blumenthal said. “It makes a physician, a nurse or a hospital better at deciding what medications to prescribe and what other kind of treatments or tests need to be included when medication is prescribed.”