E-Prescribing Federal Incentives Are Driving Adoption

As of the end of 2010, more than 34 percent of the nation's prescribers were actively managing prescriptions electronically and 25 percent of prescriptions were transmitted electronically. To put those numbers into perspective, consider that in 2004 approximately 0.4 percent of prescribers sent 0.001 percent of prescriptions electronically. Simply put, e-prescribing is well on its way to becoming a mainstream practice.

These and other important statistics and analyses were recently published in The National Progress Report on E-Prescribing and Interoperable Healthcare. Each year, Surescripts publishes this report in an effort to provide the nation's healthcare system with a measure of the actual use of e-prescribing by physicians, pharmacists and payors throughout the nation. Following are some of the highlights of the 2011 report.

Prescribers

E-prescribers include physicians, nurse practitioners and physician assistants. E-prescribers use either standalone e-prescribing software or an EHR to generate these transactions.

Key Prescriber Adoption Statistics

• Approximately 234,000 prescribers routed prescriptions electronically by the end of 2010, up from 156,000 at the end of 2009.
• Approximately 81 percent of the 234,000 prescribers were physicians.
• Approximately 36 percent of physicians are e-prescribing nationwide, Surescripts estimates.
• Adoption rates are highest among cardiologists, at 49 percent; and family practitioners, at 47 percent. (See Figure 1.)
• In terms of practice size, adoption rates are highest among practices with five to 10 physicians, at 44 percent; and among those with two to five physicians, at 42 percent. (See Figure 2.)

Key Prescriber Use Statistics

• The number of e-prescriptions sent by prescribers in 2010 grew to 326 million, up from 190 million e-prescriptions in 2009.
• Electronic responses to requests for prescription benefit information more than doubled, from 188 million in 2009 to 423 million in 2010.
• Prescription histories delivered to prescribers more than doubled from 81 million in 2009 to 230 million in 2010.

Pharmacies

Fig. 1. Cardiologists, family practitioners and internists lead the e-prescribing pack. Source: Surescripts, The National Progress Report on E-Prescribing and Interoperable Healthcare. Used by permission.

There are approximately 62,000 community pharmacies in the United States, including both chains and independently owned pharmacies. In addition, pharmacy benefit managers (PBMs) and some chain stores operate mail-order pharmacies. To receive and process e-prescriptions, these pharmacies require prescription routing connectivity with prescribers, which enables providers to send new prescriptions electronically to the pharmacy of the patient's choice and allows pharmacies to send prescription renewal requests to the practices' e-prescribing software for their review and electronic response. Surescripts works with pharmacies to provide this connectivity.

Key Pharmacy Statistics

• At the end of 2010, approximately 91 percent of community pharmacies in the U.S. were connected for prescription routing and six of the largest mail-order pharmacies were able to receive prescriptions electronically.
• More than 98 percent of chain pharmacies were connected to the Surescripts network for prescription routing in 2010.
• Adoption among independent pharmacies has grown significantly, from 46 percent in 2008 to 73 percent in 2010 (See Figure 3).

Payors

The nation's public and private payors and their associated PBMs provide prescription benefit and medication history information to help inform prescribers when they select medication therapy. Surescripts gives prescribers access to this information through its electronic connections to PBMs, which represent connections to thousands of health plans.

Key Payor Statistics

• At the end of 2010, Surescripts was able to provide access to prescription benefit and medication history information (on behalf of payors and pharmacies) for more than 66 percent of patients in the U.S.
• By the end of 2010, participation by payors in e-prescribing allowed prescribers to locate and access     more than 250 million member records from participating health plans.

The critical role of federal incentives

Smaller practices leading the way
Practice Size	% Active E-Prescribers	% EHR Users
100+	21.9%	99.3%
26-100	30.7%	93.3%
11-25	33.6%	84.5%
6-10	43.5%	79.9%
2-5	41.7%	73.8%
Individual (Solo)	30.6%	63.5%
Fig. 2. In general, smaller practices report higher rates of e-prescribing than larger ones or solo practices. Source: Surescripts, The National Progress Report on E-Prescribing and Interoperable Healthcare. Used by permission.

Beyond the numbers, the report offers a clear understanding of what's working and what needs work.

The Health Information Technology for Economic and Clinical Health (HITECH) Act was one of the biggest contributors to e-prescribing growth in 2010. The goal of the HITECH Act is to encourage the adoption and meaningful use of EHRs through incentive payments to eligible physicians and hospitals. The act identifies e-prescribing as a core objective of the meaningful use standards for eligible providers, and Stage 1 requires that at least 40 percent of eligible prescriptions be sent electronically. To maximize potential incentive payments, physicians must file to receive benefits in 2011 or 2012. Since demonstrated use must last at least 90 days, the 2011 deadline is Sept. 30.

Although HITECH has been a high-visibility driver of e-prescribing, it's not the only one. The Medicare Improvements for Patients and Providers Act (MIPPA) incentive program remained a key driver of e-prescribing growth in 2010, especially for non-EHR practices. MIPPA, introduced in 2009, offered a 2 percent bonus payment in 2010 for qualified e-prescribers that prepared and sent prescriptions using a qualified e-prescribing system, such as EHR software or a stand-alone application.

The looming penalties in 2012 will be of concern to non-adopting practices and will influence acquisition of prescribing technology through 2011. That said, practices should be reassured by the fact that requirements for compliance are relatively low. For example, practices are only required to send 10 prescriptions electronically during Medicare visits in the first six months of 2011 to avoid MIPPA financial penalties for non-compliance in 2012, and only 25 during all of 2011 to avoid MIPPA financial penalties in 2013. Sending 25 prescriptions electronically in 2011 also qualifies practices for MIPPA financial incentives for the year.

Looking ahead

Fig. 3 Adoption of e-prescribing has risen significantly among independent pharmacies. Source: Surescripts, The National Progress Report on E-Prescribing and Interoperable Healthcare. Used by permission.

We believe that 2011 could represent a watershed year for e-prescribing—we are projecting that adoption by office-based physicians should exceed 50 percent by year's end.

Beyond MIPPA and HITECH, there are two additional drivers of future growth that are highlighted in the report: healthcare reform and the e-prescribing of controlled substances.

As part of healthcare reform, the Patient Protection & Affordability Care Act has key provisions that will drive the adoption of health technology for the next five years. These factors include the potential growth in the number of insured patients as well as adjusted expense ratios for insurers.

Since June 1, 2010, the U.S. Drug Enforcement Administration (DEA) has allowed prescribers the option of issuing prescriptions for controlled medications electronically. This offers the opportunity for prescribers to avoid dual workflows caused by paper and fax-based prescribing.

To e-prescribe controlled substances, the DEA says prescribers must:

• Use an e-prescribing application that is certified for this purpose;
• Complete an identity proofing process; and
• Use a two-factor authentication process each time one of these prescriptions is issued.

State reports and rankings

Surescripts will release individual state progress reports and announce the latest rankings of all 50 states plus Washington, D.C., as part of the sixth annual Safe-Rx Awards, scheduled for September. To track your state's progress with e-prescribing adoption and use, go to www.surescripts.com/safe-rx.

For a copy of The National Progress Report on E-Prescribing and Interoperable Healthcare, go to www.surescripts.com/report.

Mary Martin, RN, is the senior vice president of customers and markets for Surescripts.