E-Prescribing: Waiting for the tipping point
Many of those working to improve health care in America have advocated for the use of electronic prescribing as an important tool for improving patient safety and moderating health care cost trends. A recent report released by the U.S. Government Accountability Office (GAO) documents abuses in the Medicare drug benefit that underline the potential value of electronic prescribing tools. According to the GAO report, some beneficiaries were able to obtain more than a year’s worth of narcotics by “shopping” different doctors. Electronic prescribing tools can enable health plans, physicians, and pharmacists to detect doctor-shopping, and assure that multiple prescriptions are not filled for the same condition within a given time period. Such an approach can both protect the health of patients who may receive duplicate prescriptions in error, and prevent fraud and abuse by those who seek prescription drugs for non-medical purposes.
In a recent review of the literature[CHRT E-PRESCRIBING] on e-prescribing, our center noted that despite the evident potential of e-prescribing, use is still very low. In 2010, only 25 percent of eligible prescriptions were prescribed using electronic tools. Indeed, Michigan had the second highest rate of e-prescribing in the country in 2009 – 20 percent – up from 4 percent in 2007. But even though rates are increasing, they are still extremely low relative to the opportunity. In a recent issue brief, the Center for Studying Health Systems Change found that in 2008, 42 percent of physicians in the country had access to e-prescribing, but only one-third were routinely using the technology.
The American Recovery and Reinvestment Act (ARRA) included significant components to promote the use of electronic medical records (EMRs). Starting this year, there are incentives for physicians who document “meaningful use” of EMRs, and starting in 2015, there are disincentives for physicians who don’t. There is already evidence that physicians are responding to these incentives to some degree, and because e-prescribing is included as part of EMR meaningful use standards, these incentives/disincentives may provide impetus for a further increase in e-prescribing. However, there are many who believe that the uptake is too slow and the incentives and disincentives included in the ARRA won’t make a big enough difference in the use of these tools.
So, why is it we can know so well that something will improve quality and safety and yet don’t use it to its potential? One key reason: the increasing availability of information and technology often outstrips the speed at which human systems change. The meaningful use guidelines recognized this by providing not only incentive and disincentive funding but also technical assistance to help physicians make the needed changes. Aligning incentives between public and private payers such that physicians get consistent messages and consistent support to embrace technology will also help.
But technical assistance and aligned incentives will only help to the extent that physicians want that help and are open to change. There is a telling statistic in the study reported by the Center for Studying Health Systems Change: the degree of e-prescribing use by age of physician. Of physicians over age 60 with access to e-prescribing, 66.5 percent used it routinely, compared to 87.2% of physicians between the ages of 29 and 40.
It would be nice if the trend toward adoption of EMR/e-prescribing didn’t rely on the retirement of older physicians. But it does appear that over time, one way or another, we will eventually reach a tipping point, and e-prescribing will become the norm, not the exception.