Pushing more doctors to ditch the prescription pad

[December 16, 2008]  WASHINGTON (AP) -- The push for paperless prescriptions is about to get a boost: Starting in January, doctors who e-prescribe can get bonus pay from Medicare. For patients, the benefits are obvious -- from shorter drugstore waits to increased safety, as pharmacists no longer squint to decipher doctors' messy handwriting.

But persuading U.S. doctors to ditch their prescription pads for electronic prescribing so far has been a long, uphill battle. Only about 10 percent of doctors are taking the plunge like Dr. Ted Epperly in Boise, Idaho, who's adopting the technology now.

Still, the movement is gaining steam as Medicare warns that its bonus payments are for a short time only: Holdouts still sticking to paper in 2012 will find their Medicare payments cut.

And continuing the push for medical information technology is a key part of President-elect Barack Obama's health-reform plans, in hopes that moving to computerized records -- not just prescriptions, but all those troublesome paper charts that contribute to medical errors and wasted care -- ultimately could save millions of dollars a year.

"We'd never go back," says Epperly, also president of the American Academy of Family Physicians. Patients "recognize that, 'Hey, Dr. Epperly's in the information age, and my safety is better and the quality of care is better.'"

What's a paperless prescription? When the doctor writes it by computer and sends it directly to the drugstore by computer, no little piece of paper to get lost or stolen anywhere along that trail.

Some doctors do write prescriptions via computer but then hand the patient a printout, or it arrives at the drugstore as a fax. Those don't count as true electronic prescribing.

In December 2007, 35,000 doctors were writing at least some paperless prescriptions, according to SureScripts-RxHub, which tracks the drugstore network.

The 2008 count isn't finished yet, but SureScripts estimates that number has doubled to more than 70,000. Moreover, the volume of prescriptions filled electronically grew about 15 percent a month since August, faster than the 5 percent to 8 percent monthly increase seen earlier in the year -- presumably as doctors geared up for the Medicare incentive.

The biggest reason for the paperless push is to improve safety. More than 1.5 million Americans are injured every year by medication mistakes. Deciphering doctors' chicken-scratch -- was that 100 milligrams or 100 micrograms? -- does play a role. But perhaps more important, electronic prescribing systems can flash an alert if the dose seems wrong or patient records show use of another drug that can dangerously interact.

By avoiding unnecessary medication injuries, Health and Human Services Secretary Michael Leavitt has estimated that widespread e-prescribing could save as much as $156 million over five years.

It can save patients cash, too. Most insurance plans divide their formularies into tiers with escalating co-pays, and e-prescribing can let doctors debating which drug to recommend can take patient cost into account. A study published last week found that Massachusetts doctors increased use of the cheapest drugs by 6.6 percent during their first year of e-prescribing.

Patients appreciate that price discussion, says Dr. Joe Heyman, chairman of the American Medical Association's trustees and a longtime e-prescriber. An obstetrician/gynecologist, he regularly discusses big contraceptive price differences.

While some patients may need Brand X instead of Generic Y, "in general any of the birth-control pills will do the job," Heyman says. "If when you e-prescribe, it tells you this is a Tier 3 drug and will cost the patient $50 instead of $10, somehow that can be more persuasive" than the ad the woman saw for a pricier version.

So why haven't more doctors joined?

There's definitely some upfront pain, as the office staff enters patient information into electronic prescription programs that can cost $3,000 per doctor. The Medicare incentive -- an extra 2 percent in reimbursement rates in 2009 and 2010, and smaller bonuses the next three years -- could offset the investment by earning the doctor an extra $1,000 to $1,500 a year, Epperly estimates.

A bigger barrier: Narcotic painkillers and other controlled substances that account for 20 percent of all prescriptions are banned from electronic prescribing. The Drug Enforcement Administration is working on rules to allow that switch.

Then there's the drugstore link. While almost all pharmacy chains are part of a national e-prescription network, smaller ones may not be -- only 27 percent of independent pharmacies were in 2007 -- and doctors also must use software recognized by the network. In Boise, Epperly says more drugstores still receive his e-prescriptions as a fax than as fully paperless, his biggest frustration.

"Change itself was a bit of a barrier," he says.

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On the Net:

Searchable list of e-prescribers:
http://www.learnaboutEprescriptions.com/

[Associated Press]

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