WASHINGTON – The country's community pharmacists – and physicians, too – are calling on the government to strengthen e-prescribing requirements, arguing the standards are too low.

The National Community Pharmacists Association (NCPA) testified Jan. 25 at a workgroup of the Health Information Technology Policy Committee Information Exchange on the experiences of independent community pharmacies in accepting e-prescriptions from physicians. Physicians and other organizations joined the NCPA in raising concerns over the state of e-prescribing today.

"Community pharmacists have a vested interest in making e-prescribing work because it potentially provides more accurate and faster electronic transmittal to pharmacists of computerized prescription information than written prescriptions," said Bruce T. Roberts, NCPA executive vice president and CEO. "However, challenges remain in the adoption and implementation of this technology.”

Virginia family practitioner Alex Krist, MD, noted that his practice has an EMR with e-prescribing that has made it possible for physicians to prescribe clearly and to keep more complete medication records. However, he said the networks that transmit e-prescriptions are prone to outages and also the records leave something to be desired.

"While systems keep historical records of all medications prescribed, active medication lists easily become cluttered with acute, short-term medications and long-outdated medications – potentially resulting in a new cause for medical errors,” he said.

Chris Snyder, DO, hospitalist and CMIO, Peninsula Regional Medical Center in Salisbury, Md., told the panel that the ability for the provider to access a comprehensive view of mediation history for the patient during the prescribing process has proven to be a powerful benefit and enticement for use of the technology. However, the current exclusion of the use of e-prescribing for controlled substances remains problematic requiring providers to employ dual processes.

“Though the impact of the exclusion varies by specialty, in our experience as much as one-third of the prescriptions generated can be for controlled substances,” Snyder added.

“Lack of standards remains a serious issue that keeps e-prescribing from reaching its maximum potential,” said Peter M. Kaufman, MD, chief medical officer, DrFirst Inc. “Internet connectivity has improved dramatically but can still be a problem in some rural areas. For users insistent on handheld devices, screen size and input method hamper effectiveness.”

CMS should strengthen e-prescribing requirements
NCPA told the panel that there is a related equity and effectiveness concern regarding standards that providers have to meet in CMS' Physician Fee Schedule and Part B Rule for CY 2010 to be considered "successful e-prescribers," and thus eligible to receive incentives/avoid penalties.

CMS now requires that a prescriber has to e-prescribe 25 times during the 2010 reporting period to be eligible for the incentive of 2 percent of all total estimated allowed charges covering all professional services furnished during the same period.

"That level of e-prescribing is too low," the NCPA noted in its written testimony.

Also, the NCPA said pharmacists were disappointed that government incentives were directed solely at physicians and not at pharmacists.

"E-prescribing is intended to foster better, quicker, safer, more efficient and less costly communications between providers and pharmacies/pharmacists regarding patient prescriptions," wrote the NCPA. "We hope the workgroup can therefore understand that pharmacists - particularly independent pharmacists - were disappointed that MIPPA (Medicare Improvements for Patients and Providers Act) provided incentives in 2009 - 2013 for physician providers to e-prescribe (and penalties in 2012 - 2014 for failure to do so), yet did nothing to encourage or facilitate e-prescribing on the pharmacist side of the relationship. The imbalance is of concern not only on the basis of equity and fairness, but also in light of effectively encouraging a robust system of e-prescribing. This lack of a parallel incentive for pharmacists in effect may create disincentives to them working with prescribers to promote e-prescribing."