With help, eRx has come a long way

ONC data shows how federal incentives have boosted e-prescribing
By Mike Miliard
03:13 PM

The feds have been taking a bit of a drubbing lately, what with the paltry early returns for Stage 2 meaningful use attestations. But if providers are having a hard time proving their worth for that next round of electronic health record incentive checks, there's one place the government can claim some undeniable stimulus success: e-prescribing.

The prevalence of prescribing via EHRs has skyrocketed over the past decade. Almost unheard of in 2006, nowadays more than 70 percent of physicians e-prescribe, according to recent data from the Office of the National Coordinator for Health IT.

Thanks in large part to two federal initiatives – first the Medicare Improvements for Patients and Providers Act of 2008, also known as or MIPPA or the "eRx incentive" program, and later meaningful use – e-prescribing has made huge gains through the first quarter of 2014, the report from ONC's Meghan Hufstader Gabriel and Matthew Swain shows.

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Using data from Surescripts, the nation's largest e-prescription network, the study shows a steep and steady climb for eRx – from 7 percent in 2008, when MIPPA was passed, to 24 percent in 2011, when meaningful kicked off, to 70 percent today.

The growth has occurred nationwide, Gabriel and Swain point out. At the end of 2008, only one state, Massachusetts, had physicians prescribing via EHR on the Surescripts network at a rate that exceeded 20 percent.

Just over two years later, in January 2011, 35 states could boast e-prescribing rates above 20 percent, with five states above 40 percent.

By this past spring, those numbers were even higher, with every state above 40 percent and 28 states exceeding 70 percent of their physicians using EHRs to prescribe. Minnesota, which stood at 100 percent; Iowa, at 95 percent; and Massachusetts, at 94 percent, had the highest rate of physicians e-prescribing as of April 2014.

Beyond the doctor's office, e-prescribing has made even bigger gains in pharmacies – in the same period, the percentage of community pharmacies nationwide wired to accept prescriptions via EHR has reached 96 percent. Maine and Delaware are the top two states, with 99 percent each.

Meanwhile the number of new and renewal prescriptions sent electronically has increased a whopping 14-fold, according to the ONC report. In 2008, just 4 percent of new and renewal prescriptions were sent electronically. By 2013, that number was 57 percent.

Interestingly, the four states with highest volume of prescriptions – California, Texas, New York and Florida – are all below the national average.

This "presents an opportunity to increase the proportion of new and renewals sent electronically among these states," wrote Gabriel and Swain.

Still, it's hard to deny that huge gains have been made in the past decade, due in no small part to federal largesse. The ONC data is just further proof that incentives have worked. In 2013, for instance, a Health Affairs study was published showing that, for the 26-month period before MIPPA, there were 1,437 new electronic prescribers per month, on average, among physician prescribers; after the federal incentives, that number leapt to 6,346 from 2008 to 2010 – a rather-less-than-modest increase of 450 percent. 

"There has been an ongoing debate regarding the efficacy of financial incentives in convincing physicians to move into the digital age, trading in their paper-based systems for electronic health records," wrote Max Sow, vice president of business intelligence at Surescripts, upon the study's release. "Thanks to new research, we can now point toward firm evidence that shows financial 'carrots' make a tremendous difference in bringing 21st century modernization to the doctor's office."

For all this progress, however, there are still limitations when it comes to e-prescribing. Writing in a July 21 guest post on John Halamka's "Geek Doctor" blog, Marvin Harper, MD, chief medical information officer at Boston Children's Hospital, spotlighted what he said was a bothersome gap in current eRx standards.

"Being able to write and route prescriptions electronically provides many advantages over the handwritten paper prescription process that inherently uses families as couriers," he wrote. "Nonetheless the current standards for e-prescribing have created a void that permits limitations in certified vendor software on both the prescribing and pharmacy receiving side."

For instance, he pointed out that "the current limitation for the entire prescription sig line within a prescription to be transmitted electronically is 140 characters. Basically a tweet.  Not close to enough for many prescriptions. As a result we must continue to provide some prescriptions on paper to the patient."

This, coupled with many other easily fixable gaps in rules and processes mean, "our patients are not yet benefiting from the full potential of e-prescribing," he wrote.

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