As a former pharmacist and a current prescriber, Dr. Autry has the unique opportunity to speak from both sides of the counter regarding electronic prescribing. She remembers holding one phone to each ear, simultaneously on hold with a physician’s office to verify an illegible drug dosage and an insurance company to confirm that an ordered medication was on the formulary plan.

Pharmacists tend to view electronic prescribing as something of a godsend. Less time spent on the phone to clarify vague or illegible prescriptions means more time to counsel patients or work more productively. Eye care practitioners also see the advantages, but a few disadvantages as well.
In keeping with this issue’s focus on technology, we offer a status update on the current trends in electronic prescription writing, better known as e-prescribing.

A Little History
Primitive forms of e-prescribing via computer-aided physician-order entry originally appeared in a handful of hospitals in the late 1970s and early 1980s.² It was the Centers for Medicare and Medicaid Services (CMS), however, that enhanced discussion, interest and participation in e-prescribing by making it a part of the Medicare Modernization Act of 2003.¹

With the shift from inpatient to outpatient care, the Institute of Medicine reports that medication errors are increasing and are already responsible for thousands of deaths yearly in the United States. The advantage of e-prescribing is clear: it decreases medication errors and increases patient safety.^3,4 Because the prescriber has instant access to the patient’s full medication profile, he or she can avoid drug duplication, allergy errors and/or drug interactions at the time of prescribing.

Pharmacists cannot misinterpret the prescription because of illegible handwriting or oral miscommunication, which currently results in about 30% of callbacks.⁴ Lastly, drug strength, dosage, instructions, drug-disease and drug-drug interactions are cross-checked immediately with pharmacy software programs. In addition, e-prescribing can improve office productivity by decreasing patient and pharmacy refill requests and save time for patients by eliminating drop-off and pick-up wait times.

Understanding E-prescribing
There are two main types of e-prescribing systems: stand-alone options and systems that operate in conjunction with an EMR system. Doctors who are not ready to completely switch to EMR can still participate in e-prescribing by registering with the National e-Prescribing Patient Safety Initiative (NEPSI) and participating through various free web-based electronic prescribing vendors such as Allscripts ( www.allscripts.com), Practice Fusion ( www.practicefusion.com/e-Prescribing) or ECP Resources ( www.revoptom.com).

Seventy-seven percent of physicians who e-prescribe use an EMR system that automatically incorporates an eRx program.⁵ An EMR system can essentially render an office paperless, and hard-copy prescriptions are one of the easiest items to dispense with first. Doctors should take heed to verify the EMR program is eRx compliant when investing in a new system.

Given its obvious advantages, e-prescribing is becoming more common. Surescripts, the country’s largest electronic prescribing network company, reports an encouraging 400% increase in adoption since 2008; the data, however, suggests only 36% of all outpatient prescriptions in the U.S. were electronically prescribed in 2011.⁶

Various factors influence those prescribers who choose to avoid or underuse electronic submission: cost of system implementation (when associated with EMR implementation), cumbersome and extraneous data entry and retrieval, impact on current workflow, and incomplete insurance and/or pharmacy information making electronic prescribing time consuming and sometimes inaccurate. It was found that older practitioners, doctors in solo practices and medical/surgical specialty physicians were also less likely to use e-prescribing when compared to younger practitioners, doctors in group or HMO settings and general physicians, respectively.⁶

Improvements in software are helping to ease the transition, however, and even legislation is catching up with prescribing. This year, various electronic vendors have implemented the DEA’s 2010 requirements, which paved the way for controlled substance prescriptions to be transmitted electronically and removed another barrier to the 20% of prescriptions that are for narcotics and other controlled medications.

Government incentives for meaningful use and subsequent penalties for non-use have been instrumental in driving adoption of electronic prescribing. Those who met CMS criteria for successful e-prescribers in the first half of 2012 will receive 100% of their earned Medicare reimbursements for 2013.⁷ Those who did not meet the necessary numbers in the first six months of this year will take a 1.5% hit on their Medicare 2013 payments.

If you have yet to become fluent in the world of e-prescribing, you cannot wait any longer. The requirements to be a 2013 successful prescriber are not final, but expect an increase in the number of required scripts; the resultant 2014 penalty of Medicare reimbursements is 2%.⁷ 

1. E-Prescribing. Centers for Medicare and Medicaid Services. 2012 May 25. Available at: www.cms.gov/Medicare/E-Health/Eprescribing/index.html?redirect=/EPrescribing. Accessed August 2012.
2. Preece JF, Ashford JF, Hunt RG. Writing all prescriptions by computer. J R Coll Gen Pract. 1984 Dec;34(269):655-7.
3. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998 Apr 15;279(15):1200-5.
4. Kaushal R, Kern LM, Barrón Y, et al. Electronic prescribing improves medication safety in community-based office practices. J Gen Intern Med. 2010 Jun;25(6):530-6.
5. Terry K. Choosing the right e-prescribing application. Physicians Practice. 2010 Dec 13. Available at: www.physicianspractice.com/eprescribing/content/article/1462168/1755974?pageNumber=1. Accessed September 2012.
6. Surescripts. The national progress report on e-prescribing and interoperable healthcare: year 2011.2012 May 3. Available at: www.surescripts.com/downloads/national-progress-report-executive-summary.pdf. Accessed August 2012.
7. 2012 Electronic prescribing (eRx) incentive program: future payment adjustments. 2012 Jan. Center for Medicare and Medicaid Services. Available at: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/downloads/2012eRx_FuturePaymentAdjustments_01-30-2012_508_2.pdf. Accessed September 2012.