E-prescribing: The rewards and risks

January 4, 2008

Going online with pharmacies can save you time and improve patient care, but liability issues may increase.

Key Points

Electronic prescribing has been slow to catch on, partly because many physicians don't see value in it. Today, only about 20 percent of doctors use either stand-alone e-prescribing programs or e-Rx modules in electronic health record systems. And until recently, most e-prescribing physicians either computer-faxed their prescriptions to drugstores or printed them out for patients.

But with the development of nationwide connectivity between pharmacies and doctors' offices, more physicians are starting to transmit their prescriptions to pharmacies online, say e-prescribing and EHR vendors. This two-way communication link allows physician offices to handle renewals electronically. Soon, the technology will facilitate several other transactions that could improve office efficiency and the quality of care. These benefits may make e-prescribing more appealing to doctors.

Whether you're planning to acquire an e-prescribing or an EHR system, or you're sitting on the sidelines, these new possibilities will change some important aspects of patient care. So it's important to know how the new technology works and what it offers, both pro and con.

National pharmacy network is a reality, but still has holes

Physicians can send scripts to drugstores via an electronic network operated by SureScripts, which was formed by the trade associations of the chain and independent pharmacies. About two-thirds of pharmacies can now accept your prescriptions online, including most of the chain outlets.

"The big gap is still on the independent side," says Cameron Deemer, president of DrFirst, a stand-alone e-prescribing vendor. "Independent pharmacies still aren't participating to the extent we need them to yet. But the pharmacy chains are aboard in a big way."

Independent drugstores remain prevalent in many rural areas. But the chains hold sway in metropolitan areas. So in some cities and suburbs, 80 to 90 percent of the pharmacies are online with SureScripts, says Kevin Hutchinson, the company's CEO and president.

Even in pharmacies that have connectivity, however, not all druggists are aware of it or understand how it works. That can create problems for physicians who send scripts online, notes internist Sarah Corley, chief medical officer of NextGen, which makes EHR and practice management systems.

"We get some pushback from physicians if they're in an area where they get a lot of callbacks when they've sent something electronically and the pharmacist tells their patients, 'Your doctor didn't send it,' because the pharmacist didn't look in the right place," she says. "That becomes frustrating, and then we have to try to work with the pharmacies in the area to make sure that they know what they're supposed to be doing."

Rick Spurr, CEO of ZixCorp, which offers an e-prescribing service, agrees. "The extent to which pharmacies have gone beyond connectivity to full training, changing workflow, and checking in the right places varies. But we're still early in this process."

There are still shortcomings on the vendor side, as well. SureScripts has tested and certified more than 60 e-prescribing programs for their ability to exchange information online between physician offices and pharmacies. However, most of the 150,000 physicians who have these programs are still using older versions of their vendor's software-versions without electronic connections to pharmacies. As a result, SureScripts says, these doctors' offices often still send new prescriptions and renewals by fax.

The vendors who participated in the roundtable discussion are trying to address this deficiency. All of them are making online connectivity with pharmacies available to new customers and have also upgraded or begun to upgrade their established customers' systems.