When it comes to estimating the number of physicians using an electronic prescribing tool, the percentages fluctuate based on variables like geographic location and size of the medical practice. But one thing the percentages have in common is that they're small.
When it comes to estimating the number of physicians using an electronic prescribing tool, the percentages fluctuate based on variables like geographic location and size of the medical practice. But one thing the percentages have in common is that they’re small.
According to the Center for Information Technology Leadership (CITL), only 5 to 18 percent of doctors are using e-prescribing. However, Kate Berry, senior vice president of market development for Surescripts, says the numbers are moving upward, and quickly.
“We’re up to approximately 25 percent of office-based physicians now,” Berry says. “In 2009 we doubled the number of active physicians who are e-prescribing. We have about 160,000 active physicians who are doing e-prescribing through our network.”
And the drivers of the growth are almost all finance related.
Who’s the driver?
Robert Brenner, MD, MMM, chief medical officer with New Jersey-based Summit Medical Group (SMG), says that a lot of the benefits of e-prescribing are long-term, opportunity benefits, which are difficult to equate to real dollars. However, in 2009, the government began reimbursing physicians 2 percent of their Medicare revenue if they are employing a full-service e-prescribing system.
So in real dollars, says Brenner, whose own practice began e-prescribing about 18 months ago, “the government is absolutely rewarding the level of care that physicians are providing.”
Even before the Medicare incentive program went into effect, many commercial health plans began implementing pay-for-performance or bonus programs that rewarded physicians for meeting certain healthcare criteria—one of which was the adoption of e-prescribing.
In addition, says Berry, there are quite a few multi-stakeholder collaborates across more than 30 states that have been put in place specifically to encourage providers to begin e-prescribing by offering them the tools and resources to implement the technology.
Those last two elements, says Berry, perhaps even more so than financial incentives, are critical to getting physicians onboard with e-prescribing. “You need education resources to help physicians figure out how to get started and how to select the right technology,” she explains. “And you need what I call implementation assistance; resources that are available to help physicians figure out how to modify their workflow, and deploy the technology in such a way that they fully utilize it, and therefore get the full benefit from it.”
Berry says that one of the benefits of e-prescribing is the ability to automate the prescription renewal process. She explains that the Medical Group Management Association has conducted time and motion studies, and conservatively predicts that automating prescription renewals equates to approximately $15,000 per physician per year in terms of the cost of time saved.
“It’s not like you get that money back,” Berry says, “but there’s definitely improved morale.” And then some.
Brenner recalls when SMG began using an electronic health record and e-prescribing through Allscripts. The patients, he said, were initially baffled. “They asked, ‘Where’s my prescription?’ I said that it’s already at your pharmacy. ‘What do you mean it’s already there?’ they asked. ‘How did it get there?’ I told them we sent it electronically. And when they came back [for their next office visit] they said ‘Wow, my prescription was ready [when I got to the pharmacy]. This is the best thing.’ So, it’s a real crowd pleaser. And it’s expedient.”
It also reduces prescription error and, according to Brenner, provides physicians with a view of the bigger picture. “If I’m looking at global care of the 55,000 encounters we have each month, or the 300,000 patients we care for, I can query our database for everyone with diabetes,” he explains. “Are they on the appropriate medicines? So, [e-prescribing] really gives you great power to look at things in a global way in helping you integrate care, and understand how you’re doing as a group.”
Time to change?
Any time there’s change, there are going to be those within a medical practice who welcome it, and those who are resistant. Brenner says that SMG had a few physicians, mostly those who had been in practice longer, who were reluctant to make the switch to e-prescribing. But, he adds, they all wound up changing.
“It’s like any change to something new. It takes time, effort and education. But it didn’t take us more than six months to get completely upramped.”
And the good news for smaller practices, says Berry, is that the American Recovery and Reinvestment Act is going to make funds available that can assist with the implementation of e-prescribing.
“Small practices struggle because they don’t have the financial resources or the IT staff to help them [implement a full-blown electronic medical record]. Ultimately, they’re going to have to move beyond e-prescribing toward meaningful use to be eligible for the incentive money. But [standalone] e-prescribing is a very good place to start.”