E-Prescribing: Challenges and Successes

A few years ago I contributed to a white paper to convince insurers to pay for e-prescribing services for physicians. I knew that we succeeded because the technology was adopted in the regions that we targeted. But I was further delighted today when I learned that many of the leading healthcare institutes in the US are using the technology and beginning to understand and quantify the benefits.

AHRQ hosted a webinar today and the Brigham & Women's Hospital presented their findings with regard to safety, efficiency, medical costs and barriers. In short, this is what I took away from those using the technology.

Physicians are acknowledging the potential of the technology but need more data to realize the full value. The data for some specialties such as peditricians who need drugs in smaller doses is more limited than specialties serving adults. I heard a similar need echoed in an earlier presentation given about the AMIE project in Arizona. AMIE is a EHR pilot underway to test a state wide EHR type system using the Medicaid population. Some of the physicians in that pilot also said they saw the potential of the technology but indicated that they needed more information to do their job. Adding more data usually isn't the hard part of an implementation - but in healthcare it is.

The sharing of medical information is part of the challenge both from a regulation and technical perspective. You may have heard the term interoperability. It is a term used to describe the process of sharing and integrating medical data. The goal is to basically make systems and equipment plug and playable with all systems. The comparison that I often hear is Mac vs PC. If you remember years ago when MAC and PC users couldn't share files. Now they can but there are some that still think Apple products work best with other Apple products. It's kind of like that. There hasn't been a standard interface used in the industry until now. Thanks to the larger healthcare systems like Kaiser, more and more vendors are adopting the HL7 standards.

The lack of data may also be contributing to another issue that I found a bit alarming. The warnings for drug interactions, doses etc. are being overridden which basically defeats one of the biggest values of the system. It wasn't clear whether it was a data issue or whether it is attributable to the learning curve. As you know technology is great when it's easy to use and integrates well with your workflow but if tasks take longer they don't use it the way it was intended to be used. It could be a bit of both because the learning curve was mentioned as one of the barriers to adoption.

Lastly, one of the interesting concepts presented was the opportunity for physicians to talk about the cost of drugs with patients. Generics obviously cost less money. When patients that take routine medications for hypertension, diabetes and other chronic conditions are ofterred a lower cost drug they are more likely to take it. Naturally, when patients with chronic conditions take their drugs they stay healthier and need less care. So what's so interesting? Historically, physicians have left money talks to other people in their office so that it didn't affect their patient doctor relationship. Now we are expecting them to be part of the financial solution while delivering care. It might be difficult for some to make that shift. Whether they do it or their staff does it, it seems like something worth figuring out.

So what are our take aways?
1. Get in the loop If you're in the process of purchasing an EHR system, be sure to ask about integration capabilities and which standards they are adopting. You definitely don't want to be left out of the medical information loop!

2. Try before you buy Pilot the system or at least see it in use before you buy it. You will gain a better understanding of whether it will work within your current envirnoment as well as changes that will need to be made.

3. Quantify the benefits If the benefits (in this case, think about the number of times you call the pharmacy to confirm something about a script or provide an authorization) outweigh the costs your staff will support the changes and use the system.

If you're interested, you may be able to see the presentation on the AHRQ website. If not, be sure to sign up for future webinars. They are worth your time.

Check out www.innovations.ahrq.gov/content.aspx?id=2599 for more information about AMIE.