E-prescribing systems not so pharma friendly

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EHR use up 10%, as small practices tame data crunch
EHR use up 10%, as small practices tame data crunch

A wave of physicians is exchanging prescriptions and other clinical information electronically, either through an EHR or other practice-based system. Pharma, traditionally slow when it comes to technology adoption, has still largely found itself on the sidelines. But with these same systems throwing up barriers to use of pharmaceutical products, a new study suggests, companies have reason to hasten their involvement.

E-Prescribing has experienced significant growth over the past several years. A June 2012 study by researchers with the Office of the National Coordinator of Health Information Technology (ONC) found 48% of US physicians were e-prescribing using an EHR on the Surescripts network, compared to 7% of US physicians in 2008.

The same study also showed that the vast majority of community pharmacies are set up to accept e-prescriptions, and that the volume of prescriptions sent electronically rose ten-fold between 2008 and 2012. 

These systems have potential to do more than just reduce errors, as it was initially envisioned back in 2000 when the Institute of Medicine issued its landmark report, “To Err is Human: Building a Safer Health Care System.” They may also actually improve patient care: A recent Surescripts study, cited by the consulting firm SciMedica Group MR&C, showed a 10% increase in patient adherence (i.e., new prescriptions that were picked up by the patient) among e-prescribing physicians vs. non-e-prescribing physicians.

However, researchers say, several limitations with current e-prescribing systems may complicate their continued expansion. While often advertised or expected, formulary information, including prior authorization, co-pays and other "utilization management" requirements, are frequently unavailable in current systems, said physicians who responded to a survey by SciMedica. 

Fewer than half (47.5%) of the 200 PCPs polled said they have access to formulary information when e-prescribing, and fewer than a third said they have access to prior authorization (31.0%) or co-pay (29.5%) information. Among physicians with formulary information access, that information was available 61.1% of the time and was said to be accurate 68.6% of the time.

Physicians with an EMR (54.1%) were more likely to have access to formulary information than physicians without an EMR (29.6%). And differences were seen depending on the EHR vendor: Allscripts physicians (32.2%) were less likely to have access to this information than “All Other” software suppliers (60.5%), Epic physicians (62.5%) and eClinicalWorks (68.8%). 

Other factors cited as limiting to e-prescribing include the inability to e-prescribe controlled substances, technical difficulties transmitting e-prescriptions to pharmacies, and problems caused by missing or inaccurate patient information.

These limitations have significant implications for the pharmaceutical industry, said Eric John, SVP, SciMedica Group MR&C. "If the formulary status of a drug is unavailable or inaccurate, physicians are more likely to prescribe a generic so the prescription isn't rejected at the pharmacy," said John in a statement. "As an alternative, they'll generate most of their prescriptions from a limited 'favorites' list that contains products they know won't encounter barriers. Both of these practices deter brand use." 

Thus, patients with “good” coverage for a company's branded medication may never realize that benefit because the e-prescribing system deters the benefit from being fulfilled, SciMedica explained.

Asked how pharma could help improve e-prescribing, more than a third of surveyed physicians in its survey said the industry should not be involved. Nearly half, however, said pharma should partner with e-prescribing software providers to ensure the accuracy of information within their systems. 

About a third (34.5%) of doctors said pharma should provide grants or loans to install e-prescribing systems, SciMedica added.

"Because of pharma's vested interest in the performance of e-prescribing systems, it's vital for companies to create a role for themselves in improving access and accuracy issues," noted John.

A majority (72%+) of the PCPs, who were surveyed through Tele-Web interviews, indicated that many types of medications are apt to be e-prescribed, including 86% generic and 79.5% brand. Seventy-eight percent said they e-prescribed for new or first-time Rx's, 85.5% for refills. 

The exception was controlled substances, which only 24% of physicians said they could e-prescribe. And Physicians with an EHR were more likely to e-prescribe generic, branded, first-time, non-chronic and controlled substances prescriptions than physicians without an EMR.

That generally jibes with another study by ONC researchers, using data from a 2011 survey of doctors, that showed adoption of an EHR was the single strongest predictor for “electronic exchange capability,” including  e-prescribing, with 55% of all doctors having e-Rx capability vs. 78% with an EHR. 

A majority of physicians polled by SciMedica said they expect e-Rx growth to continue for the next year at least (doubling from 39% of e-Rxs to 60%).

Indeed, added Ted Felix, president of SciMedica Group MR&C, "With implementation of the Affordable Care Act and Medicare imposing a higher penalty on physicians who fail to transmit a target number of e-prescriptions annually, e-prescribing is poised to expand rapidly.” He added, “This is the time to solve the problems.

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