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Making the Case for 'E-Prescribing'

By Mary Agnes Carey, CQ HealthBeat Associate Editor

May 9, 2008 -- The benefits of electronic prescribing, which include reducing costs and medication errors, should outweigh concerns about privacy or other hurdles that health care providers face in adopting "e-prescribing," experts said Friday.

A forum sponsored by the Brookings Institution's Engelberg Center for Health Care Reform highlighted the experiences of pharmacists, physicians, insurers, and others who have embraced e-prescribing as the way to improve health care. But panelists also acknowledged that many hurdles remain before the number of health care providers who issue prescriptions electronically will increase, including changing practice patterns, concerns that electronic data sharing systems could be become quickly outdated, and a Drug Enforcement Administration prohibition on prescribing controlled substances.

While widespread adoption of electronic health records is a priority for many lawmakers, health care analysts, and providers, proponents of e-prescribing say it is a simple first step that is already in place and proven to save lives. More than 7,000 people die each year as a result of medication errors, according to the Institute of Medicine.

Between 2 and 3 percent of all prescriptions are issued electronically, and less than 6 percent of physicians use electronic prescribing in their medical practices, panelists said.

But some privacy experts say e-prescribing gives insurers, pharmacies, marketers, and others the ability to aggregate and sell data without patients' knowledge or consent. "Congress thought they found a non-controversial piece of health IT they could pass and not bother anybody," Deborah Peel, founder and chairwoman of the group Patient Privacy Rights, said in an interview Friday. Peel said lawmakers should not permit e-prescribing unless there are strict prohibitions on "data mining."

Panelists at Friday's forum disagreed with that assessment. Steve Findlay, managing editor of Consumer Reports Best Buy Drugs, said e-prescribing is not the "right vehicle for the privacy concerns swirling around health IT" and that opportunity for the abuse of data is "relatively small."

E-prescribing advocates, which include a broad range of consumer, labor, insurers, and business groups, are pushing to get language included in Medicare legislation now being developed by the Senate Finance Committee that would require physicians participating in Medicare to issue prescriptions electronically, a practice that could save the program an estimated $3 billion over the next decade. Secretary of Health and Human Services Michael O. Leavitt has endorsed the idea of requiring e-prescribing in Medicare and earlier this month the Centers for Medicare and Medicaid Services released standards for electronic prescribing in the Medicare drug benefit. In addition, several Senate and House members have supported legislation (S 2408, HR 4296) to require electronic prescribing in Medicare, with payment incentives added to encourage adoption.

Michael Kim, owner of Grubbs Pharmacy on Capitol Hill, told the audience at Brookings that he implemented electronic prescribing last year once the District of Columbia allowed the practice. Since then, he said he has seen a steady, upward trend of about 20 to 30 doctors a week switching from issuing prescriptions on paper to sending them to his pharmacy electronically.

For some in the health care system, "it's probably like going from the typewriter to the computer" to adopt the new technology, but once they do they will not be disappointed, Kim said. "It's really, really a great system," he said, adding that his pharmacy technicians misread fewer prescription orders when they arrive electronically rather than being written by hand. The practice also prevents a patient from altering a prescription and allows physicians and insurers to track which prescriptions a patient filled or, more importantly, did not fill, Kim and other panelists said.

John Rother, group executive officer, policy and strategy for AARP, said consumers are ready to accept e-prescribing, noting an AARP survey that found 92 percent of people 65 and older wished their physician would issue prescriptions electronically. "It's much more convenient, it's safer" and allows both patients and their doctors to know immediately about lower-priced generics, possible drug interactions and what drugs are covered by the insurance company, Rother said.

Steve Stack, a member of the American Medical Association's board of trustees, said the AMA supports e-prescribing because it can improve patient care, increase collaboration between health care providers and reduce administrative costs.

"We want to do this. We are not interested in being a barrier," Stack said, but he added that a national, uniform set of e-prescribing standards, along with a transitional period, are key to speed physician adoption. Lifting a DEA prohibition on electronic prescribing of controlled substances would also encourage more physicians to do e-prescribing, since doctors do not want to have to issue some scripts via paper then do the others electronically.

Kim says he talks to many House and Senate members who come to his pharmacy, but "unfortunately, a lot of them don't understand the issues" around e-prescribing. "Frankly, what would push this thing along is if one of their prescriptions got screwed up," he said.

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