Providers and payers work to ease into e-prescribing

DOCTORS' handwriting has always been a source of jokes, but it's not so funny when poorly written prescriptions lead to medication errors. Electronic prescriptions have the potential to save lives by negating errors in deciphering prescriptions and alerting physicians to adverse drug interactions before they write a prescription. Preventing Medication Errors, a report from the Institute of Medicine (IOM) released in June says at least 1.5 million people are harmed every year because of medication errors. That may be the nudge the healthcare industry needs to begin widespread adoption of electronic prescribing. In fact, the committee that wrote the report said that by 2008 all healthcare providers should have plans in place to write prescriptions electronically and that all providers should be using e-prescribing systems by 2010.

That's an optimistic timeline, but not an unrealistic one, says Phil Banks, director of Pharmacy at L.A. Care, the largest Medicaid HMO in the country.

"If I could look into a crystal ball, I would think in about two or three years e-prescribing will become a standard," he says. "The key to that is a rebirth of interest in e-prescribing and support for it by payers."

"I think e-prescription adoption will be driven by payers and be payer-sponsored," Banks says. "If we can remove that initial investment barrier, eventually we will move down the road toward physicians using e-prescribing. They're not going to turn back once they implement an electronic system."

Improving patient care was the driving force behind L.A. Care's e-prescribing pilot. As a government entity, the Medicaid plan is not driven by achieving a specific monetary return on its investment. However, it expects there to be some cost savings because of improved efficiency. It also sees less-tangible benefits, such as improving relations with its provider network and making the HMO more attractive to members.

A new pilot program in Idaho has had similar experiences to the one in Los Angeles. Primary Health, an insurance company in Idaho, teamed with the Idaho Physicians Network to implement an e-prescribing pilot program that began in July. The Idaho Physicians Network represents 2,100 doctors across the state. Primary Health picked up more than half of the $2,700 cost per provider to implement the e-prescribing system at a six-physician practice, Capitol City Family Medicine, in Boise.

"This isn't the cheapest or most expensive e-prescribing system out there," says William Jonikan, MD, who is president of the Idaho Physicians Network. "Still, it'll pay for itself in a few months, just in the efficiency of e-prescribing. Of course, if it avoids even one hospitalization due to an adverse drug interaction caused by a pharmacist misinterpreting a physician's handwriting, then it pays for itself right there."

AUTO PILOT

The new pilots in Boise and Los Angeles County already are seeing improved efficiencies, but one in Detroit has 18 months of results under its belt. The nation's three largest automakers, General Motors, Ford Motor Company and DaimlerChrysler Corp., have signed on to the Southeast Michigan E-Prescribing Initiative (SEMI) for an additional year. The program is a group effort among the carmakers, Henry Ford Medical Group, Health Alliance Plan (HAP), Blue Cross Blue Shield of Michigan and pharmacy benefit manager Medco Health Solutions. Since SEMI began in February 2005, more than 1,400 physicians have joined.