Health information technology, and in particular electronic prescribing (e-prescribing), is becoming a major player in any attempt to transform the US healthcare system. A lot of effort is being devoted to e-prescribing today, eliciting greater collaboration among stakeholders and charting new directions in healthcare.
This past July, Congress overrode a presidential veto, passing the Medicare Improvements for Patient and Provider Act of 2008 (H.R. 6331). In addition to reversing Medicare pay reductions to physicians, this act strengthens the Centers for Medicare and Medicaid Services (CMS) initiative (issued in April) for the implementation of e-prescribing standards, which aimed at reducing medication errors.1 CMS's eprescribing initiative, originally intended to be launched on April 1, 2009, has now been enacted into law by Congress, instructing all Medicare prescribers to adopt this technology by 2011. To sweeten the deal, the new act authorizes Medicare to offer—for the first time—incentives for physicians between January 1, 2009, and 2011:
- Medicare reimbursement to those using e-prescribing will increase by 2% in 2009 and 2010; by 1% in 2011 and 2012; and by 0.5% in 2013.
- Those who do not adopt e-prescribing will have their reimbursement reduced by 1% in 2011 and by up to 2% in 2013 and thereafter.
In parallel, collaborative efforts in the private sector have led to the launch of the National ePrescribing Patient Safety Initiative (NEPSI) in 2007, reflecting the desire of all healthcare stakeholders to address the problem of preventable medication errors, which was first put on the national stage with the Institute of Medicine's 1999 famous report, To Err is Human: Building a Safer Health System.2 Responding to the formation of NEPSI, former CMS Administrator Mark B. McClellan, MD, PhD, observed, "NEPSI is the kind of collaboration...that can make such a difference in our healthcare system. We all know where we need to go. We know we're going to get to a healthcare system that relies on electronic information and that is much more effective in providing timely and appropriate care. But getting from here to there is... a big challenge."3
Major obstacles to adopting e-prescribing are obviously cost and technical issues. NEPSI was established with the goal of removing these barriers and is the only national organization that offers free e-prescribing software to all those who are licensed to prescribe and dispense medications in the United States. NEPSI offers access to free e-prescribing services via their website (www.natinalerx.com). NEPSI's goal, as stated on their website, "is to increase patient safety by making ePrescribing accessible—and desirable—to all physicians and medication prescribers by providing it free of charge."3 The service is offered by the e-prescribing provider Allscripts in collaboration with eRx Network, a retail pharmacy provider of electronic services.4
On August 21, 2008, the Texas Medical Association became the first state medical association to join "Get Connected"—another program that helps to implement e-prescribing, which is suppored by many national organizations, including the American Academy of Family Physicians.
SureScripts, which operates the national Pharmacy Health Information Exchange, reports that 35 million prescriptions were transmitted electronically in 2007.5 It estimates that this number will exceed 100 million in 2008.5 Given that this estimate predates the new Medicare policies, it is likely that the number of e-prescriptions will grow exponentially in 2009 and beyond.
- Centers for Medicare and Medicaid Services. Medicare Information for Pharmacists. April 2, 2008. http://www.cms.hhs.gov/pharmacy/downloads/update040208.pdf. Accessed August 29, 2008.
- Institute of Medicine. To Err is Human: Building a Safer Health System. 1999. www.iom.edu/CMS/8089/5575.aspx?. Accessed August 29, 2008.
- National ePrescribing Patients Safety Initiative. www.natinalerx.com. Accessed August 29, 2008.
- eRx Network Joins National ePrescribing Patient Safety Initiative as Connectivity Partner. www.nationalerx.com/media.htm. Accessed August 29, 2008.
- SureScripts. National Progress Report on E-Prescribing. December 2007. http://www.surescripts.com/pdf/National-Progress-Report-on-EPrescribing-1.pdf. Accessed August 29, 2008.