Free ePrescribing S/W Initiative Stirs Interest & Debate

This article includes corrections to last week's version

Will the recent offer of free electronic prescribing software and service to all U.S. physicians and others authorized to write prescriptions shake up healthcare the way the plan's backers expect? Early indications seem positive, though some key questions linger.

"A rising tide lifts all boats," says Rick Spurr, chief executive of Dallas-based e-prescribing vendor ZixCorp, a major competitor of Allscripts, the company at the center of the National E-Prescribing Patient Safety Initiative (NEPSI).

Allscripts and a nationwide coalition of technology firms, health insurers, and large physician groups announced Jan. 16 that they would spend at least $100 million over the next five years to make e-prescribing services freely available as a means of preventing medication errors and moving physicians toward electronic health records. (See Allscripts-backed Group Promises Free E-Prescribing S/W.) Healthcare providers should be able to download and start using the Allscripts eRxNOW software by Wednesday, NEPSI participants say.

"We're very happy about this," Spurr said shortly after hearing the news. "It brings attention to a problem needing a solution."

Thomas E. Sullivan, M.D., a Danvers, Mass., cardiologist who serves part-time as chief strategic officer of e-prescribing vendor DrFirst (Rockville, Md.), offered a similar sentiment, but cautioned, "The devil's in the details, and we haven't heard all the details yet."

Sullivan noted that the NEPSI coalition includes Microsoft, Cisco Systems, and SureScripts, in addition to Allscripts. All  participated in an ill-fated 2004 alliance called Café Rx. Another member of that group was NDCHealth, which was sold in part to Wolters Kluwer Health, a NEPSI sponsor. (See NDCHealth to be Sold and Split Up.)

"[Café Rx] really was a marketing effort in disguise," says Sullivan. "The thing that's different now is that Google is involved." And that worries some people.

Mountain View, Calif.-based Google is providing a custom search engine for eRxNOW users. "Google has a search bar that will be on the NEPSI project," Allscripts CEO Glen Tullman says.

Google's business model primarily is based on targeted advertising. "That's the antithesis of what we want in e-prescribing," says Sullivan, who also is co-chair of the Physicians' EHR Coalition and a past president of the Massachusetts Medical Association.

Tullman is clear that neither Google nor anyone else will mine data collected as part of the eRxNOW program and use the results for marketing purposes. "Patients and physicians will have unique access to all the information," the Allscripts chief says. "It's not our data. We don't claim it's our data."

Tullman adds, "Google will have no access to data we receive as part of the electronic prescribing process."

Another major difference between eRxNow and Café Rx is that the new program is sponsored in part by payers, namely Aetna, WellPoint, and Horizon Blue Cross Blue Shield of New Jersey, and includes 12 large physician practices as "regional supporters." 

Other questions raised about the e-prescribing program focus on accessibility of patient demographics and drug formularies. Notably absent from the list of NEPSI sponsors and supporters was RxHub, a joint venture of major pharmacy-benefit management companies that provides real-time electronic connectivity to patient-specific formulary and drug-benefit information.

"Demographic data has to be there," ZixCorp's Spurr says. The same goes with basic patient information from practice management systems. "The doctor won't type in the patient's name. A prescription pad is much faster."

Tullman acknowledges that many users would have to find a third party to link the prescribing software to existing practice management and billing systems, but says that eRxNOW follows established standards to make the link. "We're happy to interface with any practice management system."

Tullman also addressed the formulary question by saying that Allscripts has access to eligibility and preferred-drug lists of more than 95 percent of insured patients nationwide via SureScripts and through the company's own business relationship with RxHub and others. He said that Allscripts was having discussions with RxHub and with practice management vendor Per-Se Technologies — now a part of McKesson due to an acquisition that closed last week — to find ways to pre-populate eRxNOW.
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