Executive Q&A: Finding the E-Prescribing Tipping Point

The case for e-prescribing continues to be compelling, says Kevin Hutchinson, president and CEO of the Alexandria, Va.-based SureScripts, operator of the Pharmacy Health Information Exchange, the nation’s largest electronic prescribing network. Not only is e-prescribing proven to help avoid preventable medication errors, Hutchinson says it offers significant time-savings for physicians and pharmacies. Hutchinson is also a board member of the eHealth Initiative and commissioner to the American Health Information Community (AHIC). He spoke with Digital Healthcare & Productivity about the business case for e-prescribing, and the recent acquisition of MedAvant Healthcare Solutions, and AHIC developments.

DHP: Much has been said about the social case for e-prescribing and pharmacy interoperability, but you make a business case that justifies the investment in terms of time and money saved.

Hutchinson: E-prescribing is under-utilized, and purchasing software does not equal adoption or effective use. Many practices believe they are already connected to pharmacies electronically and are unaware they are simply routing prescriptions to the pharmacy’s fax machine.

E-prescribing adoption will not reach a tipping point without establishing a business case for it. The Medical Group Management Association (MGMA) showed that e-prescribing can significantly reduce the $10,000 spent annually per physician on phone calls with pharmacies related to prescription refills. Of that $10,000, if you add in not only the physician’s time that’s being spent on the refill process as well as the entire practice staff -- it actually comes out to $50,000 a year that was spent on refill management. Practices spend on average 4.78 to 4.92 hours a day managing refills. But once e-prescribing is implemented, on average, time spent per day on renewals is cut in half, according to MMA (Medicare Modernization Act) e-prescribing pilots.

DHP: But there have been recent reports that e-prescribing is running into glitches, with practices having problems sending prescriptions. There is also the issue of workflow changes for pharmacies and physicians. It seems that getting the eRx network right will take some tweaking.

Hutchinson: At the time the HSC report was initiated, only a few electronic medical record systems were certified for electronic prescribing (i.e., an EDI connection to a pharmacy). This means most of the doctors in the study could only use their computer to fax or print out new prescriptions. They had no ability to process refill requests electronically. On the pharmacy side, you had just over one-third of U.S. community pharmacies activated for e-prescribing at the time the study began.

Fast forward to today, where every major EMR and standalone e-prescribing system is certified on the Pharmacy Health Information Exchange -- over 60 physician technologies certified. And on the pharmacy side, more than two-thirds (66 percent) of pharmacies are live on the Pharmacy Health Information Exchange, and 95 percent of all pharmacies in the U.S. have certified their systems to connect.

We have been using this report to convey an important message -- that there is an unprecedented opportunity for physicians who have been using EMRs to being e-prescribing for the first time.

The study’s focus on the need for workflow improvements is correct. After focusing on standards and certification for the past few years, workflow is clearly the big focus now both on the physician and pharmacy side. It is where the critical fine tuning needs to occur for users to have the best experience possible.

DHP: Are physicians and pharmacists getting this concept, understanding the benefits?

Hutchinson: The unique thing about the physician community is that benefits are going to vary by doctor. It’s an interesting statistic that 30 percent of the physicians are responsible for writing 80 percent of the prescriptions. So it’s not necessary to get every physician in the U.S. to write prescriptions electronically. While we would love that to happen, and we expect it will over time, the real target market is the 30 percent who write the most volume.

Most major chains are certified to accept an electronic script from the Surescripts network, but only about 20 percent of independent pharmacies have computer systems certified for e-prescribing. These independents are primarily in metropolitan markets where there are physicians using technology on the other end. In rural parts of the country, where physicians are reluctant to adopt the technology, adoption has been slower. But when physicians in the market adopt, independent pharmacies are quick to activate their store.

DHP: SureScripts recently acquired MedAvant, its main competitor. Will this help streamline e-prescribing?

Hutchinson: About half the pharmacies in the U.S. had duplicate connections between SureScripts and MedAvant. This merger will help streamline a single implementation of e-prescribing standards and protocol. It also will be easier to implement services such as compliance messages of when to take medications and prescription drug refills. Expanding this e-prescribing network also could help forge a link between Electronic Health Record (EHR) systems at physicians offices and retail clinics.

DHP: You are a commissioner, appointed by Secretary Leavitt of Health and Human Services, to AHIC. What’s ahead for AHIC at its two-year anniversary?

Hutchinson: We’re in the stage where we just laid the plumbing and are probably just reaching the foundation level. We’ve been focused on lack of interoperability as well as adopting standards. Phase I came out a few months ago and Phase II is coming out soon. So there’s a lot of vendor activity to implement those standards.

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