Managed Care - February 2008 - (Page 42) Why Is It So Tough to Deliver On E-Prescribing’s Promise? The push to mandate this electronic tool is increasing in intensity, but dealing with costs and coming up with standards remain obstacles By Martin Sipkoff Contributing Editor lectronic prescribing is the holy grail of medication safety. “Its two-fold potential is very significant,” says J. Lyle Bootman, PhD, dean of the College of Pharmacy at the University of Arizona–Tucson, and a leading proponent of e-prescribing. “It improves patient safety, there is no question, and it reduces overall health care costs. Technical and financial questions remain about its implementation, but its value is not in question.” Bootman chaired an Institute of Medicine committee that produced a report in 2006 titled Preventing Medication Errors. “We recommended electronic prescribing as a method for lowering the rate of medication errors,” he says, “while recognizing that significant implementation problems do exist.” Electronic prescriptions only accounted for 2 percent of the nation’s roughly 1.5 billion prescriptions in 2007, according to SureScripts, the operator of an e-prescription network that connects doctors’ offices to pharmacies. The conventional wisdom about eprescribing is that the big holdup is doctor buy-in, both literally and figuratively. Electronic prescription software can cost a clinician up to $25,000, according to the American Medical Association. The AMA, while supporting the idea of e-prescribing, vehemently opposes any mandates. Its officials point to the fact that more than half of physician practices have five physicians or less. “Without the ability to opt out or the financial support to make the transformation, many physician practices would face a great burden under an e-prescribing mandate,” said AMA Executive Vice President and CEO Michael D. Maves, MD, in a recent public statement. “The costs for small practices of e-prescribing technology, training, and upgrades are significant.” E Inexorable forces What it really comes down to is that “doctors don’t like to be told what to do,” says Bootman, a member of MANAGED CARE’s Editorial Advisory Board. “But it may soon move beyond choice.” For example, BlueCross BlueShield of Massachusetts and BlueCross BlueShield of Tennessee DENNIS HARMS/© IMAGES.COM/CORBIS have been running successful e-prescribing pilot projects, and have announced support for the proposed Medicare mandate. “We’ve learned a lot,” says Steve Fox, vice president for provider network management at BCBSMA. “We can use lessons learned as a blueprint to a wider deployment within the provider network.” The American Health Information Community (AHIC), a federal advisory body chartered in 2005, makes recommendations to the secretary of health and human services on how to accelerate the adoption of health information technology. The group has suggested that the secretary seek authorization 42 MANAGED CARE / FEBRUARY 2008
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