Washington, DC — Let’s just start with the big number: the percent of physicians e-prescribing through an EHR increased from 7% in 2008 to 70% in 2014 (representing ~60% of all new and renewal prescription volume).
That’s a 900% increase in the number of physicians sending prescriptions to brick-and-mortar and mail-order pharmacies around the country. A major shift in behavior in just five years.
There are three big motivators behind the shift and three potential challenges for brands and patients alike created by it. Let’s take a look at both sides:
Motivators behind the shift:
- Meaningful use: As part of the big Medicare and Medicaid Electronic Health Care Record (EHR) Incentive Program designed to help practices and hospitals adopt EHR, three phases of requirements for “meaningful use” of those systems were established. The first includes a requirement that more than 40% of prescriptions be “written” that way.
- Fewer errors: No surprise – type is much less open to interpretation than the average doctor’s handwritten scrawl. Those handwriting interpretation errors were estimated to cause 9% of all medication errors before the e-prescribing systems really took off.
- Less time: The average primary care doctors writes 30 time-consuming new prescriptions per day and nearly the same number of refills. Doing all that work by hand – and handling calls from pharmacies, replacing lost prescriptions, etc. – takes a lot of time. E-prescribing reduces that time burden on both doctor and staff.
New challenges for brands and patients:
- Playing favorites: EHR makes it easy for doctors to write their favorite prescriptions by creating a favorites list. Once the list is populated, a doctor can simply call up her preferred drug and dose from a drop down list and the required information will be filled in automatically. That repeated behavior makes getting a new drug into the consideration set very challenging.
- Leaving empty handed: We know there’s a huge drop-off (see second chart in this post) between the number of patients who receive a prescription and those who actually pick it up at the pharmacy. This challenge is made even worse when they don’t have a physical prescription to remind them. Many systems are making it possible for brands or insurers to prompt EHRs to automatically print patient materials. Both because educational information delivered with the prescription has been repeatedly proven to increase adherence to therapy and because the reminder matters.
- Translating advice: The quick and often automatic notes doctors add to ePrescriptions often do not give a patient all the information he may need. In one study, nearly half of pharmacies reported that patient instructions typically had to be rewritten for patients to understand them. That’s not all those pharmacists were editing. “Many had to edit certain prescription information, such as drug name, dosage and quantity. One common cause reported by both physicians and pharmacists was that physicians must select medications with more specificity when e-prescribing and make decisions about such factors as packaging and drug form. Such decisions had typically been made by pharmacists for handwritten prescriptions.”
Surescripts and the National Coordinator for Health Information Technology, Office of Planning, Evaluation, and Analysis, 2014
Alan A. Zuckerman, MD, is in the Department of Pediatrics at Georgetown University Hospital in Washington, and Michael Martin, MD, is in the Department of Pediatrics at Inova Fairfax Hospital for Children in Falls Church, Virginia.
AHRQ, “Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies,” 2011