Many physicians report barriers to benefits of e-prescribing

The benefits of e-prescribing to patient care are often touted, but the reality is that physician practices often find some features cumbersome and unreliable, according to a new study from the Center for Studying Health System Change (HSC) in Washington, DC1.

Researchers looked at 24 physician practices using e-prescribing systems, focusing on the use of features that allow access to external patient-related information that could improve prescribing decisions.

"Adoption of e-prescribing and specific e-prescribing features has generally been low among physicians," says Joy M. Grossman, PhD, lead author of the study and a senior researcher at HSC.

While physicians have been able to use their computers to generate prescriptions for some time, says Dr. Grossman, they can't always access information from outside sources to help them at the point of prescribing. "We decided to look at this more closely," she says.

Even if physicians are using e-prescribing systems to send prescriptions, not all of them have access to the patient's medication history or the formulary, says Dr. Grossman. "In some cases, the systems didn't offer it," she says. "In other cases, they didn't implement it."

While most of the 24 practices reported that physicians had access to formulary information, only about half reported that physicians had access to patient medication histories, according to the study.

Researchers found that among practices with access to the information, the tools to view and import data into patient systems were sometimes cumbersome to use, and data weren't always seen as useful enough for physicians to spend extra time reviewing it.

Even when physicians do use e-prescribing, says Dr. Grossman, they often don't use all the available features because they're unaware of them, or because they're too difficult to use.

"With more interest in e-prescribing because of the federal incentives, this is particularly timely," adds Dr. Grossman. The "meaningful use" requirements for electronic health record use by providers to qualify for incentives are focused on using the system to send prescriptions electronically, she explains.

While the requirements around use of third party data are less stringent during the first stage of the program, adds Dr. Grossman, they may increase over the three stages of the program.

Even when physicians have access to the features, data weren't always available for a given patient, adds Dr. Grossman, and in some cases physicians considered the data to be outdated, inaccurate, or of limited use. "Often, it was hard for physicians to access that information," she says. "It wasn't readily apparent, and they had to take extra steps to get it."

Physicians weren't always able to act on what they learned, says Dr. Grossman, such as changing the originally prescribed medication to one on the formulary, or importing a medication prescribed by another physician into a patient's medication list.

"Some systems are designed to work with a click or two. If the system was more cumbersome, physicians tended to use the feature less," says Dr. Grossman. "Some feel it's easier to have the pharmacy deal with formulary information."

Potential for cost savings

"Physicians can use the patient's medication history information to reconcile their existing medication list," says Dr. Grossman. Without third-party information coming from adjudicated claims data from participating health insurers and pharmacy benefit managers, she explains, the only information physicians have is what they and their colleagues prescribed, and what the patient tells them.

Formularies also come from participating health insurers and pharmacy benefit managers, adds Dr. Grossman. "Most systems also provide access to information on generic alternatives from third-party medication databases," she says. "Without knowing anything about the patient's insurance information, the physician could pull up less costly alternatives."

Together, all of these things potentially can improve the quality of the prescription decision-making, according to Dr. Grossman. "They can make it more efficient both on the physician practice and the pharmacy end," she says. "This potentially saves the patient money in out-of-pocket costs."

If Medicaid providers are able to access medication formularies and generic alternatives, adds Dr. Grossman, this can save the state money as well.

The more complete the data is, says Dr. Grossman, the more likely physicians are to make use of it. If a particular medication isn't on the formulary, she explains, that information isn't of much use unless the physician is given an alternative.

"It's challenging for doctors to spend time pursing additional information," Dr. Grossman concludes. "The benefit has to be greater than the cost."

Contact Dr. Grossman at (202) 484-3298 or jgrossman@hschange.org.

Reference

1. Grossman, JM, Boukus ER, Cross D, et al. Even when physicians adopt e-prescribing, use of advanced features lags. HSC Research Brief No. 20, Center for Studying Health System Change, Washington D.C. (May 2011).