Doctors not adopters

Apprehension among physicians about dropping the pen and pad is causing electronic prescribing to develop slowly, despite recently becoming legal nationwide.

The effort to link physicians and pharmacies through technology surpassed a significant milestone last month when Alaska became the final state in the country to legalize electronic prescriptions.

E-prescribing, as it is commonly called, holds the promise of eliminating a large portion of medical errors by replacing handwritten prescriptions with safer, easier-to-understand electronic messages. The Institute of Medicine, a nonprofit medical-advising organization, estimates that technological health care innovations, such as e-prescribing, can prevent about 1.5 million medication errors in the U.S. annually.

But pharmacies find physicians slow to adopt the technology. Michael Kim, the pharmacist and owner of Grubbs Care Pharmacy on Capitol Hill, said he has filled about 300 electronic prescriptions since May.

“It has definitely gotten off to a slow start around here,” said Mr. Kim. “Each week, we track the physicians who sign up to do it. Sometimes, it’s around 20; other weeks, it’s none.”

Grubbs is an independent pharmacy, unlike retail giants like Rite Aid and CVS, which have more money to spend on technology, independent pharmacies are not able to adopt electronic prescribing as quickly. But for Mr. Kim, the advantages outweighed the costs.

“There is no doubt this should have been around a long time ago,” he said. “We still face human errors. Most commonly, the errors come from misreading a doctor’s handwriting, which happens more often that I’d like to mention.”

Although the District just legalized e-prescribing this year, physicians in Maryland and Virginia have been allowed to e-prescribe since its inception.

The movement toward electronic prescriptions started in 2001, when the National Community Pharmacists Association and the National Association of Chain Drug Stores founded SureScripts, the largest network provider of electronic prescribing services.

SureScripts created the Pharmacy Health Information Exchange, which allows physicians and pharmacists to electronically exchange prescription information. In addition to electronically transmitting new prescriptions and refill requests, the Pharmacy Health Information Exchange can be used by physicians to access a patient’s medication history, depending on states’ privacy laws.

In 2004, SureScripts began a campaign to educate pharmacies and physicians about the benefits of e-prescribing. Before its campaign, half the states prevented doctors from transmitting prescriptions electronically.

“There wasn’t any resistance by states, to block e-prescribing,” said Rob Cronin, spokesman for SureScripts. “It’s a new practice and changing pharmacy regulations just took some time.”

Now that governments are out of the way, resistance rests with physicians, according to health care consultants.

“I believe the problem with physicians and e-prescribing is that it is a change in work flow,” said Dr. Mark Fracasso, an obstetrician with Women’s Healthcare Associates of Northern Virginia in Alexandria, who uses electronic prescriptions. “E-prescribing changes the way physicians do prescriptions. They have to use a computer or hand-held device and now have to designate locations. They didn’t have to do that before.”

Mr. Cronin estimates that SureScripts has certified software in more than 95 percent of the nation’s retail pharmacies, meaning they are compatible with the SureScripts network. In the District, Virginia and Maryland, 1,800 pharmacies are connected to the Pharmacy Health Information Exchange network, including Rite-Aid, CVS and Wal-Mart.

But, according to a report by the Gorman Health Group, a health care research company in the District, fewer than 30,000 of the more than 900,000 prescribers in the country use e-prescribing systems.

If the current trend continues, e-prescribing will expand to 7 percent of all prescriptions by 2010, a far cry from the Institute of Medicine’s call for 100 percent, but the Gorman group expects a steady increase.

“With government policies to increase physician adoption, e-prescribing could expand to encompass 64 percent of prescriptions by 2013 and 79 percent of prescriptions by 2017,” says a report released by the group in July.

Dr. Fracasso predicted doctors will do more e-prescribing as part of a larger movement toward electronic medical records.

“E-prescribing is not yet fully appreciated by physicians, but it will latch on as they realize the cost savings with electronic medical records is more than the cost of the technology and time it takes to use it.”