More on E-Rx

Although most pharmacies generally favor e-prescribing, it is not a panacea for everyone. About 70% of the pharmacies in the US are connected to a network and can receive e-prescriptions electronically (most of the remaining 30% can be reached by fax). E-prescribing definitely reduces time spent faxing or calling physicians and it reduces illegible scripts from handwriting which in turns decreases the possibility of errors. Computer interfaces with their in-house computers reduces time and labor spent re-entering prescription information and dispensing errors can be reduced using an electronic system as well as decreasing patient wait times.

But on the down side, pharmacies must pay a transaction fee for each refill request sent out, as well as for each prescription received. This cost is thought to be minimized by the labor savings that an electronic system provides.

Pharmaceutical manufacturers have mixed feelings about e-prescribing. They understand the positive values, but they have expressed concern that e-prescribing could push more prescribers to substitute generic medications for brand name medications. This does happen in my office as well as having a defined list of common drugs that I use regularly which speeds up my process. Choosing alternate or new drugs takes more time in the computer and I therefore am less likely to do so unless there is clear benefit.

Many physicians have been slow to adopt e-prescribing and currently, only about 6% of office-based physicians are e-prescribing. Further, physicians e-prescribe only 2% of the 1.47 billion prescriptions that are eligible for electronic transmission. Reasons cited for this include hardware costs, software costs, and training costs. In addition, it has been said that old habits die hard, and physicians have been reluctant to change their workflows in order to accommodate e-prescribing.

Again, in my office, some of the physicians use it regularly and see the benefits while others like pen and pad. Some believe it is hard for an electronic prescription to beat the convenience of a pen and prescription pad and this is true initially, but once the system is up and running with the common information and drugs being utilized, it is difficult to beat it.

The biggest problem we have remains the current ban on e-prescribing of controlled substances. This is a horrible inconvenience and safety problem and it creates twice as much work for us and the pharmacies. This is a legislative problem that has to be fixed.

A Brown University study suggested that e-prescribing can cut physician time spent on renewals from 35 to 17 minutes per day and staff time spent on renewals from 87 to 43 minutes per day. I would agree that it has saved us both staff and physician time although as stated earlier, initial prescriptions are probably faster with pen and pad.

We have further benefits as our e-prescribing is integrated with our EHR so that the e-prescribing process automatically assists in maintaining an accurate drug list and assists with the medication reconciliation process.

The biggest drawback for physicians is the cost of the software and increasingly, both CMS and other payers are realizing that physicians will need financial incentives to switch to e-prescribing.