Think about the last time you were prescribed a medication. Did your doctor fill out a prescription on a paper pad and instruct you to get the medication filled at your local pharmacy? If not, chances are that he or she electronically routed the prescription to your pharmacy. This process—called electronic prescribing or “e-prescribing”—is helping prescribers and pharmacists make better clinical decisions, improve workflow, reduce costs, and ultimately enhance patient care.

E-prescribing Adoption: Where We Are Today

The nation has witnessed a significant increase in e-prescribing adoption over the last several years. Surescripts, which operates the largest electronic prescribing network in the country, shows data from February 2012 that indicate approximately 401,000 prescribers are on its network. This is an increase in e-prescribing adoption of more than 400 percent since December 2008. Additionally, more than 92 percent  of retail pharmacies are actively e-prescribing, representing a 20 percent point increase from December 2008 (Figure 1).

Figure 1: Active Retail Community Pharmacies on Surescripts Network

E-prescribing adoption has positive outcomes for the quality, safety, and efficiency of health care:

• A 2010 study done by the Weill Cornell Medical College, and supported by the Agency for Health Care Research and Quality, found that physicians make seven times fewer errors when using electronic systems to prescribe than when they are writing prescriptions by hand. [i]
• A 2012 study by Surescripts found that e-prescribing significantly increases the likelihood of first-fill medication adherence (i.e., new prescriptions picked up by the patient) and could lead to $140 to $240 billion in health care savings and improved outcomes over the next 10 years. [ii]

Many factors are responsible for the increase in e-prescribing adoption, including efforts by the public and private sectors to use payment incentives/penalties, stakeholder education, and removal of explicit barriers to enhance adoption of e-prescribing.

State Health Information Exchange: Our Role in Encouraging E-prescribing Adoption

States have enabled and encouraged e-prescribing adoption, using policy levers as well as sponsoring programs. Various state policies and initiatives pre-date the HITECH Act and ONC’s Cooperative Agreement programs, highlighting that—for some states—increasing e-prescribing adoption and use has been a long-time goal.

To date, the State Health Information Exchange (HIE) Cooperative Agreement Program has specifically focused on mobilizing pharmacy participation in e-prescribing. The full benefits of e-prescribing cannot be realized unless pharmacies participate along with prescribers. With this recognition, in the first Program Information Notice to state HIE grantees (released July 2010) [iii], ONC encouraged program grantees to employ various strategies to advance pharmacy e-prescribing adoption.

Though states have and will continue to take multiple approaches to achieve e-prescribing adoption goals, ONC has identified three broad themes emerging from leading states’ e-prescribing efforts:

1) Creating an Environment that Advances e-Prescribing

State policies and regulations have addressed a range of factors relevant to pharmacy adoption of e-prescribing. For instance, Minnesota passed legislation (Statute 62J.497) in 2008 mandating that “all providers, group purchasers, prescribers, and dispensers must establish and maintain an electronic prescription drug program.” Following this mandate, the percent of pharmacies actively e-prescribing in the state increased from 57 percent in 2008 to 90 percent by the end of 2011, according to Minnesota’s data. Additionally, in 2009, North Dakota’s legislature passed Senate Bill 2332, establishing a low-interest loan fund from the Bank of North Dakota to assist health care entities in adopting health information technology and enabling capabilities such as e-prescribing. To date, North Dakota has given out approximately $6 million of the $10 million available and has had nearly a 42 percent increase in active pharmacy adoption from June 2010 to February 2012.

2) Reducing Barriers for Rural and Independent Pharmacy Adoption

Particularly for independent or rural pharmacies, the cost of e-prescribing is often a barrier. Some states have used state appropriations, grants, or revolving loans to help alleviate financial burdens of purchasing software/hardware or paying transaction fees among target groups of pharmacies. For example, Tennessee initiated a partnership with the Tennessee Pharmacists Association to provide up to $675,000 in grants to 124 independent, community pharmacies to offset e-prescribing expenses. As of December 2011, Tennessee reports that 81 (65.3 percent) of the pharmacies targeted by the program are e-prescribing.

3) Setting and Monitoring Goals

States have also leveraged data to assess and monitor their e-prescribing environments, to identify gaps and set goals and priorities for incentive programs and outreach efforts. The Rhode Island Quality Institute’s (RIQI)e-prescribing  efforts include an e-prescribing committee chaired by the state director of health. This committee examined monthly Surescripts data to identify barriers to pharmacy e-prescribing adoption and established actionable, public goals for increasing e-prescribing accessibility and utilization in the state. RIQI attributes its success to consistent outreach to the state’s pharmacy and provider communities. Based on data collected by RIQI, 100 percent of Rhode Island’s retail pharmacies are capable of electronic prescribing as of 2009 and 67.5 percent of the state’s prescribers are currently e-prescribing.

What’s Next?

States continue to break new ground with innovative e-prescribing efforts, including the North Carolina Health Information Exchange’s work to expand an existing “Pharmacy Home” web application to connect it to the statewide exchange. After this expansion, North Carolina’s statewide exchange will be the main aggregator of disparate medication lists, enhancing providers’ ability to reconcile patient medications.

There have been great strides in the adoption of e-prescribing, but our work is not finished. Stay tuned for more updates, and for more detail about state e-prescribing efforts, please visit the State HIE Resources Bright Spots page.

To Learn More

For more information on e-prescribing, health information exchange, and health information technology, visit HealthIT.gov.

We Want to Hear From You

ONC is interested in your feedback. Let us know your thoughts on this blog post by commenting in the section below. Feel free to share a story about how e-prescribing has helped you manage your health or the health of your patients.

[ii] http://www.surescripts.com/news-and-events/press-releases/2012/february/212_eprescribing.aspx

[iii] http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_0_5545_1488_17157_43/http%3B/wci-pubcontent/publish/onc/public_communities/a_e/arra/state_hie_program_portlet/files/state_hie_program_information_notice___final.pdf