He gave up the paper pad four years ago and now only writes prescriptions for patients electronically.

While Dr. Richard Smith can’t specifically quantify the results, he knows without any doubt that e-prescribing has generated efficiencies in his medical practice.

“As you accept it in your practice, it’s a phenomenal tool,” said Smith, an obstetrician with the Henry Ford Medical Group and president of the Michigan State Medical Society. Smith, who’s been in practice for nearly 30 years, is among a growing number of physicians in Michigan and nationwide who now use e-prescribing, as health care rushes to catch up with other industries in the use of information technology. A June report shows Michigan is one of the leading states in e-prescribing rates, ranking third behind Rhode Island and Massachusetts. It moved up from fifth in 2007 and three spots from two years earlier.

In 2008, doctors in Michigan ordered 9.03 percent of all prescriptions electronically – 4.2 million new prescriptions and more than 603,000 refills – more than twice that of 2007 and more than quadruple the 2006 rate, according to Surescripts, a national provider of electronic access to health information that issues the annual Safe-Rx Awards to the top 10 states. The use of e-prescribing in other leading states has grown by similar rates since 2007. The rate in Massachusetts, for instance, grew to 20.5 percent in 2008 from 13.43 percent the year before and 8.80 percent in 2006.

Advocates of e-prescribing suspect Michigan’s 2009 rate is now in the mid-teens and say it will continue to rise rapidly. “We’re on a continuum right now,” Smith said. “We’ll see more and more.” At Grand Rapids-based health plan Priority Health, the e-prescribing rate by participating doctors was 14 percent as of May, up from just 3 percent at the end of 2008, pharmacy administrator Steve Marciniak said. Despite the strong growth in Michigan’s e-prescribing rate the past two years, Health Alliance Plan’s Denice Asbell says advocates need to maintain the push to go much further.

“Nine percent leaves a lot of room for growth and improvement,” said Asbell, project manager of purchasing initiatives at HAP, a unit of Henry Ford Health System.

A 20 percent e-prescribing rate is a “realistic goal” for 2009, Asbell said. “We’ve had a significant number of physicians come on board and start using the technology just since December,” she said. “Physicians are recognizing this is the way the world is going and they have to get on board. Patients are expecting it now.”

Helping to drive the rate higher is a 2 percent incentive payment for 2009 that doctors can receive from the federal Center for Medicare and Medicaid Services for e-prescribing when writing prescriptions for Medicaid and Medicare recipients.

In Michigan, Surescripts credits the February 2005 formation of the Southeast Michigan e-prescribing Initiative, or SEMI, with the growing adoption of e-prescribing technology by physicians. The group consists of representatives from Ford Motor Co., Chrysler and General Motors, Blue Cross Blue Shield of Michigan, Health Alliance Plan, the Henry Ford Medical Group, Medco Health Solutions and CVS Caremark Corp.

E-prescribing advocates cite its ability to improve the operating efficiency of physician practices and reduce potentially dangerous drug interactions in patients.

Since 2005, the use of e-prescribing in Southeast Michigan has generated a 24 percent reduction in the incidence of adverse drug reactions, according to SEMI.

Between 2005 and 2008, some 2.75 million prescriptions for patients were changed or canceled because the electronic network alerted participating doctors to a potential drug-to-drug adverse reaction, according to a SEMI analysis of 9.5 million prescriptions that were ordered electronically.

Doctors changed or canceled another 260,000 prescriptions because a drug allergy warning. A HAP survey of physicians found 77 percent agree that e-prescribing improves patient safety. Physicians also cited a reduction in staff time for handling prescription renewals, reduced pharmacy call backs and faster patient transactions at the pharmacy. The 500,000-member HAP estimates the collective administrative savings for Henry Ford Medical Group physicians at $560,000 annually. Another $540,00 a year is saved by reduced ER visits and hospital admissions resulting from prevented adverse reactions.

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Complete use of e-prescribing systems with formulary decision support could reduce prescription drug spending by up to $3.9 million per 100,000 patients per year, according to the authors.

Many employer health plans already rely on lists of prescription drugs known as formularies. Under these arrangements, patients are often charged the lowest co-payment for generic medications.

Researchers at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston compared changes in prescriptions written in three formulary tiers before and after e-prescribing systems were launched. The study examined data from two Massachusetts health insurers.

Doctors using e-prescribing with formulary decision support increased generic prescriptions by 3.3 percent, the authors found. The study is in the Dec. 8, 2008, Archives of Internal Medicine.

By Rita Zeidner, senior writer for HR Magazine.

3.3% Increase in prescription of generic drugs when using an e-prescription system with formulary decision support.

COPYRIGHT 2009 Society for Human Resource Management

COPYRIGHT 2009 Gale, Cengage Learning

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