25 things to know about e-prescribing

Prescription pads are becoming a thing of the past. Health systems, hospitals, physicians and pharmacies are increasingly getting onboard with electronic prescribing.

Here are 25 things to know about e-prescribing.

The basics

1. E-prescribing is the process of using an electronic device to write, modify, review, send and communicate drug prescriptions, according to the Agency for Healthcare Research and Quality. E-prescribing can occur at various levels of complexity, the final level being integration with an EHR.

2. Nine out of 10 pharmacies in the United States can accept electronic prescriptions. Additionally, 70 percent of physicians are e-prescribing using an EHR, according to the Office of the National Coordinator of Health IT

3. The market for e-prescribing is expected to reach a value of $887.8 million by 2019, according to a Transparency Market Research report. The market is expected to grow at a compound annual growth rate of 23.5 percent. Market drivers include cost savings, improved efficiency and accuracy.

State mandates and adoption

4. By April 2014, more than 40 percent of physicians in all states were e-prescribing with an EHR, according to the ONC.

5. As of April 2014, here is the percentage of physicians e-prescribing, according to the ONC.

81 percent to 100 percent
•    Indiana
•    Kentucky
•    Massachusetts
•    Minnesota
•    Missouri
•    New Hampshire
•    North Carolina
•    North Dakota
•    Oregon
•    South Dakota
•    Vermont
•    Wisconsin

61 percent to 80 percent
•    Alabama
•    Arizona
•    Arkansas
•    Connecticut
•    Delaware
•    Florida
•    Georgia
•    Idaho
•    Illinois
•    Iowa
•    Kansas
•    Louisiana
•    Maine
•    Maryland
•    Michigan
•    Mississippi
•    Montana
•    Nebraska
•    New Mexico
•    Ohio
•    Oklahoma
•    Pennsylvania
•    Rhode Island
•    South Carolina
•    Tennessee
•    Texas
•    Utah
•    Virginia
•    Washington
•    West Virginia
•    Wyoming

41 percent to 60 percent
•    Alaska
•    California
•    Colorado
•    Hawaii
•    Nevada
•    New Jersey
•    New York

6. Minnesota enacted legislation in 2008 mandating providers and pharmacies begin e-prescribing by Jan. 1, 2011. Though the legislation is designed to increase e-prescribing adoption, there are no fines or penalties associated with noncompliance.

7. As of December 2013, 97 percent of chain pharmacies were e-prescribing in Minnesota, and 90 percent of the state's non-chain pharmacies were doing the same.

8. On March 27, New York legislation went into effect requiring all prescriptions to be submitted electronically. Unlike Minnesota's legislation, New York's e-prescribing mandate includes repercussions for noncompliance, which could be civil penalties, criminal penalties or fines. The legislation is the second part of the state's Internet System for Tracking Over Prescribing law, which first went into effect in 2013.

9. E-prescribing adoption varies depending on practice size. The majority of office-based physicians e-prescribing (50.1 percent) practice in groups of one to five physicians, according to the January 2015 Data Brief from Suresripts. Here are three quick state highlights from the report.

•    More than half of e-prescribers (54.9 percent) are in practices with five or less physicians.
•    In Wisconsin, 63.9 percent of e-prescribers are in larger practices.
•    Utah had the highest overall increase in adoption at 10.5 percent.

CMS and e-prescribing

10. E-prescribing was included in the Medicare Modernization Act of 2003. CMS first published standards for e-prescribing in November 2005. https://www.cms.gov/Medicare/E-Health/Eprescribing/index.html?redirect=/Eprescribing/

11. CMS launched an eRx Incentive Program in 2009. The program was designed to encourage eligible providers to adopt e-prescribing. The last year to earn an incentive payment through CMS' eRx Incentive Program was 2013, and 2014 was the last year to incur a payment adjustment through the program.

Meaningful use and e-prescribing

12. Though the CMS eRx Incentive Program ended, electronic prescribing is included as measure in the meaningful use program. Step five to achieving MU Stage 2 requires that "more than 50 percent of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology." In Stage 1 of MU, the measure called for just 40 percent of prescriptions to done electronically.

13. In stage 3 of MU, the threshold for e-prescriptions was bumped up to 80 percent, according to HIMSS.

E-prescribing and controlled substances

14. E-prescribing is seen as a way to decrease drug abuse and fraud. Through this type of system providers can track electronic prescriptions of controlled substances through prescription drug monitoring programs, according to the ONC.

15. New York leads states in the e-prescription of controlled substances, according to Surescripts. In New York, 27 percent of providers can electronically prescribe controlled substances.

16. The second phase of New York's I-STOP law banned paper prescriptions, but the first phase developed an online database detailing all controlled substances prescribed to a patient. Providers must check the database before prescribing a controlled medication to see if there are any concerning trends relating to the prescription of controlled substances. Since the implementation of the legislation, e-prescription adoption in the state jumped. Since March 1, the number of physicians in New York with the capability to electronically prescribe controlled substances jumped 28 percent.

17. In 2015, Vermont became the last state to allow electronic prescribing of all controlled substances.

18. The Drug Enforcement Agency legalized the e-prescribing of Schedule II to Schedule V controlled substances in 2010. Here are the number of pharmacies that accept e-prescriptions of controlled substances in each state, according to DrFirst's interactive E-prescribing of Controlled Substances Status Map.

•    Alabama: 915
•    Alaska: 79
•    Arizona: 970
•    Arkansas: 500
•    California: 4,500
•    Colorado: 707
•    Connecticut: 587
•    Delaware: 184
•    District of Columbia: 108
•    Florida: 3,676
•    Georgia: 1,624
•    Hawaii: 135
•    Idaho: 228
•    Illinois: 1,890
•    Indiana: 1,075
•    Iowa: 554
•    Kansas: 473
•    Kentucky: 726
•    Louisiana: 925
•    Maine: 252
•    Maryland: 946
•    Massachusetts: 1,036
•    Michigan: 2,059
•    Minnesota: 709
•    Mississippi: 522
•    Missouri: 1,375
•    Montana: 124
•    Nebraska: 350
•    Nevada: 377
•    New Hampshire: 236
•    New Jersey: 1,627
•    New Mexico: 240
•    New York: 4,293
•    North Carolina: 1,708
•    North Dakota: 54
•    Ohio: 1,866
•    Oklahoma: 820
•    Oregon: 543
•    Pennsylvania: 2,219
•    Rhode Island: 182
•    South Carolina: 882
•    South Dakota: 105
•    Tennessee: 1,180
•    Texas: 4,212
•    Utah: 321
•    Vermont: 116
•    Virginia: 1,306
•    Washington: 874
•    West Virginia: 402
•    Wisconsin: 823
•    Wyoming: 103

Benefits and barriers

19. A study published in the Online Research Journal: Perspectives in Health Information Management examined the efficiency and accuracy of prescribing in the ambulatory setting. The study found e-prescribing benefits to include:

•    Patient safety. E-prescribing can help eliminate adverse drug events related to medication prescriptions and filling. The study found error rates decreased from 42.5 per 100 prescriptions to 6.6 per 200 prescriptions.
•    Efficiency. E-prescribing takes 20 seconds longer per patient than writing out a prescription, but overall time is saved, according to the study. The process becomes more efficient because prescribers spend less time clarifying issues, such as prior authorization and refill requests, with the patient and pharmacies.
•    Cost savings. The study authors cite a Surescripts analysis that projects $140 billion to $240 billion in cost savings over 10 years. The cost savings would largely be due to increased medication adherence.
•    Medication adherence. The study authors turned again to data from Surescripts, which found a 10 percent increase in patients picking up e-prescriptions compared to written prescriptions.

20. The study found e-prescribing barriers include:

•    Cost. Implementing any new technology requires investment in the system itself and training. The majority of primary care physicians (80 percent) reported lack of financial support as a barrier to adopting e-prescribing, according to the study.
•    System errors. Technology and its users are not infallible. Users can ignore alerts from the e-prescribing system. The system itself can experience hardware or software problems.
•    Legal issues. E-prescribing involves the electronic transmission of data, which presents privacy concerns. Users must ensure patient information is not breached.

Key players and vendors  

21. Surescripts is a health information network partnered with more than 700 EHR applications used by approximately 900,000 healthcare providers and 1,000 hospitals covering 270 million lives. The network conducts more than 6 billion data transactions each year, including more than 1 billion e-prescriptions.

22. Surescripts has partnered with a number of major health IT vendors, such as Epic, GE Healthcare, MEDITECH and NextGen.

23. Last year, Surescripts partnered with Cerner and CVS to push for wider adoption of e-prescribing software.

24. Software solutions company DrFirst was one of the first companies to offer a certified solution to electronically prescribe for controlled substances. The company's EPCS Gold meets all DEA requirements and adheres to Surescript's certification requirements.

25.  Software Advice published reviews of various e-prescribing software types. Here are 10 companies with the most reviews.

HealthFusion MediTouch EHR Software
•    300 reviews
•    83 percent recommend the software

•    273 reviews
•    90 percent recommend the software

PrognoCIS by Bizmatics
•    228 reviews
•    81 percent recommend the software

•    224 reviews
•    84 percent recommend the software

Office Practicum
•    223 reviews
•    86 percent recommend the software

Benchmark Sytems
•    154 reviews
•    93 percent recommend the software

2015 WRS Health
•    123 reviews
•    83 percent recommend the software

•    120 reviews
•    81 percent recommend the software

•    95 reviews
•    78 percent recommend the software

AdvancedMD EHR and Practice Management Software
•    95 reviews
•    74 percent recommend the software


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