HEALTH IT: Vision For E-Prescribing Outstrips Reality
April 4th, 2007
by
Chris Fleming
|
While physicians who have embraced e-prescribing wouldn’t go back to paper prescriptions, they report major barriers to using advanced e-prescribing features that many advocates believe offer the greatest potential to improve the safety and quality of health care, according to a study (free access through April 16) by Center for Studying Health System Change (HSC) researchers published April 3 as a Web Exclusive in the journal Health Affairs.
“The gap between policymakers’ vision for e-prescribing to improve the safety, quality, and efficiency of care and the reality in physician practices is pretty wide,” said lead author Joy M. Grossman, a senior health researcher at HSC. The HSC work, funded by the Agency for Healthcare Research and Quality, is but the latest reminder that the promise of health information technology (IT) is coupled with serious challenges. Yesterday on this blog, for instance, Jason Lee of the New England Healthcare Institute warned of “building unrealistically high expectations” that IT would quickly solve the health care system’s problems.
And in an interview (subscription required for full-text access) published in February by Health Affairs, David Brailer, the former national health information technology coordinator, predicted that even meeting President Bush’s goal of widespread adoption of electronic health records by 2014 — a major challenge in itself — would not immediately signal a new era of increased productivity for the health system. “We studied other U.S. industries that underwent substantial automation: manufacturing, retail, food preparation, insurance, financial services. It takes about a decade after the substantial majority of the players are automated for full benefit to be gleaned,” Brailer explained. “I think that health care won’t be much different.”
Grossman and her HSC colleagues found that physicians were positive about the basic features of e-prescribing but that products often lacked advanced features; when the advanced features existed, physicians often did not use them because of implementation hurdles or physicians’ perceptions that the features did not add value. Advanced e-prescribing features include the ability to maintain complete patient medication lists; clinical decision-support tools, including alerts and reminders; access to patient-specific formulary data; and capacity for two-way electronic communication between the medical practices and pharmacies and pharmacy benefit managers to send prescriptions, clarifications, and renewal requests.
The HSC article, titled “Physicians’ Experience Using Commercial E-Prescribing Systems,” is based on forty-four discussions conducted between November 2005 and March 2006 with representatives of twenty-six organizations, including fifteen medical practices using e-prescribing, six medical practices without e-prescribing, health plans, e-prescribing vendors, and pharmacies. Two-thirds of the practices used the e-prescribing module of an electronic medical record, while the remainder used stand-alone systems. Most practices had different technology vendors.
Matthew Holt’s The Health Care Blog has some interesting observations on the HSC study. (See “What’s Wrong With eRx?”, April 3)
