Mark McClellan, head of the Centers for Medicare and Medicaid Services, said CMS will likely require “an initial set of well-established standards” by January 2006, when Medicare begins covering prescription drugs. Although physicians would not be required to use the standards until 2009, McClellan said the move would encourage adoption by making electronic prescribing more attractive.
John Coster, vice president of policy and programs at the National Association of Chain Drug Stores, expressed cautious optimism about the move, saying that CMS would be able to provide additional incentives to physicians to adopt electronic prescribing, but, he said, “we have to make sure we dont push too hard,” and thus alienate physicians. “Weve been preparing our pharmacies for an e-prescribing world,” he said, hinting that other participants are less well-prepared.
He also said theres much work to do in terms of both workflow and technical standards, but he felt CMS appreciated the scope of the task. Other hurdles include finding ways to get physicians the necessary equipment without running afoul of anti-kickback laws and making sure that an electronic prescription system in general is not used for such commercial purposes as encouraging physicians to favor brand-name drugs or to use mail-order prescription programs (thus bypassing retail pharmacies).
Three years ago, the association created a platform, SureScripts, to increase electronic connectivity among physicians, pharmacists and technology vendors. The platform was rolled out earlier this year. According to the association, two-thirds of retail pharmacies have connected their internal applications to the network, as have more than 50,000 physicians. One of the guiding principles behind the system is to “protect patients choice of pharmacy,” a requirement that would also presumably prevent retail pharmacies from being squeezed out by mail-order programs.
Many health experts feel electronic prescribing is key to cutting both costs and errors. The Institute for Safe Medication Practices estimates that indecipherable or unclear prescriptions require more than 150 million calls from pharmacists asking doctors for clarification. However, others worry that electronic prescription could actually increase drug costs if the software steers physicians to more-expensive brand-name drugs. Several software vendors contacted for comment on electronic prescribing did not return phone calls.
CMS believes e-prescribing could prevent prescription errors by automatically screening for drug interactions and allergies, and by eliminating the need to read physicians notoriously sloppy writing.