Health information technology, including e-prescribing, is “truly on the national marquee,” according to Carolyn M. Clancy, MD, director of the Agency for Healthcare Research and Technology (AHRQ). Speaking at the Annual Conference of the Healthcare Information and Management Systems Society earlier this year, she said, “Americans are quickly coming to understand how much we have to gain from health information technology (HIT). And one thing about Americans—we don’t like to wait.”
Clancy and other government officials have been pushing for widespread implementation and use of e-prescribing and other HIT in hospitals and other care settings. In 2003 the Medicare Modernization Act included a provision offering grants to physicians who implement e-prescribing systems. While all of the talk and action have stopped short of mandating the use of this technology, the handwriting is clearly on the wall. Like it or not, e-prescribing is part of healthcare’s future.
Yet despite all of these efforts on behalf of HIT few physicians are jumping on the e-prescribing bandwagon. Current estimates show that only between 5% and 18% of physicians and other clinicians use e-prescribing.
Nonetheless, while few physicians use these systems, they clearly see their value. In one survey, 78% of physicians say they believe that within the next seven years e-prescribing will account for more than half of the prescriptions written; and 75% cited reduced medication errors and time savings as two benefits of this technology.1 Another survey showed that while only 5% of physicians say they use their handheld computers for prescribing, 100% say that they use their PDAs for drug information.2
Despite the technology’s benefits, there are many reasons hospitalists and other physicians have resisted the call of e-prescribing. However, it behooves these practitioners to know about e-prescribing, consider how they might implement various technologies in their prescribing practices, and become involved in HIT initiatives at their facilities.
Money Matters: Costs Can Keep Hospitalists from E-Prescribing
E-prescribing is not widespread among hospitalists and other physicians, suggests Philip Strong, MD, IT physician liaison at El Camino Hospital and a hospitalist with the El Camino Medical Center in Mountain View, Calif.
Mark Zielzinski, chief information officer at El Camino, says that e-prescribing doesn’t really fit well with what hospitalists do.
E-prescribing is “wonderful in the physician’s office,” he explains. This is because the community-based physician writes many prescriptions every day and needs to communicate prescription information to a wide array of facilities and pharmacies.
“Hospitalists write far fewer prescriptions than attending physicians,” says Ronald Newman, MD, medical director of the hospitalist program at Beverly Hospital in Beverly, Mass. “I don’t write more than five a day.” An e-prescribing system simply isn’t practical for him.
Dr. Strong suggests, however, that the lack of enthusiasm for e-prescribing has more “to do with dollars. Systems are fairly expensive,” he says because a good system could cost as much as $150,000.
Why so much? “For a system to make sense and create more work for hospitalists, it has to interface with whatever system a hospital is using for pharmacies in the area,” explains Dr. Strong. And this can be expensive.
The cost for an individual physician or a small practice to implement e-prescribing seems much more reasonable. However, Dr. Zielzinski says that this represents only about 20% of the total cost of new technology.