The e-Prescribing Evolution: Today's Benefits And Tomorrow's Possibilities

By Lathe Bigler, vice president, Clinical Services at Change Healthcare

Less than a decade ago, only 7 percent of physicians prescribed medications through EHRs. Thanks to regulatory nudges and incentive programs such as 2009’s Health Information Technology for Economic and Clinical Health (HITECH) Act, along with advances in health IT solutions stemming from those movements, like Meaningful Use, that rate jumped to 70 percent in 2014

Today, nearly all U.S. community pharmacies are capable of accepting prescriptions electronically, and some states — New York, Maine, and Minnesota included — even make e-prescribing a requirement in certain situations.

With e-prescribing still on the rise, benefits to patients, workflow efficiency, and cost savings for pharmacies have become more evident. As it continues to grow and evolve, providers and pharmacies will have even more opportunities to enhance safety and improve outcomes by involving patients and leveraging their health information and history at a deeper level.

e-Prescribing Evolution
Initially, e-prescribing was designed to make prescriptions faster and easier, and ultimately to save pharmacies time and money in staff and overhead costs. When filling hundreds of prescriptions daily, managing this process electronically proved useful in streamlining efforts while improving the pharmacy’s operations and bottom line. As these benefits became clearer, pharmacies were quick to adopt this approach. By December 2008, 76 percent of pharmacies were accepting prescriptions electronically.

On the other hand, providers have not been as quick to embrace e-prescribing, likely because it doesn’t enhance their workflow efficiency as it does for pharmacies. Yet incentives, along with valuable quality and decision-support features often built into e-prescribing solutions, have helped accelerate its adoption by physicians.

These features enhance patient safety by helping providers:

• Assess eligibility. Typically, today’s EHRs generate requests to assess a patient’s eligibility for pharmacy and medical benefits 24 hours before a scheduled appointment. E-prescribing technology then evaluates the patient’s record for potential drug interactions, allergies, and other factors that could lead to adverse reactions while determining the patient’s eligibility. Where physicians may have once been prescribing blindly, e-prescribing provides quality decision support at the point of care.
• Prevent formulary errors. Using e-prescribing technology in conjunction with the patient’s EHR, providers are able to consider the payer’s formulary when prescribing medications. Access to this information might specify brand name or generic alternatives, in addition to other criteria, and ensure prescribed medications will be covered.
• Improve legibility. Physicians are notorious for having poor handwriting. But e-prescribing isn’t just about making sure prescriptions are readable. It also helps ensure the drug prescribed by the physician is the correct one filled at the pharmacy and helps prevent associated medication and dosage errors.

Looking ahead, advanced e-prescribing solutions will be able to provide even more robust clinical decision-support at the point of care. For instance, genomics is an emerging method of determining whether a certain medication will be effective at treating individuals based on their genetic codes.

In the future, e-prescribing solutions will most likely include genomics as part of their eligibility assessment. Likewise, these tools will also be able to perform disease risk profiling and identify patients who may be at risk for developing certain conditions.

Leveraging these advanced decision-support tools, physicians will be better informed to make proactive decisions at the point of care, which should reduce costs for patients and promote more favorable outcomes.

Engaging The Consumer As An Essential Constituent
One option worth exploring is using e-prescribing as a way to empower patients as consumers. As most systems operate now, patients must commit to a pharmacy at the time of service when the prescription is written, and that prescription is then sent directly to the indicated pharmacy. Many factors related to this process might be inhibiting patients from filling their prescriptions.

For instance, patients might find that their out-of-pocket costs are too high at the selected pharmacy. Or they might be running errands on the other side of town and find it inconvenient to pick up their prescriptions at the more distant location. In the current process, price transparency is poor, and rerouting a prescription to a different pharmacy can be problematic.

Instead, e-prescribing participants might consider placing the power back into the patient’s hands by electronically sending the prescriptions to them — similar to a paper-based prescription — but via an e-prescribing mobile application, email or other method. This would allow patients more flexibility, not only by being able to “shop” for the best prices but also by choosing the most convenient pharmacies to fill their prescriptions.

Yielding Results
With as many as half of prescriptions not taken as prescribed and nearly 30 percent of new prescription medications going unfilled, the healthcare industry as a whole still has a lot of work to do to identify and address root causes for non-adherence.

Once these gaps in the e-prescribing process are bridged, providers and pharmacies will have even more opportunities to reduce costs while enhancing patient safety and overall outcomes.