Growth of e-prescribing intriguing, but far from finished

Surescripts, a company that connects physician offices to pharmacies online, has released electronic prescribing data for 2010 that show a rapid expansion of this key health IT capability. The number of office-based providers who prescribed electronically jumped 50 percent from 156,000 at the end of 2009 to 234,000 at the end of last year. During that same period, the number of electronically routed prescriptions leaped 72 percent, from 191 million to 326 million.

That's impressive growth, and it shows that the government incentive programs for e-prescribing and electronic health records are having an impact. But before we assume that e-prescribing has taken over the world, let's remember that 3.99 billion medications were dispensed in the U.S. last year.

Surescripts' claim that 25 percent of prescriptions were sent online in 2010 is based on a universe of 1.66 billion new prescriptions and renewals that could have been transmitted to pharmacies or mail order firms by office-based providers. That universe doesn't include pharmacy refills that don't require a renewal prescription. It also doesn't encompass controlled substances, which account for about 13 percent of all prescriptions. Although in 2010, the U.S. Drug Enforcement Administration released new regulations permitting the electronic transmittal of scripts for controlled substances, they hadn't yet been implemented.

Surescripts' universe also is limited to office-based providers and the prescriptions they write in the office. But many doctors and nurse practitioners prescribe medications in hospitals and other facilities. That apparently is another reason why the number of online prescriptions is only 8 percent of dispensed medications.

It's intriguing to speculate how many hospital and emergency-department prescriptions are ordered through computerized physician order entry (CPOE). The latest figures show that about 17 percent of hospitals have implemented CPOE, but that number is sure to rise rapidly because of the meaningful use regulations, which require the use of CPOE.

A couple of other statistics jump out of the Surescripts report. Eighty-three percent of deployed e-prescribing software applications now are included within electronic health records, and 17 percent are standalone programs. However, 148 EHR vendors have embedded standalone applications in their solutions. So, while the use of independent e-prescribing applications is becoming rarer, many live on in EHRs.

Surescripts also provides a revealing breakdown of e-prescribing usage by specialty and practice size. Forty-six percent of e-prescribing physicians are primary-care doctors/family physicians, internists, or pediatricians. But it is cardiovascular disease specialists who have the highest percentage of e-prescribers. Forty-nine percent of these specialists prescribe online (among family physicians, the percentage is 47 percent).

The one thing that's certain is that next year's e-prescribing numbers will show another big jump. Not only will many controlled substance scripts be included, but the number of doctors who prescribe electronically in their EHRs will soar as physicians reach for those federal incentive dollars. - Ken


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