Emerging and Encouraging Trends in E-Prescribing Adoption Among Providers and Pharmacies | Page 2
Published Online: September 20, 2013
Meghan H. Gabriel, PhD; Michael F. Furukawa, PhD; and Varun Vaidya, PhD
In order for providers to successfully use their e-prescribing systems, they must have pharmacies with the ability to accept these e-prescriptions. The growth in pharmacies actively e-prescribing in the United States during this study period is displayed in Figure 2. The percent of retail pharmacies actively e-prescribing on the Surescripts network increased from 43,000 pharmacies, representing 70% of all chain, franchise, and independent pharmacies in December 2008 to over 59,000 pharmacies, representing 94%, in December 2012, therefore showing a 24% increase in the past 4 years.
These increases in pharmacies actively accepting e-prescriptions and in providers’ e-prescribing mirror the increase in the volume of e-prescriptions sent on the Surescripts network. In 2008, 4% of all new and renewal prescriptions were sent electronically in the United States. It is forecasted that 45% of new and renewal prescriptions will be sent electronically in 2012. In December 2008, 61% of pharmacies in rural counties were actively accepting e-prescriptions, compared with 75% of urban pharmacies (P <.001). This 14% gap has closed during the study period. In December 2012, 94% of urban pharmacies and 93% of rural pharmacies were actively accepting e-prescriptions. For providers, adoption has remained consistent between urban and rural providers (data shown in eAppendix; available at www.ajmc.com). Additional results regarding new and renewal prescriptions and variations in e-prescribing among pharmacies and providers in rural and urban counties are also given in the eAppendix.
The majority of pharmacies in the United States have been able to accept e-prescriptions since 2008. This suggests that e-prescribing among physicians was not hindered by the lack of pharmacies able to receive e-prescriptions. In order to implement health information technologies, providers need technologies in the marketplace, be able to implement the technology in practice, and perceive that the technologies are worthwhile.18 The HITECH act and resulting programs such as the State HIE and REC have assisted with the first 3 points. However, provider perceptions are less influenced by governmental policies and programs than by their practice experience. The large increase in e-prescribers (7%-54%) suggests accumulating positive perceptions as experience grows. Over half of providers have implemented EHRs and e-prescribe via those systems. This is consistent with current literature.19
Cost and work flow concerns are most commonly cited as the primary challenges to health IT adoption.18 Studies have noted that e-prescribing has doubled prescribing time for office-based physicians. This time is partially offset by reducing other record-keeping tasks.20 The IOM reported that although ubiquitous in other major industries, the diffusion of relevant technologies in healthcare is still in its very early stages. The report states that EHRs have the potential to improve patient outcomes and also improve adherence to medications.21 Federal incentives, meaningful use requirements, and the federal programs detailed above may have helped lead toward increased positive experience, and thus driven this remarkable increase in adoption of e-prescribing.
E-prescribing is an essential component of meaningful use, an important milestone for health information exchange (HIE), and is important to meeting the triple aim.10 Tracking the distribution of new prescriptions and renewal requests on the Surescripts network is a useful way to assess the robustness to be able to afford the technologies, have access to those of HIE, as renewal requests require bidirectional exchange between pharmacist and prescriber. Additionally, patient adherence to medications is better with e-prescribing.22 A recent review article found that 92% of health IT studies during that time showed either positive or mixed positive outcomes. 23 Complete EHR use may add additional quality and outcome benefits. Payers and prescribers are enabled to communicate information that will lead to improved quality care for patients. Formulary benefit alerts, safety alerts, adherence reminders, and gaps in care alerts are some of the initial innovations that HIE via EHRs makes possible.
In addition to the challenges faced by urban providers, rural providers and pharmacies face unique issues with access, resources, and connection. With this in mind, the RECs have worked with over 50% of eligible providers in rural areas to provide assistance regarding e-prescribing and other requirements of meaningful use. Additionally, the State HIE Program has reached out to rural pharmacies to help facilitate e-prescribing. Our study found no current major differences in provider adoption by rurality. This is in agreement with 2 early studies of physician offices which showed that Health IT adoption and use in rural offices was not lower than in urban offices.24,25
Despite the progress made in the use of e-prescribing, there is also a concern of lack of ability to receive and process e-prescriptions by independent or rural pharmacies for reasons such as availability of broadband Internet and concern over transaction fees. Studies have suggested that incentive programs or grants to help with infrastructure would help to overcome that issue.26 It is important to note that our study reports no difference in ability of pharmacies in rural and urban counties which are actively e-prescribing. This indicates the potential success of incentives, grants, and technical assistance provided to such pharmacies.
With the increase of health IT use among providers and pharmacies, concerns have been raised regarding patient privacy and increased third-party access to health information. It is of note that in the period of this study, those issues do not appear to impede rapid growth in utilization and adoption. However, questions regarding the cost and health benefits of health information technologies such as e-prescribing and EHR use continue to be voiced. This analysis suggests that increasing experience with various HIE technologies such as e-prescribing results in their rapid growth. This is a trend encouraging continued exploration of the clinical and economic benefits of HIE.
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