Currently Viewing:
The American Journal of Managed Care April 2010
Estimated Effect of Asthma Case Management Using Propensity Score Methods
Sylvia Brandt, PhD; Sara Gale, MPH; and Ira B. Tager, MD, MPH
Pharmacist Collaborative Management of Poorly Controlled Diabetes Mellitus: A Randomized Controlled Trial
John P. Jameson, PharmD; and Philip J. Baty, MD
Age and Rural Residence Effects on Accessing Colorectal Cancer Treatments: A Registry Study
Jayashri Sankaranarayanan, PhD; Shinobu Watanabe-Galloway, PhD; Junfeng Sun, PhD; Fang Qiu, MS, PhD; Eugene C. Boilesen, BS; and Alan G. Thorson, MD
Low-Value Services in Value-Based Insurance Design
Peter J. Neumann, ScD; Hannah R. Auerbach, BA; Joshua T. Cohen, PhD; and Dan Greenberg, PhD
Pharmacy Cost Sharing, Antiplatelet Therapy Utilization, and Health Outcomes for Patients With Acute Coronary Syndrome
Tomas J. Philipson, PhD; Essy Mozaffari, PharmD, MPH; and John Ross Maclean, MD
Getting the Right Services Covered by Health Insurance
Dean G. Smith, PhD
Relationship Between High Cost Sharing and Adverse Outcomes: A Truism That's Tough to Prove
Niteesh K. Choudhry, MD, PhD
Knowledge of Cost Sharing and Decisions to Seek Care
Amy M. Lischko, DSc; and James F. Burgess Jr, PhD
Economic Evaluation of an Internet-Based Weight Management Program
Rafia S. Rasu, PhD; Christine M. Hunter, PhD; Alan L. Peterson, PhD; Heather M. Maruska, BSc, PharmD(Cand); and John P. Foreyt, PhD
Currently Reading
Health Information Technology and Physicians' Knowledge of Drug Costs
Chien-Wen Tseng, MD, MPH; Robert H. Brook, MD, ScD; G. Caleb Alexander, MD, MS; Allen L. Hixon, MD; Emmett B. Keeler, PhD; Carol M. Mangione, MD, MSPH; Randi Chen, MS; Eric A. Jackson, PharmD; and R. Adams Dudley, MD, MBA

Health Information Technology and Physicians' Knowledge of Drug Costs

Chien-Wen Tseng, MD, MPH; Robert H. Brook, MD, ScD; G. Caleb Alexander, MD, MS; Allen L. Hixon, MD; Emmett B. Keeler, PhD; Carol M. Mangione, MD, MSPH; Randi Chen, MS; Eric A. Jackson, PharmD; and R. Adams Dudley, MD, MBA

High rates of health information technology use by physicians were only modestly associated with better knowledge of drug costs.

At the time of our study, an informal review indicated that several health plans in Hawaii made copayment and formulary information available via the Internet, but not necessarily via EHR, e-prescribing, or PDA. A highly promoted type of e-prescribing software in Hawaii contained formulary information only for the single health plan that sponsored its adoption.16 Thus, we speculate that this may have been why use of the Internet, but not other IT types, was associated with slightly better knowledge of copayments.

This study indicates that improving physicians’ knowledge of drug costs will require more than simply increasing physicians’ use of health IT. Given the financial burden of drug costs on patients, there is a critical need to determine if the problem is that drug cost information is not adequately available via various types of IT, physicians are unaware of its availability, or physicians find such cost information too difficult to use. We did not ask physicians who reported using health IT why they still experienced difficulty accessing drug cost information. However, other studies indicate the issue may be the variability among formularies and out-of-pocket costs from patient to patient, as well as the need for further availability of drug cost information via IT.5,13 Nearly all of our participants recognized the financial burden of drug costs on patients and the importance of considering out-of-pocket drug costs. However, unless health IT is designed to make the costs of drugs (and other medical services) automatically available at the point of care, physicians and patients will likely continue to be hampered in obtaining healthcare that is appropriate from both a cost and a quality perspective.

Among our participants, no single type of IT was used by more than 60% of physicians. National estimates of physicians’ use of different types of IT for clinical care are generally lower than 50%: 41% use the Internet for computerized decision support,4 13% to 26% use EHRs,3,17 10% to 13% use e-prescribing,6,18 and 26% to 47% use PDAs.6,19 Thus, cost information will need to be accessible via multiple IT types to achieve a wider impact in improving physicians’ knowledge of drug costs.

There are several important limitations to this study. We sampled physicians from a single state, and the impact of IT use on physicians’ knowledge of drug costs will vary depending on how well cost information is integrated into local IT systems. Our findings, however, show that in at least 1 state, even physicians with very high levels of IT use still experience substantial problems accessing drug costs, and this issue warrants policy intervention. Our results are based on self-report, and physicians could have overreported or unnderreported their actual use of IT. Physicians reported only whether they regularly used IT in general clinical care; we did not ask specifically about their use of IT to retrieve drug cost information. Further studies are needed to determine whether physicians use IT specifically to access drug cost information and if so, how. If they do not use IT to access drug cost information, the reasons why must be investigated. Physicians also self-reported their knowledge of drug costs, and actual knowledge is likely to be even poorer.11 We focused on busy, community-based primary care physicians, and our results cannot be generalized to specialists or physicians who see fewer patients.5,6


Despite high rates of health IT use in clinical care, there was only a modest association between IT use and physicians reporting better knowledge of drug costs. Policymakers and insurers should examine the integration of cost information into future health IT systems and its usability by community physicians at the point of care.


We would like to thank Ms Allison Imamura for her invaluable help with the project.


Author Affiliations: From the Department of Family Medicine and Community Health (CWT, ALH), University of Hawaii, Honolulu, HI; Pacific Health Research Institute (CWT, RC), Honolulu, HI; RAND Corporation (RHB, EBK, CMM), Santa Monica, CA; Departments of Medicine and Health Services (RHB, CMM), UCLA, Los Angeles, CA; Department of Medicine (GCA), University of Chicago, Chicago, IL; Department of Pharmacy Practice (GCA), University of Illinois at Chicago, Chicago, IL; Department of Family Medicine (EAJ), University of Connecticut, Hartford, CT; and Department of Medicine (RAD), University of California, San Francisco, CA.


Funding Source: Dr Tseng’s work on this study was funded by the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program. Dr Dudley’s work was funded by an Investigator Award in Health Policy from the Robert Wood Johnson Foundation. Dr Mangione received support from the Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME) funded by the National Institutes of Health/National Institute on Aging (P30 AG021684). The sponsors had no role in study conduct, data analyses, or manuscript preparation.


Author Disclosures: The authors (CWT, RHB, GCA, ALH, EBK, CMM, RC, EAJ, RAD) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.


Authorship Information: Concept and design (CWT, ALH, RAD); acquisition of data (CWT); analysis and interpretation of data (CWT, RHB, GCA, ALH, EBK, RC, RAD); drafting of the manuscript (CWT, RHB, RC, RAD); critical revision of the manuscript for important intellectual content (CWT, RHB, GCA, ALH, EBK, CMM, RC, EAJ, RAD); statistical analysis (CWT, EBK, RC); obtaining funding (CWT, CMM); administrative, technical, or logistic support (CWT, EAJ); and supervision (RHB, CMM).


Address correspondence to: Chien-Wen Tseng, MD, MPH, Department of Family Medicine and Community Health, University of Hawaii, 95-390 Kuahelani Ave, Honolulu, HI 96789. E-mail:

1. Kaiser Family Foundation. Side-by-side comparison of major health care reform proposals. July 10, 2009. sidebyside.cfm. Accessed March 21, 2010.
2. Hillestad R, Bigelow JH. Health Information Technology. Can HIT Lower Costs and Improve Quality? Research Highlights 2005. http:// Accessed March 21, 2010.
3. DesRoches CM, Campbell EG, Rao SR, et al. Electronic health records in ambulatory care—a national survey of physicians. N Engl J Med. 2008;359(1):50-60.
4. Grant RW, Campbell EG, Gruen RL, Ferris TG, Blumenthal D. Prevalence of basic information technology use by U.S. physicians. J Gen Intern Med. 2006;21(11):1150-1155.
5. Shrank WH, Asch SM, Joseph GJ, et al. Physicians’ perceived knowledge of and responsibility for managing patients’ out-of-pocket costs for prescription drugs. Ann Pharmacother. 2006;40(9):1534-1540.
6. Furukawa MF, Ketcham JD, Rimsza ME. Physician practice revenues and use of information technology in patient care. Med Care. 2007;45(2):168-176.
7. Kaiser Family Foundation. Kaiser Health Tracking Poll. Public Opinion on Health Care Issues. June 2009. upload/7925.pdf. Accessed March 21, 2010.
8. Allan GM, Lexchin J, Wiebe N. Physician awareness of drug cost: a systematic review. PLoS Med. 2007;4(9):e283.
9. Shih YC, Sleath BL. Health care provider knowledge of drug formulary status in ambulatory care settings. Am J Health Syst Pharm. 2004;61(24):2657-2663.
10. Fischer MA, Vogeli C, Stedman M, Ferris T, Brookhart MA, Weissman JS. Effect of electronic prescribing with formulary decision support on medication use and cost. Arch Intern Med. 2008;168(22):2433-2439.
11. Walzak D, Swindells S, Bhardwaj A. Primary care physicians and the cost of drugs: a study of prescribing practices based on recognition and information sources. J Clin Pharmacol. 1994;34(12):1159-1163.
12. Alexander GC, Casalino LP, Tseng CW, McFadden D, Meltzer DO. Barriers to patient-physician communication about out-of-pocket costs. J Gen Intern Med. 2004;19(8):856-860.
13. Landon BE, Reschovsky JD, Blumenthal D. Physicians’ views of formularies: implications for Medicare drug benefit design. Health Aff (Millwood). 2004;23(1):218-226.
14. AHRQ National Resource Center. Health information technology. Best practices transforming quality, safety, and efficacy. Accessed March 21, 2010.
15. McMullin ST, Lonergan TP, Rynearson CS. Twelve-month drug cost savings related to use of an electronic prescribing system with integrated decision support in primary care. J Manag Care Pharm. 2005;11(4):322-332.
16. Allscripts Web site. Accessed March 21, 2010.
17. Hing ES, Burt CW, Woodwell DA. Electronic medical record use by office-based physicians and their practices: United States, 2006. Adv Data. 2007;(393):1-7.
18. Hing E, Burt CW. Characteristics of office-based physicians and their medical practices: United States, 2005-2006. National Center for Health Statistics. Vital Health Stat. 2008;13(166). Accessed March 21, 2010.
19. Garritty C, El Emam K. Who’s using PDAs? Estimates of PDA use by health care providers: a systematic review of surveys. J Med Internet Res. 2006;8(2):e7.

Copyright AJMC 2006-2020 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up