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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

CONCLUSION

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.

Acknowledgment

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: cwtseng@hawaii.edu.

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