Several Acumen blogs this year have been about eRx: PQRS and reporting in April, how to avoid the eRx penalty in June, and eRx and Meaningful Use Stage 2 in September. Ever in search of the meaning part of Meaningful Use, I’ve spent some time trying to figure out the benefit of eRx. What does e-prescribing really mean? Is e-prescribing better for providers? Is e-prescribing better for patients?
The Surescripts story
If you really want to know about the Meaningful Usefulness of eRx, then you should know a little bit about the major player in the e-prescribing world: Surescripts. In 2008 Rx Hub and Surescripts consolidated to form a “single, secure, nationwide network for e-prescriptions and the exchange of health information.” Prior to 2008, Rx Hub was entirely owned by Caremark Corp, CVS, Express Scripts, Inc., and Medco Health Solutions and had expertise in patient identification and drug benefit information delivery to the provider. The National Association of Chain Drug Stores and the National Community Pharmacists Association owned Surescripts, which had expertise in e-prescription transmission from office to pharmacy. Rx Hub and Surescripts joined in a 50/50 ownership split to form the new Surescripts, which today is considered a “low-cost health information utility.”
Surescripts is the largest e-prescription network in the U.S. It connects provider prescribers with payers, independent pharmacies, and chain pharmacies. Surescripts doesn’t just transmit prescription information, it also oversees the secure electronic exchange of clinical information such as discharge summaries and lab results. An article in The Washington Post in August described Surescripts as providing “the last mile of connectivity” for healthcare because of Surescripts’ ability to be a data hub for Healthcare Information Exchange among disparate stakeholders. Surescripts is, in effect, a “national record-sharing service.”
Surescripts ensures the secure transmission of not just prescriptions, but also of the clinical data that puts prescriptions in context, so that patient safety issues like medication incompatibility and medication errors can be identified. With Surescripts, a physician can see the big picture of patient prescriptions across multiple providers and over time. With connections to payer and Pharmacy Benefit Management (PBM) data, Surescripts also integrates formulary data that is specific to the payer, which saves time and paperwork.
E-prescribing by the numbers
e-Prescribing has taken off in the past 10 years and the government would like to take credit. In an article in Health Affairs in July 2013 several authors from the ONCHIT presented data that suggests that the adoption of e-prescribing was significantly accelerated by the eRx incentive payments authorized as part of the Medicare Improvements for Patients and Providers Act (MIPPA) in 2008. According to this article, in 2007 35,500 providers (6% of office-based providers) were e-prescribing. In contrast, the latest numbers from the Surescripts 2012 National Progress Report show:
- 69% of office-based physicians or 380,000 doctors e-prescribe
- 44% of all dispensed prescriptions were electronically submitted, a total of 788 million prescriptions
- 93% of internists and 78% of nephrologists e-prescribe
- 93% of community pharmacies accept e-prescriptions
- 255 million American are enrolled in health plans that share medication and prescribing information through Surescripts. Delaware is the #1 state for e-prescribing.
Meaningful use and beyond
eRx is front and center in Meaningful Use Stage 2, which requires 50% of permissible prescriptions generated and transmitted electronically during the reporting period. Hopefully those of you who have been onboard with eRx since MIPPA was enacted in 2009 will be able to meet this requirement easily. Hopefully, too, with Surescripts’ secure transmission of meaningful and useful data to prevent medication duplication, errors, and allergies, eRx has Meaning for patients and providers beyond Meaningful Use. Estimates already suggest that eRx will help avoid 3.5 million medication errors and will save $22 billion healthcare dollars….very meaningful indeed.
Has eRx made your life easier or harder? Does e-prescribing reduce your paper work? Has eRx helped you avoid a medication error? Tell us what you think about the meaning and usefulness of e-prescribing.