Is the E-Prescribing Jar Half Full or 98% Empty?

A new report by the eHealth Initiative lays out, in painstaking detail, the current state of affairs in electronic prescribing. At first glance, the numbers suggest real progress.

For example, the report notes that in 2004, little electronic prescribing took place. By the end of 2007, some 35,000 prescribers were actively dispatching their medication orders straight to pharmacies. In that same year, some 35 million prescription transactions were sent over a nationwide network known as the Pharmacy Health Information Exchange, operated by SureScripts. In other words, in a little over three years, the industry has gone from virtually no electronic prescriptions to tens of millions of them.

The catch, of course, is that, high numbers aside, the proportion of overall prescriptions sent electronically is tiny. "The adoption level at the end of 2007 represented approximately 2% of the potential for electronic prescribing," the report notes.

We are indeed a medication-happy society, consuming 3.52 billion prescriptions annually! So in the big picture, adoption of e-prescribing remains low. Massachusetts leads the way, with 13% of prescriptions in this highly "wired" state sent electronically. My home state, Illinois, is far down the list, ranked at 28th with just over 1% of medication orders sent via electronic networks. I'm sure not helping boost those numbers myself.

Last week, I dutifully toted my antibiotic prescription across town from my physician to the drugstore. It's not a long walk, and his handwriting is fairly legible, but to me the missing piece here is compliance. My physician has absolutely no way to know if I fulfilled the prescription.

This scenario plays out time and time again. North Dakota ranks dead last, with a mere .09% of prescriptions transmitted electronically. How many actual prescriptions does that work out to? Perhaps there is some solo physician up there who practices medicine part-time and who uses an EMR a few times a week.

I don't know which astounds me more—the sheer quantity of drugs that we Americans consume, or the continued reliance on paper-based prescription orders to facilitate the transactions. Even if you take out controlled substances (which face legal restrictions on electronic orders), the number of prescriptions being toted by hand by consumers to their local pharmacy is huge. Yet, this report lays out some compelling reasons why physicians have not adopted this technology, including cost, workflow, and data standards. This is a thorny issue indeed, and the eHealth Initiative (and its partner, the Center for Improving Medication Management) deserve kudos for compiling such an exhaustive analysis.