Feb 13, 2012 (11:02 AM EST)
California Begins To Embrace e-Prescribing

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Electronic prescribing increased rapidly in California from 2007 to 2010 but still has a long way to go. That's the conclusion of a new report from Cal eConnect, the nonprofit organization that is marshaling stakeholders to make e-prescribing universal in the Golden State.

Incorporating data from Kaiser Permanente and the VA system as well as Surescripts, the report provides a detailed picture of the state of e-prescribing in California. Because the rate of adoption in the state is close to the national average, some of the report's conclusions about barriers to e-prescribing adoption will be of interest in other states.

At the end of 2010, about 25% of California physicians were sending prescriptions electronically, compared with 3% in 2007, the report found.

The report found that the vast majority of e-prescribers worked for large healthcare systems, leaving a "significant gap in usage" among small and solo practices. Ron Jimenez, MD, co-chair of the Cal eConnect ePrescribing Advisory Group, told InformationWeek Healthcare that much of the difference can be attributed to workflow issues and the conservatism of some physicians.

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Electronic health records (EHRs) might be another factor. Eighty percent of e-prescribers used EHRs, and e-prescribing activity picked up significantly after the introduction of the Meaningful Use incentive program in 2009, the report noted. Because big groups are more likely than small practices to have EHRs, the correlation between group size and e-prescribing might reflect that difference "to some extent," said Jimenez. Also, he said, large groups and academic institutions "are where the resources and the sophisticated staff are."

Another obstacle to e-prescribing in small practices was the prevalence of community pharmacies that didn't accept electronic prescriptions. These pharmacies tended to be concentrated in rural counties where the percentage of connected drugstores was under 70%. Overall, 75% of independent pharmacies have been activated for e-prescribing, compared to 90% of all community pharmacies.

"The lack of pharmacy adoption among independent pharmacies likely is due to both the workflow changes and financial barriers associated with implementation," the report said.

According to Surescripts data, only 16% of all California prescriptions were sent electronically, indicating that a significant number of scripts were printed or faxed. Some of these, Jimenez indicated, had been written for controlled substances.

Surescripts data also showed that 18% of patient visits included a request for electronic benefits and just 10% involved a request for community medication histories. Both kinds of data were available for 72% of patients.

The Cal eConnect Prescription Advisory Group is in the process of addressing the issues that hold back e-prescribing in California, Jimenez said. Besides tackling the controlled substances problem, he said, the group is looking at the usability of e-prescribing applications and the development of a "core dataset."

"You have to define a core dataset needed to complete a prescription," he said. "Vendors have a good handle on what data they need to do a transaction. But we have to establish a workable dataset" for physicians and pharmacists. Among the components of such a dataset would be allergies, medication histories, and patient-identifying information. Some e-prescribing systems bring this information to bear when a provider prescribes a medication and others don't, he added.

Cal eConnect can only make recommendations to the state about what they'd like EHR vendors to include in their applications. But as the state-designated entity that is developing a health information exchange for California, Cal eConnect has "indirect" influence on how vendors design their products, he said.

"For example, when we put together the provider directory RFP, it won't be a mandate from the state, but it will be, 'here are the parameters we'd like to see in this technology solution.'"

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