Raising the bar on e-prescribing

I do find it interesting that CMS just proposed a new rule on Monday to require all e-prescribing transactions between providers and pharmacies to be sent in a standard electronic format instead of computer-generated faxes. While I generally believe it makes sense to raise the bar on e-prescribing in terms of patient safety and overall efficiency, I wonder the value of this proposed rule given that such a large percent of physicians still don’t use e-prescribing at all.  Several studies have shown that e-prescribing adoption represents less than 20% of physicians, although a significantly larger percent of prescription volume.  Physicians are either using pure-play standalone e-prescribing solutions or e-prescribing solutions integrated into their EHR.  

• Based on extrapolating from several different data sources, I believe that 50-60% of doctors who use e-prescribing are using standalone solutions such as Zix and Dr. First.  I believe that these solutions already support this new electronic data standard called Script developed by NCPDP.  These standalone solutions have gained adoption through state-based collaboratives such as MA eRx Collaborative and Illinois E-Rx Collaborative which heavily or fully subsidized e-prescribing solutions for physicians by large payers. 
• The other 40-50% of e-prescribing docs use software from their EHR.  These systems are most likely to need to upgrade to the new data standard.  At the same time, this is likely to represent the highest level of growth for e-prescribing in the future.

From the pharmacy side, SureScripts reported to CMS that all chain drug stores and 20% of independent pharmacies are capable of sending and receiving Script transactions.  While it does represent a significant IT investment for the independent pharmacies, the pharmacy stands to gain through efficiency.  ~30% of prescriptions require a callback to physician, many of which are related to poor legibility.  By reducing some pharmacy callbacks to physicians, this also improves efficiency at the physicians office.My opinion is that the rule makes sense.  If you are going to use e-prescribing, it should be a fully electronic data transmission.  CMS is seeking comments on the proposed rule to be submitted on-line until August 31, 2007.  A final rule will be published later in the fall and will be effective for claims on or after January 1, 2008.