Physicians avoid e-prescribing even if they have access

Fewer than 10% of all physicians use advanced e-prescribing capabilities such as drug interaction warnings, even when they have access to them.

Even physicians with access to e-prescribing don't use it, and those who use it still eschew advanced features that the federal government is providing financial incentives for, reports the Center for Studying Health System Change (HSC).

Slightly more than two in five physicians reported that they have e-prescribing capabilities, according to results from HSC's 2008 Health Tracking Physician Survey reported in an issue brief. HSC surveyed 4,182 office-based physicians (response rate, 62%).

Of physicians with e-prescribing capabilities, 64.5% routinely used the drug interaction feature, 53.7% routinely transmitted prescriptions to pharmacies and 34.3% routinely used the formulary information feature. While 59.4% reported that all three features were available in their practice, 22.7% used all three routinely. So in 2008, only 9.6% of all office-based physicians routinely used the three advanced e-prescribing features, according to the study.

Medicare started paying bonuses in 2009 for e-prescribing, and in 2011, "meaningful use" regulations will provide further incentives. Then, penalties will kick in for physicians who don't meet federal requirements.

The percentage of e-prescribers more than doubled between 2008 and 2009, and since the implementation of the bonus program, e-prescriptions have risen 181%.

HSC's issue brief reports that the experience is a harbinger of challenges that federal policymakers will face when rolling out meaningful use regulations. E-prescribing is mature technology, but barriers in other sectors hamstring its rollout. These include formulary information that is seen as incomplete and inaccurate, alert fatigue induced by some systems, and retail and mail-order pharmacies that don't use e-prescribing.

"The challenges to implementation of EMRs as a whole are substantially more complex than e-prescribing," the authors wrote in the issue brief. "And, EMR technology is much less mature, suggesting that policy makers should expect a substantially longer time horizon to achieve meaningful use of health IT than the five- to six-year horizon of the Medicare and Medicaid incentive programs."