Senator John Kerry and former Speaker of the House Newt Gingrich wrote an op-ed piece in the Wall Street Journal on November 16th. In it, they outlined a few compelling reasons for all doctors everywhere to switch from the archaic method of writing prescriptions (paper and pen) to electronic submission. If the benefits are so compelling, why aren't doctors flocking to these new technologies? The answer lies, of course, in the economics of adopting these tools.
One of the most compelling arguments against electronic prescriptions so far has been cost. Sending prescriptions electronically yields a substantial amount of operating efficiencies, though only a margin of those efficiencies are realized in the physician's office. The problem starts with the doctor writing the script. To implement an electronic prescription system, the physician must also implement an office wide electronic medical record (EMR) system. EMRs are prohibitive in cost to smaller practices where a majority of physicians practice. Further, stand alone electronic prescription writing applications do not exist as stand alone products; they are add on products to the more costlier EMRs.Besides cost, electronic prescription writing is subject to the same security concerns that any other Internet application is subject to. The HL7 interface is circumventing many of the security concerns though these systems are still open to hacking and abuse. With paper and pencil, it's hard to fake a prescription. I recall when the pharmacy called me to make sure my physician employer had meant to prescribe a "half-pound of mo-fine" for a patient. The patient was detained and the stolen prescription pad was recovered. Electronic prescription fraud would be easier to carry out. One would need to submit a prescription request using the standard interface - no stolen prescription pad required. Prevention policies are already in place, though the profit in stolen prescriptions is so great that the same hackers incented to send us all spam email could easily make their way to the health sector.It is often noted that when the first fax machine rolled off the line it was worthless. Sure, one person could send a facsimile, but where could she send it? The value of the fax machine wasn't realized until the second fax machine was installed and it really didn't make sense until they were a standard in all offices. So too is this phenomenon in EMR (and electronic prescriptions) technology. To send an e-prescription requires the pharmacy to be able to receive the request. This requires a system wide change in the operations of medicine. Concurrent adoption of sending and receiving must occur both at pharmacies and physician offices in order for the true value of e-medicine to come to fruition.Making medicine more efficient is imperative. Rising costs and lack of efficiencies are costing Americans greatly in their delivery and quality of care. Presently, one of the only places EMRs make sense are hospitals. A centralized place of healthcare delivery where physicians and pharmacies are tied together makes it easy for administrators to calculate and achieve a return on a large technology investment. Indeed technology has helped increase the quality of care and reduce mistakes in hospital systems like the VA. In order for medicine to make the strides Misters Kerry and Gingrich propose in their Journal piece, the market must respond with a technological solution to fit with small private practice providers.
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