Dr. David Gorelick has been e-prescribing for years. An internist at Aquidneck Medical Associates, in Newport, he’s a pioneer in health care IT use in general, involved in multiple pilot projects and quality-improvement initiatives.
And he’s an evangelist of sorts, helping educate his peers about the benefits of electronic medical records (EMR) and electronic prescribing: the speed, the efficiency, the built-in decision supports, the ability to look at all the drugs a patient is taking to avoid bad interactions.
Many doctors, he admits, are reluctant, concerned that it’s too costly and cumbersome. He understands – “it’s time and it’s money and it’s experience.” But he’s enthusiastic.
“My experience,” he said, “has been very positive.”
Now, with EMR adoption growing and new financial incentives – including a 2 percent bonus on Medicare payments for 2009 and 2010 for doctors who e-prescribe – less-adventurous colleagues are finally joining Gorelick on the electronic frontier.
In the first nine months of 2009, 63.3 percent of Rhode Island doctors used the Surescripts system, the network that connects pharmacies and providers across the country, up from 51.4 percent last year and 39 percent in 2007, according to the Rhode Island Quality Institute.
The state, which was the first pilot site for Surescripts in 2003, recently celebrated a big victory: With the addition of a small, independent drugstore in South County, 100 percent of Rhode Island pharmacies are now enabled for e-prescribing.
“This is a very significant milestone in our efforts to leverage health-information technology to improve the quality, safety and value of health care in Rhode Island,” said Laura Adams, president and CEO of the Quality Institute, which has led the state’s e-prescribing efforts since the beginning. “When a misplaced decimal point can cost a life, the value of eliminating hand-transcribed prescriptions cannot be overstated.”
But the success, Adams acknowledged, is still limited. Not only are more than one-third of doctors still not using the system, but many who do use it aren’t consistent about it.
Sometimes it’s not a choice – federal law prohibits e-prescribing of controlled substances such as narcotics and barbiturates, for example, so doctors still have to use paper for them, and many find it easier to give everything on paper to those patients. The U.S. Navy also requires paper, Gorelick noted, so he has to print out prescriptions for his Navy patients.
Still, of the prescriptions that could be sent online in the first nine months of the year, only 31 percent actually went through Surescripts, said Jennie Chiller, health IT adoption manager at the Quality Institute. That’s a big leap from 23 percent in 2008 and especially from 11 percent in 2007, but it’s far short of the state’s goal of 75 percent.
So what will it take to make e-prescribing the norm in Rhode Island?
For starters, a lot of collaboration, Adams said. That’s what has gotten the state this far: Along with the Quality Institute, itself a collaborative effort, the e-prescribing initiative involves the R.I. Department of Health, Quality Partners of Rhode Island, CVS Caremark Corp., Rite Aid, Surescripts, Blue Cross & Blue Shield of Rhode Island, Lifespan, Coastal Medical and others.
Information is crucial, Adams said, because doctors don’t know their options and may not know about all the incentives available. The Quality Institute has designed a “matrix” to help them, citing programs from Medicare, Medicaid, Blue Cross, Tufts Health Plan and more.
And the institute is counting on doctors such as Gorelick to help spread the word and persuade their colleagues, helping them overcome their concerns and offering advice.
For example, doctors who want to e-prescribe but don’t use EMRs yet might consider a standalone system; Surescripts can be accessed through Web-based portals and programs that work on handheld devices. But one of the biggest obstacles to e-prescribing, Adams and Gorelick both noted, is that it requires a change in doctors’ work flow, and if a doctor can’t easily send a prescription from the exam room, it’s going to be cumbersome.
Gorelick, on the other hand, carries a laptop computer and enters all his patients’ information directly into the EMR. Sending a prescription requires just a few more clicks. Refill requests queue up automatically, too, so they take seconds to respond to.
That’s where both Adams and Gorelick said they see most of the growth in e-prescribing in the coming years – with doctors who are adopting EMRs. That is a much bigger change that requires serious investment, effort and learning, Gorelick said, but his experience with EMRs (in his case, eClinicalWorks) has been “tremendous, phenomenal.”
The software still has flaws that need to be worked out, Gorelick said, but every day, he does more with the EMRs. Recently, for example, he ran reports to ensure patients who take the blood-thinner warfarin had all gotten their quarterly blood tests.
Even the state is reaping the benefits. At the same event where the 100 percent milestone was announced, Dr. David R. Gifford, the state health director, said Surescripts data will be used to supplement doctors’ reporting on H1N1 and influenza in general. •
