Commentary: Stand-alone e-prescribing applications may not be best for your practice

Just in time to help you meet Medicare’s June 30 deadline for starting to e-prescribe or face a 1% reduction in your 2012 payments, a newly updated guide to e-prescribing is available with a plethora of useful information.

The guide falls short in one key area, however. It doesn’t advise that stand-alone e-prescribing applications may not work with the electronic health records (EHRs) that you’re going to have to acquire.

Among the highlights of “A Clinician’s Guide to E-prescribing,” originally published in 2008, are information about this year’s e-prescribing requirements, an explanation of e-prescribing’s role in the meaningful use of EHRs, and the Drug Enforcement Administration’s new rules on e-prescribing controlled substances. Read the updated guide here.

Publishers of the updated guide include the American Academy of Family Physicians, the American College of Physicians, the American Medical Association, the Center for Improving Medication Management, the eHealth Initiative, and the Medical Group Management Association.

The comprehensiveness of the information contained in the guide and the caliber of the organizations that assembled it makes it difficult to understand why they were not more explicit regarding the potential drawbacks of using stand-alone e-prescribing software. The guide notes that more than 75% of e-prescribing now takes place within “full EHRs.” That percentage is sure to rise, experts say, because physicians who want government incentives are interested in acquiring EHRs, not standalone systems.

Yet the guide’s section on choosing an e-prescribing application places stand-alone e-prescribers on the same level as EHRs. It states: “There are many e-prescribing systems and EHRs to choose from and evaluating them may seem difficult. Be sure that you select a system(s) that is certified for meaningful use and has robust, easy to use e-prescribing, including drug-benefit checking, eligibility and formulary checking, medication history from outside sources, drug-drug and drug-allergy checking, and bi-directional electronic routing with pharmacies.”

Later, the guide points out that whether or not a physician is e-prescribing now, he or she faces a choice between starting with a standalone e-prescriber and adding other EHR modules later, or purchasing a full-blown, integrated EHR now. Either choice, the report suggests, can enable the user to meet the meaningful use criteria provided that the e-prescriber and the other modules are certified. What’s important is to make sure that the e-prescriber or EHR can interface with the physician’s practice management system so that administrative data doesn’t have to be entered twice.

All of these statements are true, but the first two are misleading. If you start with a stand-alone application, it may or may not be integrated with the EHR that you will want to buy later on. If not, you will either have to re-enter all of the medication information from the e-prescriber’s database into the EHR or continue to use it side-by-side with the EHR.

One Michigan physician who chose the latter course was still happy with his stand-alone e-prescriber, which has beneficial features that the EHRs prescribing module lacks, but found it laborious to input his data twice each time he wrote a prescription.

Stand-alone e-prescribers can be certified for meaningful use, as the guide notes. It’s even possible to assemble a group of certified modules that together meet all of the requirements for the Health Information Technology for Economic and Clinical Health (HITECH) Act incentives. Regiments of vendors are marching in this direction to profit off of meaningful use. But be sure to ask yourself whether a nonintegrated EHR is going to serve you well in terms of efficiency, workflow, or security.

Perhaps the organizations that wrote the e-prescribing guide failed to discuss this obvious issue because the government allows stand-alone programs to be certified for meaningful use, or because they didn’t want to appear to be supporting the major EHR vendors. But from a practical standpoint, it’s a glaring omission.