Do state legibility laws affect e-prescribing adoption?

Ten states have passed laws that require prescriptions to be legible, according to the National Conference of State Legislatures. These include Colorado, Delaware, Florida, Idaho, Illinois, Maryland, Michigan, Montana, Tennessee, and Washington. The question is, have these statutes encouraged physicians to prescribe electronically?

Not as much as you might suppose. According to SureScripts, a company that has built an electronic system connecting pharmacies and physician offices across the nation, Maryland, Florida, and Delaware are among the top 10 states for numbers of prescriptions sent online to drugstores. But these states rank lower than Rhode Island, Nevada, and Massachusetts—none of which have legibility laws. Of the other states that require legibility, none are in the top 20 except Washington, which is number 20.

"These laws probably have had some effect, but they're one of a half dozen variables," says Ken Whittemore, vice president of professional and regulatory affairs for SureScripts. Among the other key factors, he says, are health plan subsidies to e-prescribers, efforts by stakeholder groups to promote e-prescribing, and the absence of state regulatory barriers.

Of course, pharmacies are not ready to accept scripts online in every market, and many physicians who write prescriptions electronically print them out for patients or computer-fax them to drugstores. So the SureScripts data is only a partial indication of the impact of legibility laws. But one of the largest vendors of e-prescribing software, Allscripts, doubts these statutes are spurring many doctors to prescribe digitally.

"I haven't seen a causal link between the legislative framework and the number of physicians who are writing electronic prescriptions," says Lee Shapiro, president of Allscripts. "The real key to adoption of e-prescribing is whether there's an application that meets physicians' workflow needs and whether there are physician champions who are prepared to adopt change."

Tennessee, Nevada, and California, for example, are all leaders in e-prescribing, says Shapiro. While Tennessee has a legibility law, the other two states don't. Jill Helm, Allscripts' vice president of e-prescribing, ascribes the high adoption rate in Nevada to the cooperation among the Clark County Medical Society, Southwest Medical Associates, and the Sierra health plan in promoting the technology. In California, she says, the key factors are the sponsorship of Blue Cross of California and the prevalence of large groups and IPAs.

Whittemore agrees that the leadership of regional and statewide entities can help push e-prescribing adoption up. In Rhode Island, SureScripts' top state for online prescribing, the Rhode Island Quality Institute, which includes providers, insurers, consumers, and employers, and Life Span, a major health plan, have helped increase e-prescribing to the point where Governor Donald Carcieri has called for the majority of prescriptions written in the state to be online by the end of 2007. Illinois Gov. Rod Blagojevich, similarly, has set a goal of having all Illinois physicians use e-prescribing systems by the end of 2011.