The lowdown on e-prescribing

Heather C. Williamson, a family physician in Bridgeton, MO, sees no reason to prescribe electronically. She's never had an instance when a pharmacist couldn't read her handwriting and dispensed the wrong drug. The pharmacy callbacks her office receives are usually about prior authorization or requests for cheaper medications, not about drug interactions. If she had an electronic medication list on her PDA, she adds, she'd still have to go through the paper chart and double-check the patient's medications with the patient himself.

Williamson articulates just some of the concerns that cropped up in an informal poll of Medical Economics readers about e-prescribing. While a small portion of the respondents are writing digital scripts, most of those are doing so through their EHR system. And some of the doctors who are using stand-alone e-prescribers have received them for free from health plans.

According to a 2004 report from eHealth Initiative, no more than 18 percent of physicians prescribe electronically; our poll revealed some of the core issues behind that low-adoption number. Though unscientific, it also showed why some doctors like writing digital scripts and feel their investment has paid off. Here's the good, the bad, and the ugly.

A stand-alone e-prescribing system can cost anywhere from $2,000 to $6,000 in the first year, and you can expect to pay from $100 to $500 a month for it thereafter. That covers drug updates, software upgrades, and technical support.

For many cash-strapped primary care doctors, even the lower end of this range is too much money. Already struggling with expenses, they feel they can't spare a dime for luxuries like e-prescribing.

Some payers-notably, Blues plans-are offering to subsidize part or all of the cost to make e-prescribing more appealing. But even doctors who say Yes are mindful that these are limited-time offers. Take FP Steven Gitler, who practices in Camden, NJ. He got an e-prescribing system gratis from Horizon Blue Cross Blue Shield of New Jersey. "It's really cut down on pharmacy callbacks," he says. "But if we had to pay a monthly fee, we'd probably stop unless the cost was very low."

Not all physicians are eager to accept free or deeply discounted e-prescribing systems. After clashing with plans over downcoding, late payments, and reimbursement cuts, some doctors see something fishy in health plans' sudden eagerness to fund e-prescribing.

Payers do have a profit motive in promoting electronic prescribing: By providing formulary information at the point of care, e-prescribing encourages greater use of generic drugs, which saves insurers money.

Other physicians see e-prescribing as yet another health-plan effort to limit their autonomy. "It's just one more way that 'others' are telling physicians what we need to do," says FP Eldridge Gene Burns of La Place, LA. "With all the intrusions on the way we practice medicine, this is repugnant."