Sand in the gears of "free" e-prescriber

Last January, the National ePrescribing Safety Initiative (NEPSI) launched with great fanfare a supposedly free e-prescribing program called eRx NOW. The software, provided gratis by Allscripts, was predicted to expand the universe of e-prescribing physicians significantly. To encourage adoption of eRx NOW, several major health plans pledged to reward physicians who used the e-prescriber, and big computer companies like Dell, Microsoft, Intel, Cisco, and Google promised to support NEPSI financially (InfoTech Bulletin, Jan. 26, 2007).

As of early August, five months after eRx NOW became available, "several thousand" physicians were using it, according to Allscripts. While that isn't negligible, considering the slow uptake of e-prescribing in general, it doesn't appear that most physicians are eager to start e-prescribing even if the software is free. Part of the reason is the workflow changes that are required; also, physicians fear that e-prescribing will slow them down.

Another major stumbling block is the cost of using and maintaining the software. Aside from purchasing computers and wireless networks, physicians who want to download patient demographic data automatically have to pay for an interface with their practice management system. If their PM system is one of those that already has an interface with eRx NOW, the cost is modest—$295 for setup and $20 per physician per month for maintenance in most cases. But if a practice's PMS vendor doesn't offer a free interface, it would have to pay several thousand dollars for one.

That's the situation of one primary-care practice in Jacksonville, FL. FP Frederic Porcase Jr., the group's leader, says he looked into getting eRx NOW, but his WebMD practice management system (now sold and maintained by Sage Software) doesn't connect with eRx NOW, and the practice didn't want to spend the money for an interface.

Sage Software doesn't have any objection to building an interface to eRx NOW, but hasn't been invited to, says Mike Burger, the company's director of clinical product management. At the same time, he notes that Allscripts is one of Sage's competitors, and that Sage views eRx NOW as an inducement for physicians to purchase Allscripts' EHR.

While Allscripts has admitted that this is one of its objectives, the coalition's overall aim is to increase patient safety through e-prescribing. Stanley Crane, Allscripts' chief technology officer, says vendors should be sharing information to benefit patients rather than focusing on their proprietary interests.

About three dozen PMS vendors have provided free interfaces to eRx NOW, charging only the abovementioned fees for maintenance. Besides Allscripts and its Healthmatics subsidiary, they include such leading brands as Lytec, Medisoft, MicroMD, Misys, and NextGen. But overall, Crane admits, "not many vendors have offered to write a PM interface for free." One reason, he speculates, may be that NEPSI requires them to offer it to all their customers at no charge.

Crane says he's surprised by how many of the practices that use eRx NOW haven't gotten PMS interfaces. About a third of eRx NOW users have no practice management systems, he says, and eight of the 10 top sites by prescribing volume are entering patient demographic information manually. "They've dedicated a staff person to type in the name of the patient as they come in," says Crane. He thinks this may indicate that interfaces are less important than some experts have said it is. But that's not the story that InfoTech Bulletin gets from physicians, who view manual data entry as a costly, time-consuming chore.