As the Wall Street Journal blog suggested in a recent post, combine prescription pads, publicity about drug errors, and doctors' notoriously sloppy handwriting, and you've got to wonder why e-prescribing hasn't taken off. In some places—we'll talk about the auto industry in a moment—e-prescribing is becoming increasingly common. Yet, electronic prescriptions remain the exception, not the rule.

A recent Center for Health Transformation study (brought to our attention by BNA - subscription required) reviewed the benefits of, and barrier to, e-prescribing. The study, Electronic Prescribing: Building, Deploying and Using E-Prescribing to Save Lives and Money, concluded that an electronic prescribing system would improve patient safety and control costs. But the barriers to wider adoption of e-prescribing are substantial. Implementing a system is costly; fear of change is also a factor.

There are several e-prescribing initiatives that illustrate that these barriers can be overcome. Here's an example:

American automobile companies are determined to reduce high employee health benefits costs to stay competitive in the global market. Ford estimates that $1,000 of every automobile price tag goes toward paying for employee health benefits, and GM estimates that the amount it spends on health benefits in one year could build four new plants, launch six new vehicle programs or renovate 16 paint shops. Armed with this much motivation, Ford, GM, and DaimlerChrysler (with health care partners, such as Medco Health Solutions and Blue Cross Blue Shield of Michigan and others) launched the Southeast Michigan e-Prescribing Initiative (SEMI) in February 2005. SEMI provides financial incentives for doctors at the Henry Ford Medical Group to adopt e-prescribing.

The SEMI program has been so successful that now an incredible 90% of the electronic prescriptions written in Michigan (over eight million prescriptions) are written by physicians participating in SEMI. The Henry Ford Medical Group says that the increased use of generic drugs has saved more than $3.1 million per year. And the cumulative savings of generic drug use, reduced medical errors, and improvements in work flow are estimated at around $4 million dollars per year. The survey data and cost savings were so promising to the sponsors of SEMI that they have extended physician enrollment from May 31, 2007 to June 30, 2008. Michigan now ranks fifth among the top e-prescribing states, according to a 2008 report by SureScripts, operator of the Pharmacy Health Information Exchange. Rankings are based on the number of scripts written and sent electronically as a percentage of scripts that could be.

We are really encouraged by this news. We already knew that, in theory, e-prescribing can cut costs by:

• Avoiding medical errors. Electronic alerts check for dangerous drug-to-drug interactions at the time of prescribing; the electronic prescriptions eliminate errors due to illegible handwriting
• Encouraging the use of generic drugs. Generics often cost significantly less than brand-name drugs, reflected both in the co-pay and the insurance reimbursement
• Streamlining the prescription process. Electronic prescriptions transfer between pharmacies and providers instantaneously, saving time and increasing productivity

The SEMI experience, however, demonstrates that e-prescribing is more than just a good cost-saving idea in theory. In fact, a recent survey of Detroit area physicians participating in the initiative found that:

• Seventy-five percent of physicians believe strongly that e-prescribing improves safety for their patients, and 70% say it improves the quality of care
• More than 80% of all prescriptions written by the physicians surveyed are currently electronic, and 40% of surveyed practices now only write prescriptions electronically
• More than 70% saw a reduction in communication with pharmacies over prescription questions
• More than 50% strongly agree that e-prescribing saves clinicians time and increases productivity
• More than 1 million drug-to-drug risk alerts were sent, and 41% of those prescriptions were cancelled or changed
• 39% of the time physicians changed prescriptions to less expensive generics when alerted of the option at the time the prescription was written

Some of these achievements were shared at a recent Senate Finance hearing. We hope that this real world example will spur Congress to move ahead with legislation to promote more e-prescribing and health IT in general.