E-Prescribing Technologies May Improve Efficiency and Safety While Lowering Costs for Three Billion Prescriptions a Year

CHCF analysis concludes that several products show capability to quickly. inexpensively. and easily help physicians

The potential for technology to significantly reduce the costs and medical errors associated with physician drug prescribing habits is still largely untapped, but a handful of companies have started to make inroads, according to a new report commissioned by the California HealthCare Foundation.

Based on the analysis of 19 companies offering a range of basic to comprehensive e-prescribing products, four were found to offer “practical, interim alternatives to more costly and complex integrated prescription-writing solutions.” These were Allscripts, ePocrates, PocketScript, and Wellinx.

This report examines e-prescribing products and organizes the technologies into four categories based on functionality: (1) electronic drug references; (2) integrated drug reference and formulary tools; (3) e-prescribing solutions; and (4) integrated electronic medical records (EMR) and e-prescribing systems. Each of the four categories was rated based on ease-of-use, implementation costs, and potential impact on patient safety. The results provide potential buyers with an easy way to assess the range of options and implementation considerations.

The products provide electronic tools that support physicians’ needs to access information on thousands of drugs, correlate that information to a health plan’s list of approved drugs or formulary, check for patient-specific drug-interactions, capture medical notes, and finally, electronically transmit a legible prescription to a printer or directly to a pharmacist.

“In light of significant cost and complexity barriers to adopting some of the e-prescribing technology solutions, we concluded that four stand-alone prescribing products on the market favorably impact prescribing efficiency, cost, and quality while still being affordable and easily integrated into a physician’s practice,” said Melissa Buckley, M.P.P., author of the report, Improving Drug Prescribing Practices in the Outpatient Setting: A Market Analysis.

Each of these four products rely on the use of a personal digital assistant (PDA) to provide the physician-at the point of patient contact-with a combination of either drug information, formulary information, or patient-specific information.

Three of the companies (Allscripts, PocketScript, and Wellinx) offer the capability to transmit a prescription to a printer or pharmacy. The fourth (ePocrates) integrates health plan formulary information from health plans and pharmacy benefit managers with drug reference information.

Costs for the products reviewed in the study range from none to more than $200,000. Low-cost products in the drug references category are useful tools but offer little in the way of improved safety outcomes and cost control. On the other hand, solutions that offer formulary information integrated with a patient’s electronic medical record offer significant impact on safety, but come with a high cost and complex implementation challenges.

The study points out that the adoption by physicians of point-of-care prescribing products based on PDA technology has been slow. In a survey cited in the report, only 30 percent of 1,200 physicians surveyed owned a PDA. Of those, a little more than half used the device to access drug information.

Nevertheless, physicians must manage a staggering amount of drug information. According to the report there are more than 17,000 drug brands for sale in the United States; some 1,500 new pharmaceuticals are now slated for FDA approval; and an average of 16 managed care contracts and related formularies are managed by a typical physician group.

“If physicians in greater numbers start to use the tools available for drug prescribing, we believe it will contribute to reducing medication errors and lowering the total cost of drug spending, which increased 17 percent to $154.5 billion in 2001,” said Claudia Page, CHCF program officer.

Each of the four categories was rated as low, moderate, or high on efficiency, lowering costs, improving patient safety, ease of implementation, affordability, and stability and use in the market. See the report for details. Following are the products (and vendor names) in each category:

  1. Electronic drug references: Formulary Data Source (Council for Affordable Quality Healthcare); ePocrates Rx 4.0 (ePocrates); Pocket PDRRS (Franklin Electronic Publishers); Physician’s Drug Handbook (Handheldmed.com); DrDrugs (Skyscape.com); and mobilePDR (Thomson Medical Economics).
  2. Integrated drug reference and formulary tools: Rx Formulary (ePocrates), based on the Palm OS platform.
  3. E-Prescribing solutions: Touch Works:Rx+ (Allscripts); PocketScript (On October 30, 2002, Medix Resources, a New York-based e-prescribing company, announced that it intends to buy the assets of PocketScript.); and Wellinx Clinical Information System (Wellinx), all based on the Pocket PC platform.
  4. Integrated EMR/e-prescribing systems: TouchWorks Rx+ (Allscripts); PowerChart (Cerner Corp.); Medicware (Companion Technologies); EpicCare, Epic OnHand (Epic Systems); Centricity, Logician (GE, Medical Systems Information Technologies); Entity (Health Care Data Systems); Misys EMR (Misys Health Care); Concept, Lytec, MediSoft (NDC Health); NextgGenEMR (NextGen); ChartStation (VitalWorks); and OmniChart (WebMD). “CHCF’s iHealth Program seeks to accelerate the adoption and effective use of new information technologies in health care. While the Foundation does not endorse specific products or companies, this iHealth Report is intended to provide health care providers and decision-makers with practical, timely, and reliable information on available technologies,” said Page. “We recognize that this is a fluid market and that each product reviewed has both benefits and limitations and may or may not be practical for any given medical practice.”The full report is available online through the link below.

Contact Information:
Eric Antebi
Director of Communications

About the California Health Care Foundation

The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.