1. E-prescribing lacks uniform and/or complete technical standards and physician technology vendors have yet to implement what standards do exist.
2. E-prescribing is expensive for prescribers.
3. Pharmacies in my community do not accept electronic prescriptions.
4. Physicians incur the cost of e-prescribing while enjoying little of the financial gain.
5. E-prescriptions take more time than paper prescriptions.

• Physicians and pharmacists are successfully e-prescribing today in all 50 states, plus Washington, D.C., using technical standards that have been developed and have been in use over the past 10 years.
• The SCRIPT standard, developed by the National Council for Prescription Drug Programs (NCPDP), has been the common and utilized standard to facilitate e-prescribing since April 1997.
• The SCRIPT standard is currently on Version 10. SureScripts uses the SCRIPT standard to test and certify physician and pharmacy software vendors. Today, the SCRIPT standard has been implemented by all major physician and pharmacy software vendors.
• Physicians are able to keep current with the standard through their normal schedule of
• software upgrades – i.e. there is no need to throw away existing technology or wait for the next version of the standard.
• The Centers for Medicare and Medicaid Services (CMS) adopted the SCRIPT standard as a foundation standard to be used by participants in the Medicare Part D program for electronic prescribing. The foundation standards adopted by CMS include:
• Transactions between prescribers (who write prescriptions) and dispensers (who fill prescriptions) for new prescriptions
  • Refill requests and responses
  • Prescription change requests and responses
  • Prescription cancellation, request and response
  • Eligibility and benefits queries and responses between prescribers and Part D
  • Sponsors
• The Pharmacy Health Information Exchange processes over 500 electronic prescriptions every two minutes and nearly 250,000 each day using these CMS foundation standards. The nation’s pharmacies estimate that by the end of 2008, 100 million e-prescription transactions will have been securely and successfully processed.
• The Medicare Modernization Act (MMA) required CMS to implement pilot projects to test standards that facilitate additional function and information exchange. These additional standards were pilot tested in 2006 and subsequently adopted by CMS. They are:
  • Formulary and benefit information
  • Medication history
  • Fill status notifications
• Additional standards for prior authorization, patient instructions (Structured and codified SIG) and clinical drug terminology (RxNorm) remain in development. When ready, these additional standards will allow more advanced functions and features to be added to existing e-prescribing systems. However, they are by no means preventing any physician, pharmacist or patient from realizing the substantial and measurable benefits associated with e-prescribing today.
• Many of the organizations that helped develop the standards used in e-prescribing were in Washington, D.C., recently attending a semi-annual conference dedicated to the continued development and successful implementation of e-prescribing standards. A sample of the long-standing participants includes:
  • Pharmacies: Ahold USA, Longs, McKesson Pharmacy, Medicine Shoppe, Rite Aid, Supervalu, Walgreens and Wal-Mart
  • EMR and E-Prescribing Companies: Allscripts, Athena Health, Cerner, DrFirst, eClinicalWorks, Epic, iScribe, Misys, NextGen, RelayHealth, RxNT, Sage and Zix
  • Health Systems: Cleveland Clinic, Duke University Health Systems, University of Pittsburgh Medical Center

E-prescribing is expensive for prescribers.

• The cost to a prescriber of acquiring a standalone e-prescribing system ranges from – no cost to $100/month.
• While an investment in an electronic medical record system offers many benefits to a physician practice, including the potential to e-prescribe, there are many standalone eprescribing solutions that inexpensively allow a physician to send and receive prescription information to and from local pharmacies electronically.
• E-prescribing-only solutions can be a first step towards deployment and use of an EMR system.
• Currently, the Certification Commission for Healthcare Information Technology (CCHIT) does not certify standalone e-prescribing solutions. As a result, these solutions are not eligible for donation to physicians under the Stark law (i.e. the law stipulates that health systems may donate only those e-prescribing technologies that are certified by CCHIT).

Pharmacies in my community do not accept electronic prescriptions.

• There are over 40,000 pharmacies e-prescribing today, representing more than 70 percent of all pharmacies in the U.S.
• Nearly 100 percent of chain pharmacies and 30 percent of independently owned pharmacies e-prescribe.
• Of the community pharmacies that are not currently e-prescribing, SureScripts estimates that approximately 86 percent have the capability to e-prescribe; however, these pharmacies either have not upgraded their software to the necessary certified version or have not requested to have their software activated for e-prescribing. The vast majority of these e-prescribing capable pharmacies are independently owned.
• For more details, see page 6 of the National Progress Report on E-Prescribing –
• www.surescripts.com/report.
• For a list of e-prescribing pharmacies by state, go to www.surescripts.com.

Physicians incur the cost of e-prescribing while enjoying little of the financial gain.

• A study by MGMA’s Group Practice Research Network estimated that administrative complexity related to prescriptions costs practices $15,700 a year for each full-time physician – that does not even take into consideration the time and cost of managing faxes.
• Studies have shown time spent managing refills drops from 5 minutes each to 20 seconds when e-prescribing is implemented in the practice. Reports from prescribers across the U.S. echo these time and cost savings:
  • Dr. Mark Fracasso, an OB/GYN specialist from Virginia, has seen even more dramatic results in his practice. According to Dr. Fracasso, his staff now spends about 4 seconds per renewal authorization, down from 13 minutes prior to implementing electronic prescribing.
  • Dr. Richard Olarsch, a Family Medicine physician from New Jersey estimates that he is saving as much as 5 hours a day by virtually eliminating prescription-related phone calls and faxes after he adopted an e-prescribing application.
  • Dr. David Gorelick of Newport, Rhode Island estimates savings of roughly 10 hours each week, by having reduced the prescription-related phone and fax burden on the staff.
  • Patricia Hernandez, a physician assistant with Richland Family Medicine in Washington reports that electronic prescribing has taken a 15 minute process to approve a refill down to 15 seconds.
  • Dr. Samuel Kelly of High Point, North Carolina says e-prescribing reduced the time spent managing prescriptions from 10% of total work hours to approximately 5%.
  • Dr. Michael Randolph of Baltimore cites a tenfold increase in daily efficiency and ability to authorize and transmit 20-30 refill authorizations in a matter of seconds.
  • Dr. Rebecca Andrews of New Britain, Connecticut and Dr. Kenneth Adler of Tuscon, Arizona both report that e-prescribing has eliminated 2 hours a day previously spent managing charges and paper prescriptions.
  • Dr. Gul Chablani in Rockville, Maryland reports that whereas his practice formerly spent 3-4 hours/day to fulfill prescription refill requests, they now spend one hour/day. Clarification requests from pharmacies have been reduced from 6-10/day to nearly zero.

E-prescriptions take more time than paper prescriptions.

• Once patient preferences and medication histories have been established within the eprescribing software, generating new prescriptions takes the physician less time and is more convenient and safe for the patient. This is especially the case with patients on multiple chronic medications.
• This misperception ignores the substantial time spent by practices processing refills that can be saved with e-prescribing (see Reality behind Myth # 4).