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E-Prescribing Defined
National Statistics on E-Prescribing
Statistics on U.S. Prescription Drug Market
Statistics Illustrating the Challenge Posed by Paper-based Prescriptions
Benefits of E-Prescribing
Important Developments in Support of E-Prescribing
E-Prescribing Defined
A physician’s use of real-time, patient-specific clinical and economic information, for consenting patients, to: - Prescribe the most medically appropriate and cost effective prescription at the point of care, and
- Transmit the prescription electronically to the patient’s pharmacy of choice.
Pharmacies can also request refills by sending an electronic refill request to the physician office for approval
National Statistics on E-Prescribing
(Highlights from the National Progress Report on E-Prescribing (December, 2007))
E-Prescriptions - In 2007, 35 million prescription transactions were routed electronically in the U.S.
- There were more electronic prescriptions in the first three quarters of 2007 than in 2004, 2005 and 2006 combined.
- Of the estimated 1.47 billion new prescriptions and renewals eligible for electronic routing in the U.S. in 2007 – two percent (2%) were electronically prescribed.
- For 2008, SureScripts estimates the number of prescription transactions routed electronically will grow to over 100 million, thereby increasing the percentage of the nation’s new prescriptions and renewals transmitted electronically to approximately seven percent (7%).
E-Prescribers - Through the end of 2007, there were over 35,000 prescribers e-prescribing in the U.S.
- UPDATE: As of March 31, 2008, there are over 40,000 e-prescribers in the U.S.
- The vast majority of e-prescribers (95 percent) are physicians.
- This means that six percent (6%) of the 563,000 office based physicians in the U.S. are e-prescribing.
- More prescribers electronically prescribed in the first 10 months of 2007 than in all of 2004, 2005 and 2006 combined.
- For 2008, SureScripts estimates the number of electronic prescribers will grow to approximately 85,000.
E-Prescribing Community Pharmacies - There are over 40,000 pharmacies e-prescribing in the U.S.
- UPDATE: As of March 31, 2008 – there are nearly 42,000 pharmacies e-prescribing in the U.S.
- This represents over 70 percent of pharmacies in the U.S.
- For 2008, SureScripts estimates the number of e-prescribing pharmacies will grow to 45,000.
Statistics on U.S. Prescription Drug Market
Number of Physician Office Visits in the U.S. in 2007 - 1.56 billion – Office Visits*
- 550 million – Number of office visits generating at least one prescription*
- 20 % - average rate of unfilled prescriptions**
Number of Drugs Prescribed in the U.S. in 2007** - 4,416,285,490 – Total Written
- 883,257,098 – Unfilled
- 3,533,028,392 – Total Dispensed
- 1,834,547,592 – New and Renewals
- 910,998,864 – New Prescriptions
- 923,548,728 – Prescription Renewals
- 1,698,480,800 - Refills
Money Spent on Prescription Drugs in the U.S. - The U.S. spent $270 billion on prescription drugs in 2007.**
*AHRQ - Medical Expenditure Panel Survey
**NACDS Economics Dept.
Statistics Illustrating the Challenge Posed by Paper-based Prescriptions
Paper Prescriptions Cost Physicians Time and Money - A study by the Medical Group Management Association’s Group Practice Research Network estimated that administrative complexity related to prescriptions costs a practice approximately $15,700 a year for each full-time physician on staff – a figure that does not even take into consideration the time spent managing faxes.
- Multiplying that figure by an estimated 563,000 office-based physicians currently practicing and prescribing medications in the United States reveals an opportunity for e-prescribing to significantly reduce the up to estimated $8.8 billion worth of physician and staff time spent on the phone clarifying prescription information.
- According to research by SureScripts, refills management costs $50,000 a year/per practice
- Practices spend on average 4.78 to 4.92 hours/day managing refills
- Prescribers spend on avg.1.84 – 1.88 hrs/day
- Staff spend on avg. 2.94 to 3.04 hrs/day
Medication Errors - According to a July 2006 report issued by the Institute of Medicine, more than 1.5 million Americans are injured annually by medication errors.
- According to the Institute for Safe Medication Practices, many medication errors result from:
- Miscommunication due to illegible handwriting
- Unclear abbreviations and dose designations
- Unclear telephone or verbal orders
- Ambiguous orders and fax-related problems
- According to the September 10, 2007 issue of the Archives of Internal Medicine
- Serious adverse drug events and related deaths more than doubled between 1998 and 2005
- From 1998 to 2005, the number of reported serious adverse drug events increased 2.6-fold from 34,966 in 1998 to 89,842 in 2005.
- The number of fatal adverse drug events increased 2.7-fold during the same time period, from 5,519 in 1998 to 15,107 in 2005.
- The number of adverse events increased four times faster than the total number of outpatient prescriptions, which rose from 2.7 billion to 3.8 billion during that time frame.
- "...We saw increases in drugs whose risks we've really known about and should be able to manage. We've had insulin for 50 to 60 years, yet adverse events are increasing rapidly..."
Growth in Similar Sounding Drug Names - According to the April 14, 2008 issue of the American Medical News, there are 3,170 pairs of drug names that look or sound alike and can result in medication errors. They were found in a recent U.S. Pharmacopeia review of more than 26,000 patient records submitted over three years by 870 health care organizations. That total is nearly double the 1,750 similarly named drug pairs identified in a 2004 report issued by USP, a Rockville, Md.-based nonprofit standards-setting organization.
- The more than 30,000 drug-name mix-ups included in the January 2008 USP report harmed patients 1.4% of the time, with seven patient deaths attributed to mistakes. USP leaders and other experts said including the indicated use for a medication could prevent such problems.
- One physician's faxed order to discontinue hydrocodone, marketed as Anexsia, was misread by the pharmacist as an order to discontinue Arixtra, an anticoagulant.
Benefits of E-Prescribing
Economic Benefits - According to researchers at Brown University, e-prescribing helped physician practices cut in half the average time spent per day processing prescription renewal requests from pharmacies.
- Physicians using e-prescribing are vocal about the benefits they see for their practice and patients. To read some first hand accounts, go to www.GetRxConnected.com.
- Statistics from the Henry Ford Health System based on its use of e-prescribing:
- Improved Generic Use Rate
- Henry Ford Medical Group has improved its generic use rate by over 20%
- Health Alliance Plan has improved its overall generic use rate by over 71%
- Reduced Administrative Costs
- 2 min administrative time savings per script (time study identified 4 minutes) at $12/hr
- $.03 per script pad savings
- A recent survey of physicians in the Southeast Michigan ePrescribing Initiative (SEMI) program revealed that improved patient safety and quality of care topped the list of key benefits of the technology. According to the survey, conducted by HaldyMcIntosh & Associates:
- More than 70 percent saw a reduction in communications with pharmacies over prescription questions.
- More than half strongly agree that ePrescribing saves clinicians time and increases productivity.
- According to a recent survey of participants in the Massachusetts eRx Collaborative – an e-prescribing adoption effort headed by Blue Cross Blue Shield of Massachusetts (BCBSMA), Tufts Health Plan and Neighborhood Health Plan (NHP) – 81 percent of prescribers would recommend e-prescribing to a colleague:
- That is up from 75 percent in 2006.
- The percentage of prescribers that say ePrescribing results in fewer calls from pharmacies rose to 66 from 55 in 2006.
- Seventy-one percent of respondents say ePrescribing saves time, with the majority saving one hour to two hours per day due to ePrescribing technology.
Clinical Benefits: Patient Safety, More Informed Prescribing - According to the Center for Information Technology Leadership (CITL), use of electronic prescribing systems with a network connection to pharmacy and advanced decision-support capabilities could help prevent 130,000 life-threatening medication errors annually.
- Statistics from the Henry Ford Health System based on its use of e-prescribing:
- Reduced Adverse Drug Events
- Hospital Admits
- 2% of hospital admissions due to ADEs (50% of published research)
- 33% of these avoided with ePrescribing
- Emergency Department Visits
- 1% of ED visits due to ADEs (50% of published research)
- 33% of these avoided with ePrescribing
- A recent survey of physicians in the Southeast Michigan ePrescribing Initiative (SEMI) program revealed that improved patient safety and quality of care topped the list of key benefits of the technology. According to the survey, conducted by HaldyMcIntosh & Associates:
- Three out of four prescribers believe strongly that ePrescribing improves safety for their patients.
- Nearly 70 percent of respondents say it improves the quality of care.
- The study also found that nearly 65 percent of physicians changed at least one prescription in response to a safety alert that warned of potentially harmful drug-drug interactions and drug-allergy risks at the time of prescribing.
- According to a recent survey of participants in the Massachusetts eRx Collaborative – an e-prescribing adoption effort headed by Blue Cross Blue Shield of Massachusetts (BCBSMA), Tufts Health Plan and Neighborhood Health Plan (NHP) – approximately 104,000 electronic prescriptions were changed due to drug safety alerts in 2007.
- This represents 2.1 percent of total electronic prescriptions that were changed or cancelled due to drug messaging.
- This number increased after mid-year, and remained steady for the latter half of the year at around 2.5 percent.
- The highest number of electronic prescriptions that were changed or cancelled in a single month was 9,960.
- A 2005 survey of 2,888 physicians sheds light on what they value most from the opportunity to prescribe electronically. Their responses covered a range of clinical and administrative capabilities.
- The top three clinical opportunities for e-prescribing:
- Medication history across providers
- Patient adherence
- Identify potential drug interactions (drug, food, allergy)
- Eighty-three percent of physicians say they could productively use more information on their patients’ medication history and potential drug interactions at least some of the time.
- Thirty-six percent say they could productively use more information most of the time
- 47 percent say some of the time
- Before writing a prescription, physicians do not typically use e-prescribing to learn their patients’ medication history.
- The most common way physicians learn of their patients' prescription history is by asking the patients themselves—57 percent.
- Twenty-three percent pull the patient's chart, and 6 percent use an electronic system.
- The survey of 407 physicians was conducted June 7 through July 6, 2007 by Ayres, McHenry & Associates, Inc.
- Respondents were selected randomly from a list of physicians throughout the country in fields that typically write prescriptions.
- The sample was purchased from American Medical Information, and all respondents confirmed that they regularly write prescriptions for their patients.
Clinical Benefits: Improving Medication Adherence/Compliance - According to data from the AHRQ Medical Expenditure Panel Survey (1997-2005) and an analysis of that data by the NACDS Economics Department, an average of 20 percent of prescriptions written go unfilled.
- According to studies cited in a recent report by the National Council on Patient Information and Education (NCPIE), only about 50 percent of American patients typically take their medicines as prescribed, resulting in approximately $177 billion annually in direct and indirect costs to the U.S. economy.
- Experts have long viewed e-prescribing as a means of raising awareness of non-compliance when it occurs so that appropriate steps can be taken to help patients.
- Two studies have looked at the relationship between e-prescribing and medication adherence/compliance.
- First, CVS Caremark and Horizon Blue Cross Blue Shield of New Jersey, (Horizon BCBSNJ) on April 17, 2008 release preliminary results of a study that analyzed when and if prescriptions written for the treatment of various chronic conditions, such as cardiovascular disease, were dispensed to patients.
- Study results found a high rate of noncompliance among all patients taking medications to treat a variety of cardiovascular diseases such as high blood pressure, with approximately 18% of those prescriptions unfilled after 60 days.
- Patients continuing their therapy were found to be significantly more compliant than those starting a new therapy with a cardiovascular medication.
- Noncompliance among patients continuing therapy was approximately 6
- Noncompliance rates for patients initiating therapy with a cardiovascular medication (i.e., primary noncompliance) were much higher, with up to 70% of patients noncompliant after 60 days.
- Data was collected between January 1, 2005 and October 31, 2006 from a subset of 507 Horizon BCBSNJ providers who use iScribe e-prescribing technology.
- Researchers conducted a retrospective analysis comparing prescriptions for medications to treat chronic diseases (i.e., asthma, cardiovascular diseases, and diabetes) as well as prescriptions for antibiotics written via iScribe during this time period to submitted drug claims for medications dispensed between January 1, 2005 and December 31, 2006.
- Second, in October of 2007, Walgreens and SureScripts announced research that tracked the number of prescriptions received by pharmacies before and after physicians began using electronic prescribing
- The research showed an 11 percent increase in new prescriptions filled after physicians began using electronic prescribing
- The research – which used prescriber data from IMS Health -- links a physician prescribing electronically, or “e-prescribing”, to more of that physician’s prescriptions making it to the pharmacy.
| Prescription Counts For 100 Prescribers: Before & After E-Prescribing |
| |
3 Months
Before e-Rx |
3 Months
After e-Rx |
Difference |
| New Prescriptions |
272,103 |
302,616 |
11.21% |
- The research involved a convenience sample of 100 active electronic prescribers across five states, 93 different pharmacy organizations at 14,638 locations, and over one million prescriptions. No patient data was used in the analysis. The six months of prescriber data included three months before and three months after physicians began e-prescribing. To account for seasonal influences on prescribing, activation dates spanned 19 months: from April 2005 through November of 2006. The study also controlled for variations in prescribing software by involving physicians using 15 different software vendor applications.
- By reviewing a subset of the overall data (prescriptions sent to Walgreens), researchers also observed that as many, if not more, patients picked up their prescriptions when they were sent electronically to their pharmacy (i.e. as compared to handwritten, printed, faxed, or telephoned prescriptions).
- And while further research is needed to ascertain how electronic prescribing causes more prescriptions to be received by pharmacies and picked up by patients, experts are suggesting the study’s results represent the first evidence that e-prescribing could help address prescription leakage, one part of the long-standing problems of patient adherence. Adherence defines how well a patient sticks to their drug regimen.
Important Developments in Support of E-prescribing
Consumer Support - Nearly 90% of the 1,000 adult respondents to a May 2008 Harris Interactive survey said they want their doctors to be able to share information electronically, and another 71% said they want their doctors to be able to order prescriptions by way of computers.
- The following organizations have formally voiced support for e-prescribing:
- AARP
- AFL-CIO
- American Federation of State, County, and Municipal Employees
- Center for Medical Consumers
- Childbirth Connection
- Consumers Union
- Health Care For All
- National Consumers League
- National Family Caregivers Association
- National Partnership for Women & Families
- SEIU
- A November 2007 survey of 600 seniors in predominately rural counties throughout the country reveals that rural seniors say electronic prescribing sounds like a good idea by a two-to-one margin.
- According to a survey by Ayres, McHenry & Associates, Inc, when read the benefits of e-prescribing and told of the caveats that it would require time and money for doctors to install in their offices, seniors in these medically underserved areas say e-prescribing sounds like a good idea rather than a bad idea by a 48 to 25 percent margin.
- According to a February 2006 survey of more than 1,000 American adults, the vast majority -- 3 in 4 -- feel that their physician would provide them with better care if the physician had access to their current and past medication record, including information from other doctors.
- From a nationally representative telephone survey of 1,032 adults ages 18 and over, conducted February 2 – 5, 2006. Demographic weights were applied to the data to ensure the sample accurately reflected the total population of U.S. adults, 18 years of age and older. The margin of error for the study is +/- 3.1% at the 95% confidence level.
Federal Policy - Starting January 1, 2009, all computer-generated prescriptions covered by the Medicare Part D program must be transmitted electronically and not via fax.
- In July of 2006, the Institute of Medicine recommended that all prescriptions be written electronically by 2010.
- In December of 2007, U.S. Senator John Kerry joined with former Speaker Newt Gingrich and a number of Senate colleagues to announce the introduction of the Medicare Electronic Medication and Safety Protection Act (“E-MEDS”). The E-MEDS bill proposes to offer physicians reimbursements for investing in e-prescribing technology as well as incentive payments each time a prescription is transmitted electronically and the claim is submitted through Medicare.
- In early December 2007, the Senate Judiciary Committee held hearings on the Drug Enforcement Agency’s policy prohibiting e-prescribing of controlled substances. This policy requires physician practices to maintain two separate processes for prescribing: one that is paper-based for controlled substances; and another that is electronically based for all other medications. In the view of many physicians and pharmacists, the administrative burden of maintaining two separate processes is a significant barrier to adoption and use of e-prescribing. If the DEA were to permit e-prescribing of controlled substances, it would represent another potential boost to e-prescribing adoption and use.
On June 27, 2008, the DEA proposed regulations that would provide physicians and other authorized prescribers with the option of issuing electronic prescriptions for controlled substances. These regulations would also permit pharmacies to receive, dispense, and archive these electronic prescriptions. The agency is seeking public comment on the proposed regulations through September 25, 2008.
Physician Leaders Take Unprecedented Step - On March 4, 2007,tThe American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Cardiology (ACC), the American College of Obstetricians and Gynecologists (ACOG), the American Osteopathic Association (AOA) and the Medical Group Management Association (MGMA) recently launched a nationwide program designed to boost adoption and utilization of e-prescribing technology.
- Created in conjunction with The Center for Improving Medication Management (www.TheCIMM.org), the program aims to help an estimated 150,000 prescribers located throughout the United States that are currently using e-prescribing and electronic medical record software to fax prescriptions to pharmacies. Starting January 1, 2009, all computer-generated prescriptions covered by the Medicare Part D program must be transmitted electronically and not via fax.
- The "Get Connected" program is an opportunity to help these physicians make the transition from fax to electronic prescribing before the deadline arrives. Through GetRxConnected.com, physicians and their staffs can find out if their existing software is compliant with the new Medicare regulations and can receive a free, personalized report to help them request an electronic connection to pharmacies through their vendor.
- The Get Connected program is equally intended for physicians and practice management professionals who have yet to invest in EMR or other clinical software. The portal provides guidance on how to evaluate and acquire technology that supports e-prescribing. GetRxConnected.com also helps physicians and practice management professionals to assess the financial impact of e-prescribing using an interactive feature that allows them to calculate an estimate of the time and resources their practice is currently dedicating to the manual processing of prescriptions.
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