With so much focus on the struggling health insurance exchange web sites, other equally important aspects of healthcare reform haven't been getting much press.

One of those is the push to move physicians into using electronic prescribing and electronic health records. The idea is that e-prescribing flags possible adverse reactions, provides an electronic record, and gives physicians ready access to formularies and how drugs are tiered. The goal of using electronic health records something we should have accomplished many years ago is to allow seamless, accurate communication among doctors, hospitals, and patients for all of a patient's medical records.

There is actually some good news on the e-prescribing and EHR front, and some cautionary words for the pharmaceutical industry.

Decision Resources Group's Physician & Payer Forum earlier this year surveyed 174 physicians on their use of e-prescribing and electronic health records, and found a dramatic increase in the use of both over the past seven years.

The survey found that before 2007, only 7% of surveyed endocrinologists and 11% of PCPs said they used e-prescribing. Compare that to 2013:  physicians estimate that 76% of their Medicare patients and 79% of their non-Medicare patients are treated via e-prescribing, rates they expect will increase to 84% and 85%, respectively, in the next year.

Surveyed physicians also revealed a rapid uptake in the use of electronic health records particularly in the past three years driven by the desire for improved efficiencies and the prospect of increased compensation from Medicare and Medicaid. Starting in 2015, physicians will also face penalties for not demonstrating meaningful use of EHR.

All of this is good for the healthcare system in general; it means information can be shared more efficiently and accurately, and eventually physicians will be able to undertake population health management stratifying their patient populations into those who need preventive care, those who need to change their health behaviours, and those with chronic conditions who need help closing care gaps.

Of course the systems are still imperfect: e-prescribing can be cumbersome, pharmacy information can be difficult to find, and formulary information can be incorrect.  And according to the PPF survey, only 20% of endocrinologists and 28% of PCPs with EHRs use them to track drugs effectiveness. But there is finally momentum toward digitally driven management of patients.

For the pharma industry, the move to electronic prescribing and EHR presents both challenges and threats. Roy Moore, who directs the Physician & Payer Forum, offers these caveats:

  • As the use of e-prescribing expands, a brand's formulary status takes on greater importance, and MCOs will likely use this growing importance to seek greater pricing concessions from the pharmaceutical industry.
  • Among physicians with access to formulary information in their e-prescribing system, more than three-quarters say they find themselves paying more attention to patient costs. MCOs want to impact drug choice through the cost-sharing amounts that show up in e-prescribing.
  • Although most physicians do not yet appear to be using EHR to track drug effectiveness, early adopters are likely headed that way, and electronic medical records will allow them to do greater analysis of drug outcomes.

-But there is also good news for pharma, according to Moore. Surveyed physicians face challenges getting drugs and their reimbursement information properly included in their e-prescribing programs. They want the drug industry to work with e-prescribing vendors and MCOs to ensure that drug names and formulary information are correct. They also want to see information on copay coupons integrated into their e-prescribing so that they know patients, costs are reduced when they fill their scripts.

And in the future, physicians expect more clinical and efficacy data about drugs, opening up e-prescribing as a platform for brands that can demonstrate improved compliance and better outcomes.

Follow Sheri Sellmeyer on Twitter @SheriSellmeyer

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