Accelerating e-Prescribing

New Study Reveals Patient Safety and Cost Effectiveness of e-Prescribing

According to a new study published in the Archives of Internal Medicine, computer-based systems that allow clinicians to prescribe drugs electronically are designed to automatically warn of potential medication errors. The new study reveals electronic prescribing not only prevents mistakes, but is also helping to reduce health care costs.

The study suggests that Massachusetts physicians using a commercial electronic prescribing system for a six month period in 2006 may have prevented three deaths and more than 400 injuries as well as saved more than $400,000 by heeding medication error alerts.

"Our previous research showed that most doctors ignore or reject most drug interaction alerts, calling into question the value of this technology," says the study's lead author, Saul N. Weingart, MD, PhD, vice president for quality improvement and patient safety at Dana-Farber. "However, these new findings show that these systems create significant value despite the high number of ignored alerts."

The researchers reviewed 279,476 alerted prescriptions written by 2,321 ambulatory care clinicians in Massachusetts using a single commercial e-prescribing system from January 1 through June 30, 2006. An expert panel reviewed a sample of common drug interaction alerts and then estimated the likelihood and severity of adverse drug events associated with each alert, the likely injury to the patient, and the health care utilization required to address each adverse drug event. Researchers established the cost savings due to e-prescribing by using third-party-payer and publicly available information.

"The findings add support to current, national efforts to expand the use of electronic health records in ambulatory care," says Weingart. "However, the work also shows that these systems are often inefficient. We need to develop more powerful and refined systems to better support the work of frontline clinicians."
The study was supported by a grant from Blue Cross Blue Shield of Massachusetts.

e-Prescribing Alerts Improve Patient Safety

According to HealthDay News, drug interaction alerts from electronic prescribing programs improve patient safety and reduce costs in outpatient care, despite the fact that over 90 percent of the alerts are overridden by physicians, according to a study in the Sept. 14 issue of Archives of Internal Medicine.

Saul N. Weingart, M.D., from the Dana-Farber Cancer Institute in Boston, and colleagues examined the benefit of electronic prescribing and drug interaction alerts in ambulatory care using data from 279,476 alerted prescriptions in Massachusetts in the first six months of 2006. The impact of the alerts on patient safety and health care utilization was determined by an expert panel. They note that drug interaction alerts occurred in 7.3 percent of prescribing attempts and 91.1 percent of alerts were overridden by clinicians.

The panel estimated that the electronic alerts likely prevented 402 adverse events. Accepted alerts may have prevented three deaths, 14 cases of permanent disability, and 31 cases of temporary disability. The researchers estimated that alerts may have led to 39 fewer hospitalizations, 34 fewer visits to the emergency department and 267 fewer office visits, resulting in a savings of $402,619. The panel estimated that 331 alerts were required to prevent one adverse drug event, and only 10 percent of alerts may have accounted for 78 percent of the reduced costs.

"Electronic prescribing alerts in ambulatory care may prevent a substantial number of injuries and reduce health care costs in Massachusetts," Weingart and colleagues conclude. "Because a few alerts account for most of the benefit, e-prescribing systems should suppress low-value alerts."

The study was supported by a grant from Blue Cross Blue Shield of Massachusetts.

Five Decisions Determine the Fate of e-Health Records

FederalComputerWeek indicates that there are 5 critical decisions that will determine the fate of e-health records. Under the economic stimulus law passed earlier this year, as much as $45 billion will be distributed to health care providers who buy and use approved electronic health record systems.

The road ahead is still bumpy for EHRs, but experts say success hinges on the outcomes of five major decisions.  FederalComputerWeek's five decisions are listed here:

1. Follow the rules or be innovative?

Officials at the Health and Human Services Department have the daunting task of creating a framework for certifying EHR systems that are capable of collecting and sharing patient data in ways that satisfy the broader goals of the stimulus law. A critical question is whether HHS can strike the right balance of rigidity and flexibility.

“There is always a trade-off between innovation and any kind of a certification process,” said Wes Rishel, a vice president and distinguished analyst at Gartner’s health care provider research practice.

2. Broaden the meaning of “meaningful use?"

In the stimulus law, Congress said only doctors and hospitals that show meaningful use of EHRs can receive incentive payments. That language was meant to prevent the buying of systems that sit idle or are not used as intended. Key decisions for HHS are how broadly and stringently to apply the meaningful-use framework to meet major goals, such as cost savings, improved care and better public health.

3. Take baby steps or giant leaps forward?

To help HHS meet its fast-approaching deadlines, an advisory committee urged the agency to immediately set up a temporary program that would allow an existing organization to certify vendors’ EHR systems until more permanent arrangements could be made.

Dr. Carol Diamond, managing director of the Markle Foundation’s Health Program, said HHS should allow the same sort of flexibility for providers to meet EHR-use goals. Some are already using EHRs, but others lag far behind, she added. “We still live in the real world,” she said. “You cannot get up to speed all at once.”

4. Let the states lead the way on data exchange?

The ultimate goal of health information technology is the automatic sharing of patient data. The reasoning goes that if providers exchange patient data with government agencies and one another, analysts can identify trends and send the results back to doctors and hospitals to help them provide better care and reduce costs.

For now, a little sugar is making the medicine go down easier — such as the $564 million in state grants for health information exchanges that HHS announced in August. But the agency still has a key decision to make on the federal government’s role in creating that data network.

“You have to either grow the state exchanges that will be connected or try to seed from the top,” said Deven McGraw, director of the Center for Democracy and Technology’s Health Privacy Project.

5. Wait for broader health reforms or forge ahead?

Dr. David Blumenthal, HHS’s national coordinator for health IT, said he hopes to strike a balance between incentives and penalties for EHR use. The rules must foster competitiveness, innovation, privacy and security, among other often-conflicting goals. But decisions are also looming about how hard HHS should push for health IT in advance of more comprehensive reforms that will affect health care access and payments.

“If we do not do the work on payment reforms, we will not really reap all the value of health IT,” McGraw said.