'E-prescribing' can stop errors

May 06, 2007

In an original op-ed, CHT Project Director Jim Frogue and Alabama Policy Institute Vice President Michael Ciamarra propose a race to see which state can be the first to arrive at 100 percent e-prescribing. By Jim Frogue and Michael Ciamarra
(originally published in The Mobile Press-Register)

The race is on. No, it's not a NASCAR event or a regional marathon. What we're proposing is a race between Alabama and Georgia to see which state can be the first to arrive at 100 percent "e-prescribing."

The winner will lead the nation by becoming the first state in America to have every prescription transmitted electronically from physician to pharmacy.

A resolution in the Alabama Legislature makes note of all of this and urges Alabama to become the first. But Georgia is aggressively chasing the title, too.

This is an important issue because, according to the Institute of Medicine, medication errors kill 7,000 Americans annually. They injure 1.5 million, and cost billions of dollars in emergency room visits and other complications.

That is the equivalent of 100 Alabamians killed, 22,000 Alabamians injured, and tens of millions of dollars wasted each year.

Virtually all of this pain and cost is unnecessary. The great majority of these medication errors could be avoided if our health care system had the same level of accuracy and speed we have come to expect from everyday companies such as UPS, FedEx, Google and Expedia.

Each of these is highly profitable, growing and very popular with consumers. The fact that their services are inexpensive or in some cases free certainly contributes to that popularity.

Take UPS and FedEx as specific examples. Most people have gone online to track in "real time" a package they sent to a loved one or a business associate. The accuracy and reliability of UPS and FedEx are unparalleled.

In rare instances where they have trouble with a package, it is almost always the result of human error -- torn paper labels, incorrect addresses or theft -- not the underlying tracking technology.

Surely we can get at least that level of precision in the interaction between physicians, pharmacists and patients. (The joke goes that when a UPS delivery person walks into a doctor's office with his hand-held scanning device, he doubles the amount of computer power on the premises.)

It is in everyone's interest, from a health and cost perspective, that we move aggressively to electronic prescribing and away from illegible handwriting that invites medication errors.

To hasten that process, we've proposed the contest with our neighbor to the east.

Right now, there is no state in America that is close to 100 percent. Fewer than one in five practicing physicians currently e-prescribe.

Georgia and Alabama are well below that national average. Indeed, e-prescribing was literally illegal in Georgia until last year.

Now, though, the Center for Health Transformation is aggressively leading a project in Georgia that already has brought together representatives of all the relevant political and industry players in the state. These include Gov. Sonny Perdue, key legislators of both political parties, physicians, hospitals, chain and independent pharmacists, insurers, and employers.

All are supportive and actively working together.

Our work is complemented by the National E-Prescribing Patient Safety Initiative which removes one of the biggest hurdles to widespread adoption of e-prescribing by doctors: cost.

By simply going online at www.nationalerx.com, doctors can download the necessary software for free. Learning how to use it takes 20 minutes.

The program is already connected to 95 percent of pharmacies, with more coming online everyday.

The eRx initiative is designed specifically to target smaller, less well-funded doctors in urban and rural areas who are not currently e-prescribing. It is not intended to displace commercial programs already in use. The eRx system puts a heavy emphasis on using computer power to cross-check potential interactions and contraindications for individuals who take more than one prescription.

A specific way the state government can create the right incentive to facilitate the move to e-prescribing is for the state-run Medicaid program to reimburse pharmacists, doctors and hospitals at a higher rate for electronic prescriptions as opposed to paper prescriptions.

This is a simple legislative fix that should not have partisan boundaries. Suddenly the central players would have a genuine financial interest to move rapidly to e-prescribing.

The Institute of Medicine has called on all physicians across America to adopt e-prescribing by 2010 as a key solution to improving health outcomes and lowering cost. The Center for Health Transformation will gladly share what it is learning in Georgia with anyone in Alabama who is interested.

While the suggestion for a contest between our two states is lighthearted, saving lives is not a game. The faster any of us can get to 100 percent e-prescribing, the better off we will be.