Incentives for ePrescribing
The Wall Street Journal has a story last week on ePrescribing, written by Laura Landro, a WSJ managing editor and CML survivor:
"Medicare this month began paying doctors a bonus if they switch their patients over to e-prescribing. Some private health plans also have begun offering extra payments along with free equipment, such as digital handheld devices. And a coalition of technology companies is giving doctors free software to encourage them to ditch their paper prescription pads. As a result, the number of physicians prescribing medicines electronically has more than doubled in the past year to about 70,000, or about 12% of all office-based doctors....
"But there are still barriers to full-fledged adoption of e-prescribing. Federal drug laws, which are under review, prohibit electronic prescribing of controlled medications such as narcotics, insomnia drugs and anti-depressants...
"In a study published last month in the Archives of Internal Medicine, researchers at Brigham and Women's Hospital found that e-prescribing systems that allow doctors to select generic or lower-cost medications can reduce annual costs of delivering drugs to consumers by $845,000 for every 100,000 patients..."
Comments on the story
The comments from user physicians and pharmacists have been generally negative, revolving around privacy concerns, cost of use, the cumbersome nature of the interface, and how it's not integrated into the billing and existing practice management systems. One commentor draws an analagy to the travel industry, when early adopters got free miles for booking flignts online instead of using the telephone, and now one is charged for using the telephone and not booking online—he predicts the same will happen with ePrescribing (surprise!).
Make ePrescribing convenient—reduce the friction and maintain safety
My concern has to do with prescribing of schedule II and above narcotics, which are mandatory for treating pain in cancer patients. I was in practice in California when we had "triplicate" perscriptions. These were purchased from the state, and had to be filled in precisely. The back copy of the perscription was kept in my "triplicate book," the two copies handed to the patient; when the patient filled the perscription with the pharmacist, the pharmacist kept the original on file (for the inevitable audit), and forwarded the remaining copy to the state. We were forever running out of them, and forever getting calls from the pharmacists because of writing errors. They could not be faxed, so that people who lived far away or legitimately ran out of their narcotics over the weekend were out of luck. This procedure certainly increased the hassle factor for prescribing narcotics over say, Tamoxifen, but I don't know whether it reduced the narcotic diversion problem. Triplicate prescribing had been abandoned by 2003, when I moved away.
ASCO's comments on the Drug Enforcement Administration's proposed rule on ePrescribing
ASCO joined the AMA, ASH, and thirty-one other professional societies (letter here) in encouraging the Drug Enforcement Administration (DEA), which has jurisdiction over narcotic prescribing on a federal level, to accomodate ePrescribing. The letter was written in response to a proposed rule on ePerscribing, in which "DEA proposes a process for electronic prescribing (eprescribing) of controlled substances that supplements, but does not replace, existing prescribing and dispensing requirements established by the Controlled SubstancesAct (CSA) and DEA regulations."
From a user perspective, we should have minimal hassles to prescribing necessary narcotics to cancer patients, consistent with the applicable law on narcotic prescribing. ePrescribing should be designed to meet both needs—that of the cancer doctor and the regulatory and law-enforcement authorities.
Incentives for ePrescribing