The two e-prescribing systems involved (Caremark's iScribe® and Allscripts' TouchScript®) had implemented features making use of the medication history and the formulary and benefit standards. This offered the opportunity to compare perceptions among e-prescribing users and nonusers who had all volunteered to be relatively early adopters of these systems. At the time of the survey, some physicians in the program had been using e-prescribing (for up to 2 yrs) and others were still awaiting e-prescribing installation. The study assessed whether the standards worked to deliver the intended benefits and elucidated opportunities for improving the e-prescribing infrastructure. We conducted a cross-sectional self-administered web-based survey to assess perceptions about RxH and F&B information (including its accuracy and usefulness), office workload, and prescribing safety and quality, among physicians who were enrolled in a program that sponsored e-prescribing adoption. 10,24 For e-prescribing to benefit patients, its rate of adoption will need to accelerate and, once adopted, such systems must be effectively integrated into clinical workflow. 23 Even in settings where e-prescribing has been adopted, usage and effective integration into clinical workflow varies widely. Although e-prescribing systems have been widely available for several years, previous studies have found that only 11–24% of physicians have adopted e-prescribing in the outpatient setting 20-22 and e-prescribing only accounted for 2% of the roughly 1.5 billion prescriptions filled in the United States in 2007. The barriers to e-prescribing adoption and use also require further study. 7,19 Similarly, obtaining standardized formulary and benefit information could help providers to minimize patients' out of pocket costs and to ensure better patient adherence. 6 While safety alerting was common among commercial e-prescribing systems, previous studies have found that systems rarely integrate data from external sources to support this alerting. In the case of the medication history standard, benefits are expected from having a more complete and accurate medication list available for drug interaction alerts and reminders for important omitted medications. 17,18 System features that make use of the RxH and F&B standards could improve prescribers' workflow through the avoidance of telephone calls from pharmacies, pharmacy benefit managers (PBMs) or health plan administrators when prescriptions are not filled due to safety or coverage concerns. 16 However, the extent to which these standards, as implemented, actually deliver their intended benefits is not known.Į-prescribing standards, like any structural component of health care, should be assessed based on the extent to which they enable improvements in health care processes and outcomes. Based on industry experience and preliminary results of pilot testing, CMS issued rules that will require use of the formulary and benefits, and medication history information standards for e-prescribing programs under Medicare Part D. 14,15 Two of the standards that required pilot testing, the Medication History ( RxH) transaction of the NCPDP SCRIPT standard, and the NCPDP Formulary and Benefit ( F& B) Standard, were already in use within some commercial e-prescribing systems and could be evaluated in the field.
Recognizing the importance of interoperable data exchange in e-prescribing, the Medicare Modernization Act of 2003 (the MMA) required the United States Department of Health and Human Services to conduct pilot studies of electronic prescribing standards and to issue rules requiring the use of standards found to be beneficial for electronic prescriptions to be covered by Medicare.
6–10 Because most patients in the United States receive their pharmaceutical care from a network of organizations including physician offices, retail pharmacies, prescription benefit management companies, and health plans, implementing advanced e-prescribing features requires the use of standards for exchanging data among these separate organizations. 5 Yet for e-prescribing systems to create these benefits, they need to go beyond simply authoring and storing prescriptions to incorporate more advanced decision-support features such as drug interaction alerts based on the patient's complete and current medication list and guidance in selecting medications that match the patient's drug benefits. Ambulatory electronic prescribing (e-prescribing) is a form of health information technology that is expected to have immediate benefits, including improved quality and safety of prescribing, 1–4 more cost-effective medication options for patients, 4 and improvements in ambulatory care workflow.
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