Support as Important as Incentives for E-Prescribing

By M.L. Baker  |  Posted 04-25-2005
A small raft of health care payers and their partners have launched new campaigns to encourage physicians to write electronic prescriptions. This time, they are offering support along with free equipment, software and other incentives.

On Friday, a collaborative of three automakers sent letters to over 6,000 physicians asking them to participate in a new program: SEMI (Southeast Michigan ePrescribing Initiative), which offers physicians belonging to the Blue Cross Blue Shield of Michigan's Blue Preferred Plus network on-site training for using electronic prescriptions. Physicians can also receive undisclosed incentives through the program as well as discounts from the auto manufacturers. Eventually, the program may be expanded to as many as 17,000 physicians.

SEMI simply provides physicians with a list of companies offering e-prescribing software, but at least two programs on the East Coast are collaborating with specific vendors. This month, Horizon Blue Cross Blue Shield of New Jersey and pharmacy benefit manager Caremark Inc. announced they are providing software and hardware from Caremark's iScribe division. Some $3 million has been set aside to provide equipment for an estimated 700 physicians.

Also this month, software vendor Zix Corp. announced that the e-prescribing activity of physicians who signed up for free services had been high enough that the program's funder, Blue Cross and Blue Shield of Massachusetts (BCBSMA), has authorized signing up 300 more physicians.

In e-prescribing, doctors send prescriptions to pharmacies electronically rather than handing a piece of paper to a patient. Proponents say that the practice will reduce medical mistakes as well as the effort necessary to write, fill and refill prescriptions. Health plans think it will keep costs down because physicians will be more likely to prescribe drugs on formulary lists.

Physicians have objected to e-prescribing systems, saying they cannot afford necessary technology and that writing a prescription on paper is often faster. Last year, WellPoint Inc. famously offered thousands of physicians free e-prescribing tools only to have the majority refuse them in favor of practice-management systems. In another reported instance, the Washington, D.C.-based Council for Affordable Quality Healthcare, a coalition of health plans, offered 200 free subscriptions to e-prescribing software, only to have 100 takers.

But attitudes may be shifting. A 2004 survey of 180 U.S. and European physicians found that American doctors were most willing to try the new technology, with 73 percent being amenable to trying the tools, according to Markets and Research. Another survey of hundreds of U.S. physicians found three-fifths of PDA-owning physicians used their handhelds for electronic prescribing if their clinic was set up to allow it.

Kirk Paul Kirkman, vice president of physician recruitment and retention of Zix, which had previously partnered with WellPoint, said vendors are getting more savvy about persuading physicians to adopt e-prescribing. For one thing, he said, vendors realize that even if physicians don't pay for hardware and services, the disruption caused by getting the systems up and running could slow physicians down and so cost money. Some incentive programs failed because doctors had to deal with several entities to get the right hardware, software and connectivity.

He said that's not the case with the program in Massachusetts, which is funded by BCBSMA and sponsored by eRx Collaborative, a coalition of health care payers and other entities. "We make sure they have one source of accountability." In addition, software vendors must figure out when and how to offer help because providers might abandon technology rather than ask for assistance. "We know they won't pick up a phone during patient hours and call a vendor," Kirkman said, so Zix compares the number of prescriptions written before and after practices turn from ink to electrons. "If the prescriptions drop, they are having trouble, and we have to fix that."

Kirkman said physicians are signing up for e-prescribing at an accelerating rate, sometimes more than 100 physicians a week, and that adoption rates for physicians have been similar regardless of incentives offered by health plans. (Kirkman declined to say what these incentives are, but health plans often offer higher reimbursement rates to e-prescribing physicians.) Zix is paid by the collaborative per physician deployed.

Tammy Lewis is chief marketing officer for SureScripts, the main e-prescribing network that connects doctors' offices to pharmacies. SureScripts educates physicians about e-prescribing and keeps a list of certified solution providers, but does not back particular vendors or provide hardware or software. She told Ziff Davis Internet News that physicians are adopting e-prescribing faster in communities with initiatives or with active RHIOs (regional health information organizations). But momentum is coming from national trends too, like widespread connectivity and the Medicare Modernization Act (which requires some groups to be capable of e-prescribing next year).

"Last month, we had phone calls from more than 5,000 practices," she said.