Study Shows ePrescribing Hamstrung By Insufficient HIE

While many e-prescribing systems have features to provide access to external patient information, physician practices face challenges using these tools effectively, according to a study by the Center for Studying Health System Change (HSC).

Most of the practices that were studied for the report had access to formulary information, but only about half reported access to patient medication histories. Additionally, many physicians did not routinely review these sources of information in making prescribing decisions.

According to HSC Senior Researcher Joy Grossman, Ph.D., coauthor of the study, most physicians who did consult medication histories reported reviewing that information in the presence of their patients. As such, those patients could corroborate or refute its veracity. Often, the data was handiest, for example, when patients could only remember their medication as being, “the blue pill or the pink one.”

Willingness to access the information, “depends on the motivation and interests of the doctor.” For example, physicians with long-term patient relationships may not need to reference outside sources of information while, for new patients, “such additional data can be quite valuable,” she said.

Study respondents highlighted two main barriers to use: tools to view and import data into patient records were cumbersome to use in some systems; and data were not always seen as useful enough to spend the extra time to access and review them, particularly during time-pressed patient visits.

“It really boils down to a time and cost versus value decision — is the data going to be there, is it accurate, is there enough useful information, versus how hard is it to pull up and take advantage of,” Grossman explained. “Some said, ‘It’s easy to pull into my record and make part of my active medication list and prescribe,’ while others said, ‘It’s on another screen, and it’s not reconciled.'”

She said more extensive adoption of standards is needed to facilitate the required information exchange. Grossman added that while the government’s Meaningful Use program is bringing more data into the process, crucial constituencies remained outside its purview.

“Much of the necessary data involved in eprescribing comes from insurers and pharmacy benefit managers (PBMs), and they don’t have to participate in Meaningful Use,” Grossman said. “This also holds true for labs, radiology organizations and other third parties. We need to focus on how to get them to participate.”

She added that further hampering effective eprescribing (in terms of referencing medication histories) is the lack of a unique medication identifier.

On the bright side, Grossman said she was pleased the HIT Policy Committee, through its workgroups, had cast an eye on EMR usability. “I think usability should be built into certification because, from my perspective, it’s very hard for doctors to assess.”

Funded by the U.S. Agency for Healthcare Research and Quality (AHRQ), the qualitative study examined the experiences of 24 physician practices using e-prescribing systems, focusing on the use of features that allow access to external patient-related information that could improve prescribing decisions.

The study’s findings are detailed in a new HSC Research Brief — Physician Practices, E-Prescribing and Accessing Information to Improve Prescribing Decisions.