Blumenthal talks e-prescribing

As you may have already heard, Surescripts today gave its annual update of progress in e-prescribing. About one-third of office-based clinicians now write at least some prescriptions electronically and the overall e-prescribing rate is up to 12 percent.

Surescripts had a transcription service present and provided these remarks from featured speaker Dr. David Blumenthal:

Well, thank you, Mr. [Harry] Totonis [president and CEO of Surescripts]. I appreciate your kind words. And it’s a pleasure to be here. It’s a pleasure to be part of the recognition of these ten states, who are pioneering and meeting on a very important contribution to the health and welfare of Americans.

As I go down the list, I can’t help noticing that my home State of Massachusetts is at the top.

And I want you to know that until 17 months ago, I was a proud electronic prescriber in Massachusetts contributing to that first place finish.

I’m sorry Senator Reed has left because I would have noted that Rhode Island, though it has a lot to teach the rest of the country, also has a lot to learn from Massachusetts.

I also notice that I have visited five of those ten states in the last three months. I hope to get to the rest of them before I run out of steam. I also note that six of them had been recipients of our Beacon [Communities] Award Program, which is a way of saying that e-prescribing is a gateway into success along a whole range of electronic and health care performances because our Beacon Program really was about health care improvement through electronic systems, rather than about electronic systems.

Though the senators have left, I can’t help noting that Senator Whitehouse was indeed a terrific champion for the legislation that created my office. It is to him that I owe the privilege of serving in this role because he and his colleagues equipped it with such important tools to move the needle on adoption and meaningful use of electronic health information systems in the United States.

And he I know was a leader in Rhode Island as well through the Rhode Island Quality Institute, which has provided an example on many levels to other communities that have sought to emulate their work on e prescribing and electronic exchange of information.

I find his notion of enjoyment a little bit paradoxical. I’m sure for those of us sitting under that scrutiny, it’s a little less enjoyable. But I do look forward at some point to having the opportunity to experience Senator Whitehouse’s prosecutorial skills (Laughter.) at the other side of that exchange.

I also want to congratulate Surescripts and Harry Totonis for their leadership. It is the private sector that is moving this work forward. The federal government is a catalyst. We can help correct market failures. We can help make the playing field more hospitable for the private sector. But it is thousands upon thousands of providers and thousands of companies and community leaders, insurance companies, and businesses outside of the health sector who are making it possible for communities to lift themselves up on every dimension of health care, not just on health information technology, though that is, we believe, obviously a foundational element.

To argue that there are 200,000 physicians e-prescribing is really reassuring. We, however, have a long way to go. Two hundred thousand is probably about a third of the practicing physicians in the United States. And it’s that two thirds that we are concerned about and making sure that they have the tools, incentives, the rewards for becoming e-prescribers in the very near future.

We know that there are important gains from e-prescribing. I know there are important gains. I have spoken in the past of my own personal use of the electronic health record, of the experience that I had using an e-prescribing capability through computerized provider order entry, in which the drug allergy checks that are brought to bear by e-prescribing prevented me from prescribing medication to which a patient was allergic. And I know that that kind of feedback in real time at the point of decision is only possible through order entry and e-prescribing with the drug-drug interaction and drug allergy checks that are possible to add on to the e-prescribing and computerized provider order entry functionalities.

We did some work in my own research group at the Mass General Hospital before I left documenting the cost reductions associated with electronic prescribing. So I know and have seen through my own group’s work the potential impact in well done scientific studies of electronic prescribing in terms of moving from brand to generic medications.

And also I saw in my own e-prescribing the way in which it enabled me to prescribe drugs that were on a patient’s formulary in which I could check the cost of the medication in real time looking at all of the options available for that class of medication and picking not only the one that was covered by that patient’s insurance but the least expensive one covered by that patient insurance. That would be hours of work without the electronic prescribing capability.

The states which are recognized here, of course, are recognized for the work of their clinicians in prescribing, but we also know at the Office of the National Coordinator that states have a very important leadership role.

We have given over $560 million to the 56 states and territories to encourage them to play a leadership role to build in their state government or in related entities that they have chosen the capacity to provide leadership for health information technology in their states. And one of the things that we have prioritized is creating e-prescribing as a leading effort at information exchange.

And we have also, of course, included e-prescribing in many ways within the Meaningful Use framework. And I should give credit to my colleagues at the Centers for Medicare and Medicaid Services who have actually lead responsibility for that Meaningful Use framework, but our Policy Committee, the [Health IT] Policy Committee for the Office of the National Coordinator, was also extremely helpful and highlighted four functionalities in Meaningful Use that relate to e-prescribing or support it; first of all, the maintenance of an active medication list; secondly, directly the generation and transmission of permissible prescriptions electronically; thirdly, the implementation of drug formulary checks; and, fourthly, the performance of medication reconciliation between care settings.

The latter two were in the menu set, the menu set, from which you could pick five. But we have suggested in that regulation that some of these menu set, actually, all of these menu set functionalities would be part of the required set for stage 2 of Meaningful Use.

Of course, e-prescribing under the influence of the Health HITECH Act was one of the required functionalities for Meaningful Use. So I can’t claim that we dreamed this up entirely. But we do see that it is one of the ways in which Meaningful Use will create value for the American people.
A lot has been done, but an enormous amount remains to be done in our work and in the work of the recipients of these awards and throughout the offices and around the nurses’ stations of America’s physicians and hospitals.

We are looking forward and beginning, actually, to some early reconnaissance around the development of our next phase of Meaningful Use, Meaningful Use stage 2. Our Health Information Technology Policy Committee met to discuss that just about ten days ago.

We, of course, want to learn before we jump into stage 2 of Meaningful Use how things have gone in stage 1, but we also know that there was a set of unfinished tasks and things that we passed over in the effort to get the first Meaningful Use stage, the first stage of Meaningful Use, out the door in a timely way.

There are two areas that I think really deserve much more attention in the second stage of Meaningful Use. And one of them is the area of health information exchange. The first stage of Meaningful Use set the groundwork technically for health information exchange but didn’t complete that task and didn’t require really robust exchange on the part of potential recipients of incentive payments.

So I think that the provider community and the vendor community should look forward to a much more robust set of requirements around health information exchange, an exchange that consciously transcends, ignores economic relationships, institutional relationships, and geographic relationships, and political jurisdictions. Again, we want information to follow patients.
The second thing that we hinted at but did not push very hard in the first stage of Meaningful Use was the second functionality, the second type of capability that adds so much value to the electronic health record. And that is clinical decision support.

I can tell you that as a user of electronic health record, I valued the availability of information that it made possible, not having to look through those paper charts anymore and knowing that I could find the old radiology reports without scrambling through a folder or ordering up a record from Stone Mountain, which would never be there anyway in time for my patient visit, but even more I valued the way it made me, the way clinical decision support made me a better doctor, the way in which it made my decisions better, the way it made them more scientific, more consistent with the patients’ needs.

And those are the things that I think will really sell the health care industry on this technology, not the recording, the physical recording, of information electronically but the ability to be better at what you do as a result of a technology that supports you in your role as a professional.
If you’re a nurse or a doctor or a respiratory therapist or a laboratory technician, having that reinforcement, that instruction, that access to new scientific information is really what makes the provider go home with a smile on his face or her face.

We are also going to be working to improve quality metrics contained in the Meaningful Use framework and to make sure that those are electronically compatible and take advantage of the electronic capabilities of records. And we have an enormous amount to do in terms of implementing the large array of programs that we have started: our Beacon Community grants; our regional extension centers, which are there to make physicians able to become meaningful users; our state grants to health information exchanges; our training, our effort to train, over 40,000 new health information technology workers, giving them good jobs with a future in an economic sector that is exploding and will continue to explode throughout our lifetimes; and our research work through our strategic health IT advanced research programs, one of which focuses on enhancing the exchange of health information.

So we have an enormous remaining set of tasks, but it has been a privilege to be here over the last 17 months or so and watch the federal government and the private sector and the state government sector come together to set the groundwork for this, set the foundation for this revolution in health information management.

And I again want to congratulate both the states, the congressional delegations, and Surescripts for their role in making all of this possible. Thanks again.