Free Healthcare IT Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Get all the latest Health IT updates from Neil Versel for FREE!

Docs, stop whining, start e-prescribing

The whining is getting old.

Per Surescripts, in 2012, the latest year for which statistics are available, about 69 percent of physicians nationwide used e-prescribing technology in one way or another, and 44 percent of all prescriptions written nationwide were routed electronically. (That report came out in early May 2013, so expect some new numbers soon.) Both are up substantially from the previous year, probably due in no small part to the Meaningful Use EHR incentive program, which does require a minimal level of e-prescribing.

But what about the holdouts? A recent article in the journal Perspectives in Health Information Management found that cost remains the No. 1 reason why physicians still haven’t ditched the paper prescription pad in favor of electronic prescribing.

“While e-prescribing offers many benefits, not all providers have been excited about implementing e-prescribing systems. A major barrier, reported by more than 80 percent of primary care physicians, has been lack of financial support. New technology requires training and information technology support for installation and upkeep. A practice must take these costs into account when deciding whether to implement an e-prescribing system and also when choosing a stand-alone system or one that is integrated into an EHR system. According to the Health Resources and Services Administration, in a 2007 study the total cost of implementing an e-prescribing system was found to be $42,332, with annual costs after implementation of about $14,725 per year, for a practice of 10 full-time equivalent psychiatrists,” the authors reported.

Yes, but the paper also says this: “E-prescribing improves the efficiency of the prescribing process. Though the actual entering of a new prescription takes about 20 seconds longer per patient than writing a prescription, this time is offset by the time saved because of the fact that less clarification is needed for electronic prescriptions. Prescribers spent more time on the computer, on average an extra 6 minutes per prescriber per day or an increase of 20 seconds per patient when seeing 20 patients per day. If implemented correctly, e-prescribing should cause little disruption in the workflow of ambulatory care settings.”

In other words, those resisting the switch are being penny-wise and pound-foolish.

Besides, e-prescribing systems don’t have to cost that much. In fact, they don’t have to cost anything. Allscripts offers a free, standalone e-prescribing system online, while PracticeFusion, DrChrono and Kareo have e-prescribing modules in their free EHRs. A startup named ScriptPad has an e-prescribing app for Apple iOS that’s free to prescribers; transaction fees get billed to pharmacies. I can’t vouch for the efficacy of any of this software, but cost doesn’t have to be an issue.

I think the real problem here is intransigence. Some doctors simply don’t want to get with the times, and the only losers are patients.

April 24, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

CCHIT, KLAS might signal new era in EHRs

Two stories that have hit in the last 48 hours illustrate how the status quo in EHRs is being upset.

First off, as John Lynn broke late Tuesday night—first as a rumor and then as a confirmed fact—on his EMR and HIPAA blog, CCHIT, formerly known as the Certification Commission for Health Information Technology, is getting out of the health IT certification business, thus making sense out of the name change. The organization will continue to offer preparatory courses for ONC-sanctioned testing and certification, but no more actual certification.

CCHIT recommended that vendors turn to another authorized testing and certification body, Verizon-owned ICSA Labs, though there are others that still do offer certification, including Drummond Group, SLI Global Solutions, InfoGard Laboratories, and, for e-prescribing technology, Surescripts. Interestingly, CCHIT also announced that it will partner with HIMSS to offer a series of health IT events for vendors and providers. This is interesting because HIMSS was one of the three founding organizations of CCHIT in 2004, and CCHIT was under fire five years ago for maintaining too close of a relationship with HIMSS (also see this link).

When Meaningful Use came along with the passage of the American Recovery and Reinvestment Act in 2009, CCHIT lost its exclusivity in certifying health IT products, as EHR certification essentially became commoditized. Other certifying bodies also have undercut CCHIT on price, so this move really does not surprise me.

The other big story, if you pay attention to things such as vendor rankings, is that Athenahealth just unseated Epic Systems as KLAS Research’s “Best in KLAS Overall Software Vendor” of 2013. Epic had held the top spot for eight years in a row. “The old guard of HIT leaders is finally being displaced by more nimble, innovative models designed for health care’s future—not for its past. The latest KLAS rankings show that closed-system, traditional software offerings are not robust or flexible enough to meet providers’ demands anymore,” Athenahealth CEO Jonathan Bush said in a statement.

I’m not sure I’d go that far, as Epic is still eating everyone else’s lunch in the enterprise market. But, to me, this shows that smaller physician practices that don’t have IT departments are adopting EHRs and want a cloud-based product that is easy to maintain. That certainly heralds a major shift in health IT.

January 30, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Faxing should be malpractice

As you undoubtedly know by now, I am now officially all about patient safety. (Thanks, by the way, for all the support in the wake of my father’s untimely death.) That’s why I was so upset to read a friend’s recent Facebook status update: “So I discovered the real reason why I was in the hospital last week (and not generally feeling well for the past 4.5 months). My doctor’s office faxed a prescription to my mail order pharmacy that was 2x the dose I was expecting.”

In case anyone has forgotten, fax is technology from the late 1980s and early ’90s. It is now 2012. I cannot remember the last time someone asked me if I had a fax number. Yet, inexplicably, this obsolete means of transmitting low-res images—images, not computable data—remains perfectly acceptable in healthcare.

Here’s a radical proposal: medical societies and state medical pharmacy boards should prohibit the use of faxes. Medical errors related to faxed documents should be considered malpractice. Period.

May 20, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Don’t forget D.0

While everyone’s scrambling to comply with ANSI X12 5010 standards for HIPAA transactions by Jan. 1—or whenever CMS gets around to enforcing them—there’s another piece of the upgrade that hasn’t been talked about much. That’s the National Council for Prescription Drug Programs’ version D.0 standard for pharmacy transactions.

I got an inadvertent reminder this week when I picked up some prescription refills. One of my meds was out of refills, so my doctor sent a refill electronically (woohoo). Inside the bag of meds was a printout that may not have been intended for me to see, or perhaps I was supposed to mention it to my doctor. The notice contained a “reject message” with the note, “VERSION D.0 REQUIRED AS OF 1/1/2012.

Obviously, the script went through and I got my refill, but I sure hope people don’t start getting prescriptions actually rejected for being in the old NCPDP 5.1 format after the first of the year. Prescribers, get in touch with your vendors. Vendors, remind your e-prescribing clients. It’s not a big change like 5010 and the forthcoming ICD-10, but it’s significant. So get it done.

November 18, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

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.

September 21, 2010 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

AMA and EMRs, continued

Last month, I wrote a rather scathing piece on the BNET Healthcare blog about the American Medical Association‘s annual House of Delegates meeting. I wrote another one for FierceEMR. Admittedly, I focused on a handful of fringe ideas, though one of the more audacious ones actually wound up in a resolution that the House of Delegates adopted as AMA policy. For BNET, I wrote:

[A]nother resolution directs the AMA to tell the federal government that the EMR incentive program “should be made compliant with AMA principles by removing penalties for non-compliance and by providing inflation-adjusted funds to cover all costs of implementation and maintenance of EMR systems.”

It’s one thing to ask for more money to cover ongoing expenses. It’s another thing altogether to conclude that the government is not in compliance with the principles of a private organization. Talk about the tail wagging the dog.

In FierceEMR, I wrote:

Delegates also took issue with the Medicare e-prescribing bonus program that passed during the Bush administration and began this year. They said the requirement that physicians write 50 percent of their Medicare Part D prescriptions electronically was too onerous, and recommended that the threshold be lowered to 25 percent.

Not surprisingly, the posts drew several comments and e-mails.

AMA Board Chairman Joseph Heyman, M.D., someone who actually does understand—and use in his own practice—EMRs and information technology, left a detailed response on the BNET post, attempting to clarify the organization’s position on health IT. He’s right in saying that the AMA did come out in strong support of the stimulus. My criticism was about a few delegates who spoke out rather loudly about the stimulus.

Heyman also discusses the AMA’s online tools for physicians to learn about health IT, something I admittedly didn’t mention in my post, though it wasn’t completely relevant to my argument. I did interview Heyman at the meeting, and included some of his comments in a story I did in the July Physician Office Technology Report of Part B News. I’d like to extend an invitation to Heyman to do a podcast with me at some point in the future so we can discuss all of these issues, as well as his own practice’s successful experience with an EMR.

Another, anonymous, commenter suggested that other organizations, like the American Academy of Family Physicians has an agenda that “more closely aligns with the big winners of the last election cycle, and helped buy them a seat at the table.” Yeah, that would explain why some of the more conservative members of the AMA House of Delegates feel shunned. This person also says that “HIT providers”—vendors and consultants—are the real winners from the stimulus. That’s certainly a risk of the massive program.

The comments on the FierceEMR piece were more supportive of my argument. “Smart Doc” said: “To call this organization an anachronistic dinosaur would not give proper credence to how out of touch it is, not only with the public, but with physicians themselves. Like others of their ilk, they’re against government intervention except when it directly subsidizes them.”

I’m not sure if I’d go that far, but I’m certainly on record as saying the AMA really does not represent the interests of all physicians, as the organization claims to.

My favorite exchange, though, came from Jack Smyth, the very pragmatic president and CEO of ambulatory EMR vendor Spring Medical Systems. After the FierceEMR commentary appeared, he e-mailed me to clarify the rules for the Medicare e-prescribing bonus program that took effect this year:

You commented about the 50% rule for getting the eRx bonuses this year and next. In your statement you mentioned that unless a physician prescribes controlled substances, they should be able to qualify.

The way I understand it, if a doctor enters the prescription in the eRx system, it counts. Even if they have to print it out and sign it, because it’s a controlled substance, or even if the pharmacy doesn’t accept eRx and it has to be faxed to the pharmacy. There are several “G” codes that can be added to an office visit or prescription refill that allow the various scenarios to qualify for addition to the numerator of the equation.

I’m very proud of my subsequent response:

Thanks again for writing. I think you’re right about getting credit for entering it into an eRx system, regardless of whether it’s controlled or if the patient simply wants a printout. In that case, I have no idea why the AMA thinks 50% is too high. You’re either entering scripts electronically or you’re not, unless perhaps you’re Dr. House and you’ve stolen Wilson’s prescription pad.

I also asked Smyth for permission to post our exchange. He then responded: “I love your “Wilson’s prescription pad” comment! Yes you can use my email in your blog. I don’t have time to post responses on websites and I don’t like all of the banter (most of it useless) that a comment like this would create. I’ll let you do that.”

Consider it done.

July 6, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

More on e-prescribing

I recently had a long feature story published in MDNG about e-prescribing. It’s pretty basic, but fairly comprehensive.

Check it out here. I’m not sure what happened with the paragraph breaks to make so much of the text run together in the online version.

In the same issue, Alberto Borges, M.D., writes in his “The HIT Realist” column that physicians should be wary of vendors, insurers and government agencies pushing them to adopt e-prescribing and other health IT.

March 4, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

HIT advertising section in Friday’s Washington Post

There’s a special advertising pull-out section on healthcare IT running in Friday’s print edition of the Washington Post. How do I know this? Because I wrote the majority of it. I also helped with the questions posed to the “panel of experts.”

Normally I would not get involved in marketing communications, but I had pretty good editorial control over the message. I was instructed to interview representatives of the advertisers, whose quotes were to appear on the same page as their ads—normally a red flag for me—but I could add any additional information or interviews that I saw necessary. Furthermore, the advertisers did not have authority to review the copy prior to publication, so I was satisfied with the arrangements. I only had to answer to the publisher, Mediaplanet, a Swedish marketing firm with U.S. headquarters in New York. So overall, I was comfortable with the arrangements. Plus, it gets me in the Washington Post, even if it was through the back door.

For what it’s worth, you’ll note that the EMR story features a company that does not have CCHIT certification for its product. I’ll also admit that I didn’t address the security issues related to health IT.

Click here for a PDF of the section (1.2 MB). I understand it will not be available at

December 16, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: Dr. Robert Kolodner on the national HIT strategy

I love the annual Association of Medical Directors of Information Systems (AMDIS) Physician-Computer Connection. It’s a chance to hear some of the smartest and most accomplished people in healthcare, namely medical informaticists, in a small, informal setting. This year’s event, held last week in beautiful, laid-back Ojai, Calif., featured an appearance by Robert Kolodner, M.D., the national coordinator for health information technology.

After Dr. Kolodner’s presentation—more of a Q&A with his peers in medical informatics—he graciously sat down for an audio interview with me. Here is the result.

Podcast details: Robert Kolodner, M.D., on the national health IT strategy. Recorded July 16, 2008, in Ojai, Calif. MP3, stereo, 64 kbps, 14.3 MB, running time 31:24.

0:40 Background on
national health IT strategic plan toward interoperable electronic health records
3:35 Goals of the plan
4:08 Distinction between “health” and “healthcare”
5:25 Explanation of “patient centeredness”
6:20 Physicians’ role in promoting patient centeredness
7:30 IT’s role
8:50 Population health
10:40 Why physicians should care about national IT strategy
12:55 Making the issue personal
13:35 Financial incentives for technology adoption
14:37 Incremental advances
16:18 Medicare e-prescribing incentives as one step in a series of improvements
17:30 Convincing healthcare organizations to cooperate
18:08 Greater public awareness about electronic health information
18:32 Privacy and security concerns, and coming framework
20:50 Convincing doctors to share data
22:10 Trial National Health Implementation Network implementations
22:55 Where physician IT leaders can make a difference
AHIC successor
25:25 Complexity of healthcare in the U.S. and abroad
27:18 Profound workflow changes from IT and maximizing skills of healthcare professionals
29:06 Possible effects of 2009 administration change
30:15 Health IT’s fundamental role in healthcare reform

July 22, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Congress includes eRx in Medicare bill

Finally Congress has paid more than lip service to health IT. Late yesterday afternoon, the Senate approved the Medicare Improvements for Patients and Providers Act of 2008, halting the planned 10.6 percent physician fee rollback and, significantly, including financial incentives for physicians to move to electronic prescribing.

Reportedly, Sen. Edward M. Kennedy (D-Mass.), a strong advocate of health IT, surprised a lot of his colleagues by returning to the Senate in time for the vote, his first appearance there since his cancer surgery last month.

According to the eHealth Initiative, calls for bonuses of up to 2 percent for providers who use “qualified” e-prescribing systems for five years, beginning in 2009. Starting in 2012, providers would be subject to 2 percent penalties for not writing electronic scripts. The Department of Health and Human Services would have the option of adding a hardship exemption for certain providers.

This is not a done deal, however, as President Bush has threatened to veto the legislation over its proposed Medicare Advantage cuts. The bill passed the Senate by unanimous consent, but the eHealth Initiative says 69 senators voted in favor, making the margin veto-proof. The House vote on June 24 was 355-59, also enough to override a veto.

July 10, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.