I am a subspecialist ophthalmologist. E-prescribing is just not that significant an activity compared to the majority of my practice activities. While a stand-alone solution might be nice in a primary care practice, it just wouldn’t be worthwhile unless it was integrated with an EMR. For me, EMR is an expensive proposition. Because of the high data traffic in images typical in my chart keeping, I need hard-wired terminals in all my exam and treatment spaces integrated into my office computer network. Every diagnostic device I commonly used should be interfaced with the network, to minimize paper generation and maximize efficiency, which generally runs between several hundred to two thousand dollars per device, depending on the age of the device and the amount of customization needed in creating the machine interface. And of course, there is the software. A solo doctor in my specialty can spend forty or fifty thousand dollars on a modest network, not including training or software updates. You will never see that back in increased efficiencies or even in coding optimization. Moreover, there is no extramural repository for the record (unless you include offsite backup) for anyone else to draw from if they wanted. If I were in a group with many offices, the picture would change (and so would the price, for sure,) but there would at least be the benefit of VPN access to a master practice server library from other locations. But that is rarely necessary in a field where over half of the practitioners are solo.

The reality is that e-prescribing is all sticks and no carrots.

As one example, the National E-Prescribing Safety Initiative offers a free e-prescribing solution: http://www.nationalerx.com/. Many other standalone e-prescribing solutions can be obtained at reduced rates as part of health plan, government, or medical society-sponsored e-prescribing initiatives. A partial list of these programs can be found at http://www.surescripts.com/initiatives.

Getting back to the original blog entry, the recent merger of SureScripts and RxHub is expected to address many of these concerns. I encourage you to check out the following blog entry from Dr. John Halamka for a good summary of how the merger will help accelerate the adoption of e-prescribing: http://geekdoctor.blogspot.com/2008/07/surescriptsrxhub-merger.html

To quote Dr. Halamka, ” As SureScripts-RxHub integrates its services, there will no longer be a need to send out 2 queries for eligibility/formulary, medication history or routing. Also, the two sources of medication history data will be de-duplicated, providing an accurate and usable medication data flow to all stakeholders.”

Regarding pharmacy connectivity, nearly 100 percent of chain pharmacies and well over 30 percent of independently owned pharmacies e-prescribe.