Why are most physicians writing their prescriptions by hand?

Is the pen mightier than the PC?

When it comes to prescribing, it appears so. A new report from the Center for Studying Health System Change finds that most physicians write their RX scripts by hand, despite financial incentives for physicians to adopt electronic prescribing. Even those who have e-RX systems do not always use them, and when they do, they may not to use the features that were anticipated to have the biggest impact on improving prescribing practices.

HSC’s nationally representative Health Tracking Physician Survey finds that “two in five physicians in office-based ambulatory practice (41.9%) reported that information technology was available in their practice to write prescriptions in 2008 … Moreover, physicians who had access to e-prescribing did not necessarily use it routinely. About a quarter of the physicians reporting availability of IT to write prescriptions (23.1%) used the technology only occasionally or not at all. So in 2008, about one-third of all physicians in ambulatory settings (32.3%) routinely used e-prescribing.” Advanced features – drug information alerts and patient formulary information – were used even less frequently.

Primary care physicians were more likely than medical and surgical specialists to use e-prescribing, as were physicians in larger group practices.

The low adoption rates for e-RX suggests to me that financial “carrots and sticks” may not be enough to drive adoption of health information technology. Medicare will pay a 2% bonus of total allowed charge to physicians for use of e-RX systems through 2013, but penalties will go into effect in 2012 on those who do not. Even larger chunks of money are available for physicians who adopt “certified” electronic medical records for meaningful use (including e-prescribing).

I am not sure why more physicians aren’t using e-RX systems. Is it because of cost? Force of habit? Or do the systems themselves lack user-friendliness and functionality?

Whatever the reasons, it doesn’t bode well for the government’s goal of getting a certified electronic health record in every practice. The HSC authors note, “the challenges to implementation of EMRs as a whole are substantially more complex than e-prescribing. And, EMR technology is much less mature, suggesting that policy makers should expect a substantially longer time horizon to achieve meaningful use of health IT than the five- to six-year horizon of the Medicare and Medicaid incentive programs.”

Why do you think physicians are slow to adopt e-RX, even with the government”s “carrots and sticks”?

Bob Doherty is Senior Vice President of Governmental Affairs and Public Policy, American College of Physicians and blogs at The ACP Advocate Blog.

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