TECH: JSK’s 2006 Health IT Forecast

Skip over to iHealthbeat to see the ever wonderful Jane Sarasohn Kahn’s 2006 Health IT Forecast

Jane is pretty gung-ho about ePrescribing. She says:

I predict that e-Prescribing will come of age in 2006. With Medicare kicking the tires on e-prescribing standards, we’ll see adoption of eRx on a selective basis. An innovative handful of health plans will foster adoption by providing incentives to prescribers in regional marketplaces. By the end of 2006, e-prescribing will reach a tipping point, and it will take off in 2007 because of Medicare’s push for adoption.

It’s not secret that we share this view — after all we spent last year writing a study about it that will be out shortly! this is one of the times when Morrison’s corollary to Herb Stein’s law comes into play. Stein said that “if something is unsustainable in the long run, it will end”. Morrison riffed on that to say, “If it’s going to be a big deal eventually, it’s got to start somewhere”.  We think that the next 18 months is the “starting somewhere” period for eRx. I hope that we’re not being too optimistic!

Jane is however a little too polite about RHIOs. Ann Donovan from the California RHIO told me last week that the CEOs of the big players in Claifornia were sending people to their meetings but the people showing up didn’t know why they were there. Reading between Jane’s lines this looks like CHINS all over again. The first report we wrote together in 1994 was also about CHINs, and we said there that they might end up as a sideshow, and again we were being too optimistic!

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  1. I have to disagree with Dr. Gitlow. we have implemented the Wellinx ePrescribing system in our 200+ physician practice and it is almost universally loved. There has been no impact on doctor or staff productivity.
    As far as connecting to the small clinics, today we have no pharmacies (even the big ones) that want to communicate electronically. Everything is done via automated faxing. But it has eliminated the phone calls.
    There are many other benefits. Checking for contraindications has been cited by more than one doctor as a “life saver.”
    Furthermore, it bulds an active medication list as part of the prescribing process. I can tell you that most doctors do not know their patient’s medications because it is not well documented. I want my doctor to have a complete, accurate, up-to-date medication list for me.
    This is the tip of the iceberg. We have also demonstrated reduced prescribing costs which is attributable to the built-in evidence-based medicine which will suggest the most appropriate initial therapy.
    I am also going to also suggest that a patient is much more likely to comply if the prescription is waiting for them at the Rx with theit name on it than if it is sitting in their pocket. Because we have an HMO, we can actually run reports that compare medications prescribed to medication claims and really know who is complying.
    ePrescribing is real and it is ready for the mainstream. CPOE is a myth, but that is another topic.

  2. Why would I, a physician at a Community Health Center, want to prescribe electronically? We have many non-chain pharmacies in our neighborhood, and we support their use. These pharmacies do not have agreements with pharmcos to provide bulk prescribing data. They provide highly personal service, and I count on the relationship I have with the pharmacists there. It is far easier and faster for me to call in renewals once a day than it is to handle this on a computer. As for written prescriptions, we had a computer and printer generate them for a while, but eventually concluded that the expense of maintaining a computer and printer with supplies was greater than the perceived value. I like the physical act of handing the patient a prescriptionn that I’ve handwritten, and believe that this leads to superior compliance compared with that of a script emailed to the pharmacy. Yes, there are legibility issues, so I work on my handwriting. There is no perceived upside to e-prescribing by the majority of my peers, and an enormous downside, cost being the most obvious. We already have broadband internet access in the office, online charting capabilities, and EMR capabilities. Just as we went back to using written appointment books and datebooks instead of computer-based and PDA-based “solutions” because the written ones are, at this point, better, I anticipate many physicians will try eRx and then quickly think better of it. Some will be forced into it, whether by legislation or payor methodologies, but it will ultimately lead to higher physician costs and either lower profits or increased charges passed along to patients.