Groundbreaking eHealth Initiative report offers good medicine for ailing United States Health Care System

Washington, DC 14 April 2004The practice of electronic prescribing is increasingly touted in medical journals and by respected health care innovators as a promising way to improve the quality, safety and efficiency of patient care, but what changes need to occur before it can fulfil the promise? A new report produced by the eHealth Initiative (eHI) seeks to answer these questions and to transition electronic prescribing from a hot health care buzzword to an implementable reality across the United States.


The report "Electronic Prescribing: Towards Maximum Value and Rapid Adoption" reflects the collective wisdom of a diverse group of experts who began work in early 2003 with the objective of determining what action is needed to accelerate the adoption of electronic prescribing in ambulatory care.

The Chair of eHI's Electronic Prescribing Initiative, Jonathan Teich, MD, PhD, explained the report's historic importance: "This report is recommended reading for everyone in health care. It represents practical, comprehensive and consensus-based advice from more than 70 of the nation's leading electronic prescribing authorities on precisely how to advance and support these technologies to serve patients better." Jonathan Teich is Senior Vice President and Chief Medical Officer, HealthVision; Assistant Professor of Medicine, Harvard University and Physician in the Department of Emergency Medicine, Brigham and Women's Hospital.

"All of us have been grappling with how to reduce medical errors and increase cost efficiencies in our health care system", stated the co-chair of eHI's Design and Implementation Working Group, Patricia L. Hale, MD, PhD, FACP, Chair of the Medical Informatics Subcommittee, American College of Physicians; Chief Medical Information Officer, Glen Falls Hospital. "Electronic prescribing systems can do just that."

"Nationwide implementation of these technologies could prevent more than 2,1 million adverse drug events and 190.000 needless hospitalizations a year by reducing medical errors. And, electronic prescribing could save employers an estimated $39 to $74 per employee per year in medical care delivered. These improvements would be nothing short of revolutionary", continued Patricia L. Hale.

"This report comes at a critical time, not only for America's patients but also for federal policy-makers", added Janet M. Marchibroda, Chief Executive Officer of the eHealth Initiative. "The new 2003 Medicare Modernization Act commits our nation to using electronic prescribing for improved health care delivery. eHI's new report is the first document that tells health professionals and policymakers in detail how to get there - how to transition from paper-based to electronic prescriptions - and how to do so in a way that allows us to lay the groundwork for our migration to a truly interoperable, interconnected, electronic health care system which will mobilize health information to support better health and health care for patients."

The report also highlights the challenges of making a transition towards an electronic environment and therefore the need for policy changes that will align incentives among those who bear the costs of implementation and those who benefit.

"Many, many stakeholders, including practising clinicians, hospitals and other health care providers, pharmacies, health plans, pharmacy benefit management organisations, employers and other health care purchasers, and most importantly, patients, will benefit from the quality, safety and efficiency improvements that electronic prescribing will bring", stated Mark Frisse, MD, co-chair of eHI's Incentives Working Group and Vice President, First Consulting Group. "To realize these benefits, all of these stakeholders will have to be active participants in the change management effort required, and all must work together to support the short and long-term increased costs incurred by certain groups, such as prescribing clinicians."

Jennifer Covich Bordenick, Director of Strategic Programmes at eHI and Programme Director for the Electronic Prescribing Initiative, discussed the unprecedented nature of co-operation and consensus that the report reflects. "Recognized leaders from every link of the electronic prescribing chain came together under the umbrella of the eHealth Initiative and volunteered their time to address the challenges and opportunities of electronic prescribing. All involved understood the pressing need for a trusted, comprehensive resource on electronic prescribing."

eHI's Electronic Prescribing Initiative brought together experts from a wide range of constituencies across every sector of health care. Jennifer Covich added: "The importance of this effort and the unity reflected in the report cannot be underestimated, particularly given that stakeholders involved in and impacted by the prescribing chain often have strong competing interests. Speaking with one voice through the eHealth Initiative on what it will take to successfully design, implement and support electronic prescribing is a monumental leap forward."

The report outlines the graduated levels of electronic prescribing, from basic reference systems to advanced systems that integrate with electronic medical records. It features data on current electronic prescribing use and the demonstrated benefits, including improved quality, reduced medical errors,and potential cost savings for payers and employers.

The document recommends specific features and functions that clinicians should seek in electronic prescribing systems, as well as priorities for clinical decision support and it reviews the state of the art of electronic communication between providers, pharmacies, payers, and patients, and considers steps that are needed to enhance and expand these valuable services. Furthermore, the report eviews current options and critical needs in prescribing standards and vocabularies and also analyses the needs and best possibilities for economic, legislative, and other incentives that can stimulate adoption.

Key findings of the report include the following:

  • Errors and adverse drug events in ambulatory care can be common, serious and preventable.
  • Electronic prescribing can improve safety, quality, efficiency and cost.
  • Despite the benefits of electronic prescribing, adoption is still modest.
  • Electronic prescribing systems are available in a variety of graduated levels: systems at the highest level of sophistication offer the most benefit.
  • The adoption and use of electronic prescribing should be encouraged through the deployment of appropriate incentives.
  • Continuing progress toward better-designed, usable systems is likely to help with adoption.
  • A number of enhancements in standards and vocabularies are needed to facilitate interoperability among systems, thereby further enhancing quality, safety and efficiency.
  • If implemented with longer-term goals in mind, electronic prescribing can be an important stepping-stone towards an interoperable, electronic health care system which will provide enormous benefits to patients.

The eHealth Initiative is an independent, non-profit affiliated organisation whose mission is to drive improvement in the quality, safety and efficiency of health care through information and information technology. It engages multiple and diverse stakeholders, including hospitals and other health care organisations, clinician groups, employers and purchasers, health plans, health care information technology organisations, manufacturers, public health agencies, academic and research institutions, and public sector stakeholders, to define and then implement specific actions that will address the quality, safety and efficiency challenges of the health care system through the use of interoperable information technology.

The eHI Electronic Prescribing Initiative was launched in early 2003 to rapidly expand the adoption of electronic prescribing; in particular, to stimulate adoption of electronic prescribing by clinicians. The Initiative is comprised of a Steering Group and two Working Groups: a Design and Implementation Working Group and an Incentives Working Group, representing more than 70 of the nation's top experts on electronic prescribing, including practising clinicians, hospitals and other health care organisations, medical societies and associations, payers, health care IT suppliers, pharmacies, manufacturers, patient and consumer groups, insurance providers, federal agencies, and connectivity providers.

The report "Electronic Prescribing: Towards Maximum Value and Rapid Adoption" was unveiled at an eHI conference in Washington. Electronic copies of the report are available at the Web site of the eHealth Initiative.

Leslie Versweyveld

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