The 130th Annual Meeting of APHA

Abstract #39526

Helene Levens Lipton, PhD, Department of Clinical Pharmacy, University of California- San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118, (415) 476-2964, lipton@itsa.ucsf.edu, Robert H. Miller, PhD, Institute for Health and Aging, University of California, San Francisco, 3333 California St., Suite 340, San Francisco, CA 94118, and Julian J. Wimbush, ScB, Institute for Health Policy Studies, University of California- San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118.

Context: Escalating drug expenditures and the prevalence of drug-therapy errors have prompted calls for cost control and quality improvement. E-prescribing devices address both. This paper examines the implications of e-prescribing devices and the e-prescribing industry on the prescribing behaviors of physicians.

Study Design: Stakeholder analyses including 62 semi-structured interviews of experts in e-prescribing firms and key industry stakeholders.

Population Studied: Clinical and administrative leaders in e-prescribing groups including physician organizations, PBMs, pharmacies, e-prescribing vendors, health plans, and pharmaceutical companies.

Principal Findings: Physician-users valued e-prescribing device capabilities while citing workflow constraints and a need for greater functionality as limiting factors. Specifically, physicians identified technical barriers (such as speed, memory, and screen size) and lack of integration with their practice management software as workflow constraints. They desired additional functionalities, including real-time access to patient formulary information and medication history. HMOs and pharmacies are not adopting e-prescribing because they lack the capital to create the necessary information infrastructure, and lack of demonstrated value of the devices on cost and quality outcomes. Many device vendors, facing low physician adoption rates and reduced availability of investment capital, have failed. Remaining vendors have responded by increasing their devices’ functionality, exploring new sources of revenue, and partnering with pharmaceutical companies and PBMs. PBM and drug companies are the primary funders of e-prescribing devices in part to encourage use of preferred brand-name products, which can be more costly than bioequivalent alternatives. Physicians had limited knowledge of e-prescribing vendors’ ties to the pharmaceutical industry and PBMs. While continued developments in wireless and handheld technologies may overcome technological shortcomings, lack of aligned financial incentives among key healthcare decision-makers and a need for proven value threaten widespread adoption of e-prescribing.

Conclusions: Potential cost and quality benefits can come from use of e-prescribing technology, but ethical and financial barriers to adoption exist before the implementation of e-prescribing devices can be considered a success.

Policy Implications: Policymakers should consider standards for: access to clinical and financial patient data; disclosure of criteria used to label drugs as “preferred”; alignment of financial incentives for device-funders (PBMs and pharmaceutical companies) with best prescribing practices; and the conduct of objective outcome studies (such as head-to-head trials) to yield a precise understanding of the costs and benefits of e-prescribing. Further, healthcare purchasers may play a role in creating financial incentives for insurers and providers may be necessary to stimulate adoption.

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