October 29, 2007 at 11:02 am

Online Rx program helping cut errors

Big 3's e-drug plan boosts the use of generics while reducing glitches, analysis shows.

A Big Three-driven effort to replace prescription pads with computers is significantly reducing patient risk from medication errors and helping increase generic drug use, according to an analysis released today by the Southeast Michigan ePrescribing Initiative.

Launched nearly two years ago, the first review of the initiative shows that it is not only protecting patients from the harmful consequences of medication errors, but is also helping them have better discussions with their doctors about medications at the time a prescription is written.

"The benefits of ePrescribing are overwhelming in terms of reducing medication errors, lowering prescription drug costs for patients and plans, and decreasing physician practices' administrative costs," said Marsha Manning, General Motors Corp.'s manager of Southeast Michigan Community Health Care Initiatives, in a statement.

Through the initiative, doctors access online software on computers in patient rooms to write the prescriptions, prompting discussions about generic alternatives, drug interactions and allergies at the time a prescription is written.

The results are savings on drug costs and fewer medical complications, doctors and coalition members say.

EPrescribing also eliminates doctors' handwriting as a source for error, and saves patients and doctors' offices time because the scripts are sent to pharmacies electronically.

The analysis of a sample of 3.3 million prescriptions showed:

  • The ePrescribing technology sent alerts of severe or moderate drug interactions to doctors for about one-third of those prescriptions. Doctors changed or canceled 423,000 (or 41 percent) of those prescriptions.

  • The technology informed doctors of more than 100,000 medication allergies, and doctors acted on 41,000 of these alerts.

  • When an alert showed a drug was not on a formulary, the doctor changed the prescription to comply 39 percent of the time.

    The initiative, involving the automakers, Henry Ford Health System, Blue Cross Blue Shield of Michigan and others, aimed to help doctors set up electronic prescribing in their offices.

    The three automakers -- GM, Ford Motor Co. and Chrysler LLC -- are involved because they think the initiative can cut down on their health care costs, which add up to billions of dollars.

    So far, some 6.2 million prescriptions have been written by 2,500 doctors using ePrescribing technology, with more than 282,000 written each month.

    The coalition plans to extend the initiative through March 2008.

    Generic drug use up

    GM spokeswoman Carey Osmundson said it's difficult to quantify how much the company has saved with ePrescribing, but GM has seen increases in its rates of generic drug prescribing and compliance with preferred drug lists, both of which save money. For each 1 percent shift to generic drugs from a brand name, GM saves nearly $20 million, she said.

    GM spent $1.5 billion on prescription drugs alone last year for 1 million enrollees, a growing tab it had worked for years to stem.

    Henry Ford Health System conservatively estimates it is saving $4 million a year with ePrescribing, mostly from switching HAP patients from brand-name drugs to less costly generic alternatives.

    That's not including the savings patients see from reduced co-payments, said Matt Walsh, associate vice president of purchaser initiatives at Health Alliance Plan, a health insurer owned by Henry Ford.

    Royal Oak's Dr. David Allard was one of the first Henry Ford doctors to use ePrescribing.

    His office has had electronic medical records for years, but had relied on pen and paper for prescriptions until January 2005.

    He says his staff saves a lot of time that used to be spent on the phone with pharmacies handling prescription refills and questions on scripts.

    "That was hours a day in my office," he said.

    But more importantly, he sees the benefit in reducing the potential for errors.

    Refilling prescriptions, for example, involved a lot of hand-offs between staff members and interaction with pharmacies. With each step came a chance for a mistake.

    Handwriting kills

    More attention is being focused nationally on drug errors and how to avoid them.

    According to an Institute of Medicine report issued last year, drug errors kill 1.5 million Americans each year.

    The report said eliminating handwritten prescriptions is the most vital step health care providers must take to cut down on errors, and recommended that all prescriptions be written electronically by 2010.

    The institute is a branch of the National Academy of Sciences, an independent adviser to the government on scientific issues.

    Allard's patient Susan Smith said she appreciates saving money with generic alternatives that ePrescribing has brought up during her office visits. She loves the convenience of ePrescribing even more.

    Because the script goes directly to the pharmacy, she doesn't have to wait to pick it up.

    "It's so much more efficient," she said. "My time is real precious to me."

    For outside observers, the ePrescribing effort is laudable. "It not only reduces costs but improves the quality of care by reducing drug interaction," said Eileen Ellis, principal of Health Management Associates, a Lansing-based consulting firm.

    Recognizing the benefits of electronic records, health systems across southeast Michigan have been spending millions to install electronic medical records.

    But doctors' offices have lagged because of the cost, which can be in the tens of thousands and more for a practice.

    At about $2,000 a doctor to implement, ePrescribing is much less expensive, but is nevertheless a step in that direction. The coalition helps participating doctors with a $1,000 subsidy.

    "This is a great way to get technology into the doctor's office. It's not real expensive; it's fairly easy to adopt," Walsh said.

    You can reach Sofia Kosmetatos at (313) 222-2401 or skosmetatos@detnews.com">skosmetatos@detnews.com.

  • Doctors received severe or moderate drug to drug alerts for more than 1 million prescriptions, which resulted in 423,000 (41 percent) of these prescriptions being changed or canceled by the prescribing doctor.
  • More than 100,000 medication allergy alerts were presented, and doctors acted upon 41,000 (41 percent) of those.
  • When a formulary alert was presented, doctors changed the prescription 39 percent of the time to comply with formulary requirements.
  • Doctors downloaded nearly 56,000 lists of dispensed prescription histories.

  • About the initiative

    Details of the Southeast Michigan ePrescribing Initiative:

  • Set up to increase electronic prescription systems in doctors' offices, by a multimillion-dollar coalition of the Big Three, the UAW, Blue Cross Blue Shield of Michigan, Health Alliance Plan, Henry Ford Medical Group, Medco Health Solutions Inc. and CVS Caremark Corp.
  • Launched in February 2005, it has nearly 2,500 doctors participating who are writing more than 282,000 prescriptions a month.
  • Partners have invested more than $1 million so far, with more than $500,000 going directly to doctors and groups to fund their technology-related investments. It costs about $2,000 per doctor to get set up.
  • Partners will extend the initiative into 2008, continuing to enroll doctors through March.

  • How ePrescribing works

  • Doctors access patient information through online software, with a log-in and password. Doctors can access through a laptop, desktop or a hand-held device like a PDA with Internet access.
  • Once doctors write a prescription, the software checks the patient history for drug interactions, allergies, generic alternatives and compliance with insurers' preferred drug lists.
  • Doctors and patients can talk about any issues that come up, including generics and other alternatives, at the point the prescription is written.
  • The prescription goes directly to the pharmacy, so the patient doesn't have to drop it off.