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Philip J. Huber, Jr., MD
President's Page
The Texas Medical Association winter meeting took place at the
end of January in Austin. This meeting always has a Saturday
morning component that, in my brief experience, has proven to
be extremely informative. This most recent topic was devoted
to electronic medical prescriptions, hereafter referred to as
"e-script." At the meeting, a panel of physicians
using e-script presented a realistic but positive report on
their experiences. The physicians on the panel had different
practices, yet each had similar start-up troubles. All seemed
committed and all appeared generally satisfied. Not so in the
audience, where a number of speakers voiced more satisfaction
with fax and significant frustration with their e-script experience.
Clearly, there is a learning curve for physicians, pharmacies
and patients. It is early, and problems exist, but only 3% of
physicians are on e-scribing nationwide. I have only very recently
become "e-script capable," and my experience with
this is minimal to date. I have sent a couple of e-scripts and
at least one did not work. My patient called at the pharmacy,
and I ended up calling in the script. So I am a neophyte. But
e-script is apparently coming to all of us, and we should become
familiar with it.
Physicians are federally mandated to use e-prescribing by 2014 to ensure Medicare reimbursement. The gradual incentive schedule begins with a 2% increase in reimbursement rates in 2009, and ends with a 2% deduction in 2014. This system adjustment aligns reasonably closely to most proposed health care initiatives pushing the electronic medical record future. We are all due for electronic upgrading sooner or later. There is EMR language in the health care portion hidden in the Obama/Congressional Stimulus Package. E-script is a beginning.
Arguments in favor of e-script are compelling. Medical error elimination is the obvious first goal. With a good software application, constructing a legible and correctly written prescription for medicine is not difficult. We no longer worry about patient responsibility to deliver this script, but there still will be a patient responsibility to pick up the script. Can't have it all! Acquiring data on pharmacy formulary, patient payment/insurance plan, and drug interactions is also a component of the e-script system. This should reduce failure to deliver the medicine to the patient at the pick-up for cost, payment, or availability issues.
Of course, there are some downsides with e-script. The biggest gaffe in this oncoming system involves an inability to order schedule II drugs (pain meds) or schedule III–V drugs. Requiring a paper script for pain medication, and pushing this system without addressing that deficiency, can seem consistent only within the halls of Congress. This inability demands address. Additionally, in Texas, any brand name medicine currently requires a handwritten prescription. Software systems for e-script cost money as well. Currently Medco, Caremark, and all other mail order pharmacies, do not take e-script. Yes, I'm still shaking my head after disclosing these "downsides." The fact that not all pharmacies are on board with e-scripts seems considerably less daunting problematically. In truth, most pharmacies are current players.
The summation of the e-script challenge can be calmly stated as "time to load up and get on board." Yes, there are improvements to be made at the outset. My patients will be asked to sign letters to our elected representatives to have pain medicine added to this electronic prescription system. Brand names must also be included. The TMA has set up a responsive set of individuals who are eager to assist and are schooled in e-script systems. There are readily accessible helpers who were present at the e-script discussion. They can be reached by phone, and they expressed they were able to visit for educational presentations. Mandate or not, e-scripts are coming to the neighborhood. As I may repeat in subsequent missives, when one experiences being pushed by a crowd—try to get out in front and make it look like a parade! This is an opportunity to improve patient care and reduce medication errors. We need to get involved and fix this properly. And, rest assured, we need to make it work right. "I look forward to your assistance in this matter."
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