E-prescribing highlights barriers to data sharing

Of late, the volume of noise on the e-prescribing front has gotten steadily louder, with calls on all sides for rules that will encourage (or force) e-prescribing technology use. Now, with a new federal e-prescribing bill pending in both the Senate and House, some kind of mandate seems likely.

However, it looks like the federal organization which has the most control in the matter--the DEA--may hold up the progress of e-prescribing by refusing to permit Schedule 2 through 5 drugs ("controlled substances") to be transmitted electronically. This would force e-prescribing physicians to switch back and forth between e-scripts and paper ones, which could create major administrative issues.

Honestly, that's no surprise. While Medicare may have strong incentives to encourage e-prescribing, DEA rulemakers have every reason to resist. After all, if e-prescribing works, nobody is going to give DEA officials a big budget increase or even much of a high-five. Meanwhile, if it does create new security issues, they're in the doghouse.

My guess is that this is far from the last time when competing federal interests get in the way of national health information networking. After all, agencies like the DEA and HHS weren't created to work together, but rather, to administer programs which didn't even contemplate health networking.

I'm just using my imagination here, but what about conflicts between, say, the INS and HHS (over health data on possibly illegal immigrants)? Between the FTC or DOJ and HHS (over antitrust issues they could see in competitors forming data sharing cooperatives), isn't there turf the FCC or even the SEC might see as being invaded by all-reaching, integrated health networks?  I don't know, but I wouldn't be surprised if the answer was yes.

Ultimately, I imagine the various agencies will work things out, particularly if the next president takes the strong interest in HIEs that President Bush has. Still, I think things are going to get a little bit ugly first. Brace yourselves. - Anne

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