E-prescribing: What's holding it back?

Even apparent "no brainers" take time for adoption, and Rogers has described the innovation adoption curve across time and in different disciplines from agriculture (rotating crops) to medicine (using new drugs). See Rogers, Everett M. (2003). Diffusion of Innovations, Fifth Edition. New York, NY: Free Press. ISBN 0-7432-2209-1.

Basically, some people are innovative in their orientation to novel ideas and other more skeptical. Some are leaders and the majority are followers. In the US, we're still in the relatively early phase where a minority, but a significant minority, has adopted e-prescibing and made the attitudinal, organizational and behavioral changes to incorporate this into their practices (along with the financial commitments).

The carrots are clear in terms of error avoidance, reduced malpractice risk and the time/effort saved refilling meds. The sanctions for being slow to adopt are not yet painful enough and the ease of maintaining the status quo are sufficient reasons we haven't seen more universal adoption.

It's the WIFM (what's in it for me) conundrum. Right now, a doc takes a matter of seconds to physically write a prescription on a pad provided for free in many cases with a gratis pen--cost in time and ouit of pcoket is next to nothing. With an e-prescribing system the doctor has to enter the prescription into a hand-held or PC, send it off to the pharmacy which may or may not be equipped to receive it, educate the patient on what to do and why there is no physical script as is the custom, and deal with any glitches and snafus. Since doctors aren't compensated for prescribing per se, there is no upside to any of this and plenty of perceived downside. The only way to get them to do this is to make it mandatory by linking it to their payment for the visit. A carrot added to this stick in the form of subsidizing them for the costs would make it more politically feasible.

I agree with T. Nugent about the WIFM barrier from physicians although I offer a broader perspective. I learned (painfully) first hand that a vast majority of physicians do not believe that the medical errors and deaths statistically attributed to medication errors can be attributed to themselves personally. Any discussion about e-prescribing resulting in "a reduction in errors" is met with a stone WALL of resistance, sometime vocal, sometimes not.

Prescribers practice in an outrageously litigious environment and they have been brutally schooled to avoid ever saying "I made a mistake" or "I make mistakes." They are often forced into a pattern of denial: "What I don't know, can't hurt me nearly as much as what I know and don't act upon."

So, if you're in the business of encouraging adoption of e-prescribing, take THIS medicine daily and repeat as needed. Doctors do NOT make mistakes.

Patients and payers (insurers and gov't) need to demand e-prescribing because they're the ones who benefit. Adoption by practitioners who do not benefit from it personally will be glacially slow unless concrete benefits are spelled out for them. Or consumers wield a big stick.

1. Oh, So now we have to PAY for the privilege of writing a prescription. We can't charge the patients for the cost of prescribing on line.
2. We pull charts with the faxed prescription request, check the chart for last visit, compliance, correct dosage, etc. With the e-prescribing that we're experimenting with, we have to assign another staff member to check the site, pull up and print the scripts so we can pull the charts to refill the scripts, then pay same said staffer to go BACK to the computer and input the information. AND we don't get any compensation for all the trouble. I would like to see what the patients would say if they suddenly had to show up for appts to get their scripts refilled every single time, or PAY like WE have to. What galls me is that for every mandated thing, no one expects to pay the bill. "Oh, Just dump on the docs some more. They'll roll over again and do it." Well, my pay has gone down and down and down while I work harder. I make about the same as an ICU nurse now. We have NO more room to roll over.

Methinks that the simple act of a physician having to dip into their pocket and pay a nominal sum is one issue a second issue coincides with the fact that physicians are clinically responsible for writing the rx but are not reimbursed for managing oral rx's outside their practice. The third to a lesser degree is that industry can't give it away without violating the kick back statutes. Otherwise giving it away would mean 100% participation.