Blue Cross and Blue Shield of Illinois (BCBSIL) physicians and health providers have reached a major milestone in their e-prescribing efforts - the one millionth prescription script was electronically transmitted to a pharmacy in this month.

"The millionth prescription written is a major milestone for Illinois, yet the real beneficiary of this program is the patient," says Dr. Scott Sarran, chief medical officer at BCBSIL. "Benefits of e-prescribing include reducing the rate of drug interactions and eliminating legibility issues and subsequent medication errors."

E-prescribing helps reduce medical errors in part because it does away with doctors' illegible handwriting and improves efficiencies with the ability to identify medications and dosages quickly.

Physicians use an automated data entry system (such as a desktop computer, handheld device or personal computer tablet) to electronically submit a prescription to the patient's pharmacy of choice. E-prescribing gives doctors real-time access to important safety and prescription coverage information so they can make more informed prescribing decisions. The technology has been widely recognized for its ability to improve patient safety, increase practice efficiency for physicians and pharmacies, and reduce health care costs.

Sarran says since the Illinois e-Prescribing Collaborative program launched in February, 2007, over 119,000 possible drug interactions were flagged, resulting in 19 percent of scripts being changed or cancelled.

"We also found over 24,600 scripts written for patients who had a potential allergy to the drug, and 8 percent of those scripts were changed on cancelled. That's a safety step that reduces medical errors and saves patients lives."

Based on national trends, more than 670,000 prescriptions will be changed and cancelled in 2009 due to drug interaction warnings and more than 53,600 prescriptions will be changed or cancelled due to drug allergy warnings.

The Institute of Medicine reports that more than 1.5 million Americans are injured every year by medication errors and recommends that all prescriptions be written and received electronically by the year 2010.

Surescripts, a St. Paul, Minn.-based national electronic prescribing network, says e-prescribing accounts for about 4.5 percent of all prescribing in the U.S. However, e-prescribing has more than doubled to 68 million in 2008 from 29 million in 2007.

Sarran says BCBSIL providers using the technology have increased, as sees growth in scripts routed electronically. According to the 2008 Electronic Prescribing Progress Report, Illinois ranked 21st in the nation for total number of prescriptions routed electronically. In 2007, the state ranked 28th and was 27th in 2006.

Illinois had 3.79 percent of total prescriptions written via e-prescribing as of December 31, 2008. There were 1.9 million new prescriptions written in 2008 and over 2.5 million routed electronically; that's a growth of 240 percent over scripts filed in 2007.

Illinois has been making great strides, said Sarran, and was recently recognized as one of the five most improved states by Surescripts, the electronic prescribing network. Surescripts credits six organizations in Illinois as key contributors in driving the success of e-prescribing in Illinois:

1. Blue Cross and Blue Shield of Illinois, Chicago
2. Illinois eRx Collaborative
3. Northshore University Healthsystem, Evanston
4. OSF Healthcare System (Third Order of St. Francis), Peoria
5. Southern Illinois University, Carbondale
6. United Healthcare, Chicago

These groups were recognized in Washington, D.C, as part of the Fourth Annual Safe-Rx Awards by Surescripts in June.

The state progress report ranks Illinois 25th for the number of physicians who e-prescribe, with 2,354 physicians current part of the initiative. While that's 11 percent of doctors in the state, it's a growth of 146 percent over the 2007 program, which had only 41/2 percent physician participation.

Illinois ranked 16th in the state ranking for the number of community pharmacies activated for e-prescribing. Eighty-two percent of the pharmacies in Illinois are part of the program, with 1,810 locations capable of receiving routed scripts; a 9 percent increase from the previous year.

Barriers
Despite the growing numbers of scripts written and physicians in the program, there are still barriers to adoption. Sarran shares feedback from offices slow to join the program:

1. Previous negative e-prescribing experience
2. Initial and long-term cost
3. Lost productivity (new workflow adoption, training, system downtime)
4. Confusion about competing product offerings
5. Competing priorities
6. Technology requirements
7. Disengaged administrators and office staff
8. Change management issues

Promoting Adoption
Sarran sees industry factors coalescing that will promote adoption.

"Doctors can take advantage of federal incentives that began in January. The Center for Medicare and Medicaid Services (Medicare Improvement for Patients and Providers Act/MIPPA) is offering doctors a two percent bonus if they e-prescribe now or next year, but that amount will drop to one percent if they come aboard in 2011-2012. Physicians who don't jump on board will have their Medicare reimbursements reduced beginning in 2012 by one percent, following with a one and a half percent penalty in 2013 and two percent penalty in 2014.

Also, the Drug Enforcement Agency is proposing the capability of electronic prescribing for drugs in the Schedule II-IV class (controlled substances). Currently a physician must give the patient a hand-written script to present at the pharmacy and not electronically transmit this medication request.

Increased participation by payers will also aide adoption. The National Progress Report on E-Prescribing found increased payer participation enabled access to prescription benefit and history information for 65 percent of patients in the country.

It Takes An e-Collaborative
Participation by payers and other stakeholders is key, says Sarran, and that's why BCBSIL formed the Illinois e-Prescribing Collaborative in February, 2007. This group of insurers, technology vendors, pharmacies, employer groups and physicians work together to increase the use of e-prescribing. The group includes Midwest Business Group on Health, Chicago Patient Safety Forum, Illinois Academy of Family Physicians, Illinois chapter American Academy of Pediatrics, Illinois Healthcare and Family Services, Jewish Federation of Metropolitan Chicago and health plans and pharmacies.

The decision to participate in e-prescribing isn't cheap, so BCBSIL provided grants to 500 physician offices. "It costs about $3500 per provider to implement e-prescribing, although the expense includes a complete electronic medical record," says Sarran. "It's been a significant investment for BCBSIL but well worth it."

Going forward, Sarran says, BCBSIL remains committed to the e-prescribing initiative. "It fits in with our own quality initiative which focuses on decreasing medication errors and improving generic utilization. More importantly, this program fits in with our overall physician e-connectivity strategy. For BCBSIL, it's about what's best for our members. E-prescribing is about safety and convenience for patients, and that the patient's medications are covered by their health plan. E-prescribing is about getting the right medicine to the right patient as quickly and safely as possible, and if we can play a part in that, we'll continue to be part of this initiative."

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(1) SureScripts Safe RX Program. 2008 Illinois ranking: http://www.surescripts.com/downloads/SafeRX_State_Rankings.pdf.

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