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If E-Prescribing’s So Great, Why Is It So Difficult?

Some people might think that since California has such a big head start on the rest of the nation in some arenas of health care reform, that it would also be taking a lead role in launching a program for e-prescribing — the electronic communication of prescriptions between physicians and pharmacists.

But those people would be wrong.

“California is 45th in the nation,” Ned Hanson, director of formulary management at Health Net Pharmaceutical Services, said. “We’ve been looking at anywhere from 8 to 10 percent adoption.”

Hanson was part of a large contingent of health care experts gathered at the third annual California E-Prescribing Consortium meeting yesterday in Oakland.

The new player on the block is Cal eConnect, a $39 million not-for-profit public-private partnership launched last year to help organize and oversee the state’s health information exchange. Part of that effort includes tackling what has turned out to be a thorny issue of electronic prescriptions.

“We should be seizing the opportunity to build infrastructure and influence policy,” Cal eConnect CEO Carladenise Armbrister Edwards said. “There’s incongruence in the laws, in policy, and those need to be fixed. Let’s rewrite the law.”

Edwards pointed out that California has a number of challenges to e-prescribing that other states don’t, such as the state’s protections of the transfer of medical information for mental health and AIDS patients. Those protections are fine, she said, but they present one of the barriers to implementing a smooth protocol for e-prescribing.

“We need to figure out where those different roadblocks are, and identify the barriers that are inhibiting us,” Edwards said. “There are three fundamental things we want to do.”

In addition to fixing the electronic infrastructure and develop policy, Edwards said, she hopes Cal eConnect can help position California as a leader in e-prescribing. And the third tenet, she said, was to improve education and technical assistance — so pharmacists, physicians, administrative staff and patients all understand the benefits of e-prescribing and how it should work.

“We need to educate and provide assistance to those who don’t have,” she said. “Those who have, do. And those who don’t have, don’t.”

Several of the speakers and participants raised specific problems and issues that have dogged California’s effort so far — system limitations, poor communication and coordination with pharmacists, data quality and standardization, and a number of work flow barriers.

Virginia Herold of the state’s Board of Pharmacy said that California’s law was modified in 1994 to initiate e-prescribing, and that her organization has been waiting for years to see the promise of e-prescribing develop.

“Now we finally have federal guidelines, released in March,” she said. So now, after waiting for another organization to take the lead on establishing standards, the Board of Pharmacy is planning to get busy on it.

“We got tired of waiting,” she said. “We waited for industry, we waited for associations, but you know, we’re pretty good at consumer protection. So we’re going to take a leadership role. We meet for first time in January, and we need to figure out, what do pharmacies have to do to become compliant? How are we going to troubleshoot this, and how are we going to implement e-prescribing?”

Herold said the benefits are too great for e-prescribing to be derailed by inaction. “E-prescribing brings great health advantages,” she said. “It’s time to get rid of that pencil and paper.”

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