New Hampshire to Encourage E-Prescriptions
If New Hampshire Gov. John Lynch (D) and the New Hampshire Citizens Health Initiative have their way, all health care providers statewide will be able to prescribe medication electronically, or use e-prescribing, by 2008.
Critics, though, say that plan could invade patients' privacy. Moreover, since financial incentives are being offered to use e-prescription, those who don't use it will be penalized.
A federal program--the Tax Relief and Health Care Act of 2006--calls for health care quality measures, including the use of e-prescribing, to be in place by 2008. Congress is creating a Physician Assistance and Quality Initiative Fund with $1.35 billion earmarked to pay physicians for "quality performance."
The New Hampshire Citizens Health Initiative is a group Lynch created in 2005 to work with various constituencies to establish health care policies for the state. The group also promotes improved disease prevention and access to information. Members include lawyers, state government officials, business leaders, and health care providers, some appointed by Lynch.
Though e-prescription will not be mandatory, New Hampshire Citizens Health Initiative spokesman Phil Boulter said it's a goal the Granite State is poised to achieve, since many primary care doctors already have the requisite software capabilities. Advocates of e-prescribing, which would let doctors send prescriptions from office computers or handheld PDA devices to pharmacies, say it reduces costs and time spent by employees at pharmacies and doctors' offices.
Boulter, a physician, recommends e-prescribing to reduce medical errors caused by illegible handwritten prescriptions. E-prescription, he said, can also draw better attention to patients' drug allergies and possible drug interactions.
"It leads to efficiency at the pharmacy and efficiency at the doctor's office," Boulter said. "There is broad support [for the e-prescribing measure] from the hospitals, the New Hampshire Medical Society, both the community and chain pharmacies, as well as the public at large."
A July 2006 report by the Institute of Medicine, an arm of the federal National Academy of Sciences, found that under the current prescription process, pharmacists are often uncertain about the drugs and dosages doctors have prescribed. Costly errors are often caused by mistakes in prescribing or taking medication, the report stated.
With thousands of prescription drugs and over-the-counter drugs available, there is great potential for adverse drug interactions, Boulter said. Using e-prescriptions to highlight them would increase patients' safety and free up the time doctors spend answering questions about prescriptions over the phone, he said.
However, e-prescribing has dangers New Hampshire should be aware of, said Twila Brase, president of the Citizens' Council on Health Care, a St. Paul, Minnesota-based nonprofit organization that focuses on policy affecting health care access, cost, and delivery.
"Just because it's new and technology and electronic doesn't mean there aren't problems," Brase said. When new technology is implemented, "very rarely do people look at problems associated with [it]. It's not like this is an error-free program."
Although Boulter acknowledged the state would have a learning curve, he noted companies that make software and PDAs tend to have training staff, and that technical support would help facilitate the program. No state subsidies will be used to support the program, he said--but Brase called the incentives to use it "coercion lite."
"There's no mandate, but there is financial pressure," Brase said. "If you can stay in business while everyone else around you complies and gets paid more, you've managed to defy the coercive forces."
In addition, Brase said, e-prescribing limits privacy, restricts purchasing options, and, according to a study published in the Journal of the American Medical Association in 2005, could introduce up to 22 new medical errors.
"I don't think patients will be given an option to accept or refuse having their medication prescribed electronically," Brase explained. "Doctors who e-prescribe will be financially rewarded by the health plans and government agencies that want complete access to patients' personal data, no matter what patients may think. Requiring patient consent for e-prescriptions would limit their access to data, and physicians' access to dollars, so I doubt patients will be asked."
People should have the freedom to have private doctor-patient relationships, Brase said--and that includes the option of handwritten prescriptions they can choose to fill or not without having everyone, including doctors, know where or when it was done.
In addition, Brase said, the cost of maintaining and updating an e-prescribing database and software may not be fully calculated. Lawsuits could result if the database is hacked or patients' personal information is stolen.
That happened in Portland, Oregon in January 2006.
The Providence Health System used computer disks and tapes to store sensitive patient information, including addresses, phone numbers, and Social Security numbers. Employees routinely brought disks and tapes home to store such information as backup ... until the records of 365,000 patients and 1,500 employees were stolen from an employee's vehicle.
According to a February 2006 Portland Oregonian news article, Providence is expected to spend more than $7 million to cover affected patients' credit monitoring and credit restoration services.
"[Privacy is] always an issue with any technology," Boulter said. He said vendors will encrypt New Hampshire's system to make it as secure as possible.
Mary Susan Littlepage (firstname.lastname@example.org) writes from Chicago.
For more information ...
New Hampshire Citizens Health Initiative, http://www.steppingupnh.org/hhsonline/nhchi/index.asp
"Preventing Medication Errors: Quality Chasm Series," Institute of Medicine, July 20, 2006, http://www.iom.edu/CMS/3809/22526/35939.aspx
Citizens' Council on Health Care, http://www.cchc-mn.org
"President Bush Signs the Tax Relief and Health Care Act of 2006," December 20, 2006, http://www.whitehouse.gov/news/releases/2006/12/20061220-2.html
"Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors" by Ross Koppel, Ph.D., et al., Journal of the American Medical Association, March 9, 2005, http://jama.ama-assn.org/cgi/content/abstract/293/10/1197
"Providence Chief Faults Audit," by Joe Rojas-Burke, Portland Oregonian, February 28, 2006, www.oregonlive.com/printer/printer.ssf?/base/business/1141098920121120.xml&coll=7