Testimony

Statement by
Troy Trenkle, 
Director
Office of E-Health Standards and Services
CMS

on
The Benefits of Electronic Prescribing 

before
Senate Judiciary Committee on Electronic-Prescribing
U.S. Senate

Tuesday, December 04, 2007

Good morning Chairman Leahy, Senator Specter and distinguished members of the Committee.  It is my pleasure to be here today to discuss the Centers for Medicare & Medicaid Services’ (CMS) role in promoting widespread adoption of electronic prescribing (e-prescribing).  The current medication prescribing process, which predominantly relies on handwritten prescriptions, is prone to errors.¹  Physicians and other prescribing health care professionals typically make drug-prescribing decisions using whatever information is known or readily available at the time they write a prescription.  They often do not have a complete and accurate medication list or medical history for their patient and, as a result, they can miss potential contraindications or duplicate therapies.    

It is estimated that each year some 530,000 adverse drug events take place among Medicare beneficiaries alone because of drugs negatively interacting with other drugs the patient is already taking, or insufficient information about the patient’s medical history.²  The Institute of Medicine (IOM) reported last year that more than 1.5 million Americans are injured annually by drug errors in hospitals, nursing homes and doctor’s offices.³  These negative drug events may require costly interventions in order to stabilize the patient, including hospitalization.  

The Benefits of Electronic-Prescribing

¹ See Institute of Medicine (IOM).  Preventing Medication Errors, July 2006.  Retrieved from http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf.

² Field TS, et al.  2005.  The costs associated with adverse drug events among older adults in the ambulatory setting.  Medical Care 43(12):1171, 1176. 

³ IOM July 2006.

E-prescribing has the potential for improving beneficiary health outcomes.  For providers who choose to invest in e-prescribing technology, the adoption also could improve quality and efficiency and could show promise in reducing costs by actively promoting appropriate drug usage; providing information to providers and dispensers about formulary-based drug coverage, including formulary alternatives and co-pay information; and speeding up the process of renewing medications.  E-prescribing also may play a significant role in efforts to reduce the incidence of drug diversion by alerting providers and pharmacists of duplicative prescriptions for controlled substances.  

E-prescribing has the potential to empower both prescribers and pharmacists to deliver higher quality care and improve workflow efficiencies.  Typically, providers give a handwritten prescription to the patient or fax it to a pharmacy or other dispenser.  Pharmacists can have a difficult time reading handwritten prescriptions and may have little or no information about the patient’s condition for which the prescription is written.  Contacting the provider by phone to clarify the prescription often results in delays for the patient and is time-consuming for both the provider and dispenser.  According to some estimates, almost 30 percent of prescriptions require pharmacy callbacks.⁴  This translates into less time available to the pharmacist for other important functions, such as educating consumers about their medications.  A potential benefit of e-prescribing in preventing errors is that each prescription can be checked electronically – and quickly – at the time of prescribing.   

In addition to the potential for saving time, the IOM has noted that widespread adoption of e-prescribing could eliminate thousands of adverse drug events each year.⁵  For those individuals who require multiple medications, e-prescribing could help to promote medication therapy management and support care coordination across various providers.  This could, in turn, decrease the financial impact of treating the results of adverse drug interactions.  Additionally, having information about formulary alternatives could reduce patients’ out-of-pocket costs, such as co-pays. 

⁴ Medicare Program; E-Prescribing and the Prescription Drug Program; Proposed Rule.  70 FR 6256, February 4, 2005.  

⁵ IOM July 2006.

Currently just 5 to 18 percent of providers are estimated to use available e-prescribing. ⁶  The technology required to electronically receive prescriptions is already in use by many pharmacies, however.  

CMS Efforts to Promote Widespread Adoption of E-Prescribing

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) directed CMS to establish standards to support a voluntary e-prescribing program for the Medicare prescription drug program (Part D).  Although there is no requirement that providers write prescriptions electronically, providers that prescribe or dispense Part D drugs must comply with adopted standards when conducting electronic prescription transactions or seeking or transmitting prescription information for Part D drugs prescribed to Part D eligible individuals.  CMS, based on National Committee on Vital and Health Statistics (NCVHS) recommendations  reflecting industry and other stakeholder input, has taken an incremental approach to adopting final uniform standards for e-prescribing in Part D.  This approach identified foundation standards that could be implemented by January 2006 and built upon through subsequent rulemaking.  All standards will be consistent with the MMA objectives of patient safety, quality of care, and efficiencies and cost savings in the delivery of care.  

CMS published a final rule establishing electronic prescribing foundation standards for the Part D program at the beginning of November 2005.  Based on industry consensus and recommendations from the NCVHS,⁷ the final rule identified three well-accepted standards that were ready for immediate implementation – “foundation” standards.  The foundation standards took effect on January 1, 2006, and related to transactions involving:  the communication of prescriptions and prescription-related information between prescribers and dispensers; eligibility and benefits inquiries and responses between prescribers and Part D sponsors; and eligibility and benefits inquiries and responses between dispensers and Part D sponsors.⁸  The foundation standards were not pilot tested because there was already adequate industry experience with these standards.  The publication of foundation standards in 2005 helped establish a basis for future e-prescribing implementation and interoperability.

⁶ 70 FR 6256 at 6260 - 6261.