Would you buy a mobile phone that could only receive incoming calls, or a car without the ability to drive in reverse? Of course not! There would be limited value in having semi-functional products. However, that is exactly the issue we face with EMRs (recognizably not as extreme as the examples provided).
Doctors have to be able to prescribe efficiently using their EMRs. Not prescribe, print, and hand the prescription to the patient, but true E-Prescribing with direct-to-pharmacy transmission of prescriptions plus ultimately the ability to reconcile, query, and update medication lists automatically through the EMR based upon changes to the patient’s medication profile. This is not pie-in-the-sky thinking. It has been done in many countries — including the United States, which has a much larger and more fragmented healthcare system than Canada.
In November 2011, the Commonwealth Fund published results of a Multinational Comparison of Health Systems Data.
In 2010, the U.S. spent $2.6 Trillion on healthcare, more than the gross domestic product of France, the fifth largest economy in the world. Spending on healthcare is forecast to reach 11.6% of Canada’s gross domestic product (GDP) in 2011 for a total $200.5 billion. (CIHI) Total drug expenditure in 2010 reached $31.1 billion, representing 16.3% of total healthcare spending.
According to CIHI data, “after hospitals, physicians represent the second-largest category of public-sector health care spending (20% in 2011) and drugs, the third-largest. However, the price of doctors’ services was the most important cost driver of spending in this category, with compensation for doctors’ services growing by 3.6% a year.”
In December 2011, the federal government announced that Ottawa could begin cutting back on Federal transfer payments starting in 2017, reducing the payments from the current 6% rate of increase to approximately 4% (the rate of economic growth including inflation). Bottom line: neither the federal nor provincial/territorial governments can afford unchecked increases in healthcare spending.
Canada Health Infoway estimated that in 2010, Canada’s investments in drug information systems (DIS) generated $436 million in cost savings and efficiencies. This number (if correct) does not include any potential benefits that could be accrued if physicians (the gatekeeper for the majority of prescribed medications in Canada) had the ability to E-Prescribe. Even with a conservative cost savings estimate of 5% (if all physicians could E-Prescribe) through reduction in duplication, more effective use of generics, improved compliance, and reduced medication abuse, the numbers are significant. A 5% cost savings on expenditures of $31.1 billion = $1.55 billion per year. There is no doubt that the business case exists to implement widespread E-Prescibing. In fact, I would argue that this is one area in which cost saving is not just needed, it is possible with the right tools and processes.
If Canada could bring pharmaceutical spending inline with the OECD Median spending of $518 per capita, vs. $744 per capita, the cost savings would be in the range of 30% per annum. A staggering amount: $9.3 billion per year. It is interesting to note that in every country with pharmaceutical spending per capita below the OECD Median, E-Prescribing is used by almost 100% of primary care physicians and most specialists.
There is likely some additional cost savings that could be driven from policy changes and negotiation to bring drug costs down for both brand-name and generic medications. This useful comparison chart, from the Commonwealth Fund report, benchmarks drug costs against the U.S.
What do you think? Is there a business case to be made for investing in widespread E-Prescribing? If you are a physician user of an EMR, how much additional value would E-Prescribing bring you? If you are not yet using an EMR, would the ability to efficiently E-Prescribe provide the tipping point value that would make you adopt an EMR? Add your thoughts by clicking on the “Comments” link.
One of the opportunities for E-Prescribing is the ability to use advanced features such as medication reconciliation, medication compliance and others. Will Underwood (Senior Associate, Center For Practice Improvement & Innovation, American College of Physicians), discusses these advanced features on AmericanEHR Partners - http://bit.ly/xd40ha
Posted by: Alan Brookstone | January 12, 2012 at 09:45 AM