An increasing number of hospitals are using Web-based scheduling systems for their nurses and other shift employees. Statistics show at least 300 hospitals across the country are using them, and hundreds more are likely to start within the next year or two. Hospitals using the systems say one of the biggest benefits of the Internet-scheduling system, both in money saved and quality of service, has been a sharp reduction in the hospitals' use of outside nurses.
The University of Kansas Hospital has implemented an electronic medical records system in its emergency department, giving doctors access to information such as tests and medications patients have received at KU Hospital and at KU Med West. The ER installation marks the latest phase of KU Hospital's three-year implementation of a $50 million electronic medical records system. The hospital already has installed the system in its inpatient rooms and recently expanded the system to its outpatient care facility at KU Med West.
Federal regulators are preparing to announce plans to allow digital prescribing of restricted medications, easing a barrier to widespread adoption of the technology. The proposal from the Drug Enforcement Administration comes as Congress appears likely to pass a bill that would push doctors to switch to electronic prescriptions from written ones. Together, the likely bill and the DEA shift may finally lead to widespread adoption of e-prescribing. Many doctors have been reluctant to purchase the technology because of concerns including cost and DEA restrictions.
A government-sponsored survey of the use of computerized patient records by doctors points to two seemingly contradictory conclusions: The report found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care, yet fewer than one in five of the nation's doctors has started using such records. The survey also found that electronic records were used in less than 9% of small offices with one to three doctors, where nearly half of the country's doctors practice medicine.
A new report by the eHealth Initiative lays out, in painstaking detail, the current state of affairs in electronic prescribing. At first glance, the numbers suggest real progress.
For example, the report notes that in 2004, little electronic prescribing took place. By the end of 2007, some 35,000 prescribers were actively dispatching their medication orders straight to pharmacies. In that same year, some 35 million prescription transactions were sent over a nationwide network known as the Pharmacy Health Information Exchange, operated by SureScripts. In other words, in a little over three years, the industry has gone from virtually no electronic prescriptions to tens of millions of them.
The catch, of course, is that, high numbers aside, the proportion of overall prescriptions sent electronically is tiny. "The adoption level at the end of 2007 represented approximately 2% of the potential for electronic prescribing," the report notes.
We are indeed a medication-happy society, consuming 3.52 billion prescriptions annually! So in the big picture, adoption of e-prescribing remains low. Massachusetts leads the way, with 13% of prescriptions in this highly "wired" state sent electronically. My home state, Illinois, is far down the list, ranked at 28th with just over 1% of medication orders sent via electronic networks. I'm sure not helping boost those numbers myself.
Last week, I dutifully toted my antibiotic prescription across town from my physician to the drugstore. It's not a long walk, and his handwriting is fairly legible, but to me the missing piece here is compliance. My physician has absolutely no way to know if I fulfilled the prescription.
This scenario plays out time and time again. North Dakota ranks dead last, with a mere .09% of prescriptions transmitted electronically. How many actual prescriptions does that work out to? Perhaps there is some solo physician up there who practices medicine part-time and who uses an EMR a few times a week.
I don't know which astounds me more—the sheer quantity of drugs that we Americans consume, or the continued reliance on paper-based prescription orders to facilitate the transactions. Even if you take out controlled substances (which face legal restrictions on electronic orders), the number of prescriptions being toted by hand by consumers to their local pharmacy is huge. Yet, this report lays out some compelling reasons why physicians have not adopted this technology, including cost, workflow, and data standards. This is a thorny issue indeed, and the eHealth Initiative (and its partner, the Center for Improving Medication Management) deserve kudos for compiling such an exhaustive analysis.
Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at gbaldwin@healthleadersmedia.com.
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Michigan-based American Community Mutual Insurance Co., which in 2007 formed a new subsidiary called Precedent Insurance to market exclusively online in Texas, has abandoned that effort and switched to using agents. The online-only sales approach didn't work so well, and the company has ceased using the technology it had licensed from a California business software developer, said a spokesman. American Community is now using agents to sell the same individual coverage in Texas and nine other states.