By Tony Schueth
American healthcare continued to use technology at a record-breaking pace in 2015 to prescribe medications and improve patient care, according to Surescripts’ newly released 2015 National Progress Report. Here are our top 10 takeaways.
- ePrescribing adoption still grew in 2015. The Report indicates that regular electronic prescribing (ePrescribing) increased by roughly 10%, with 75% of non-controlled substance prescriptions being sent electronically. There were 1.41 billion such ePrescriptions routed through Surescripts in 2015. In fact, these ePrescriptions nearly doubled since 2012 and increased 300% since 2010.
- Despite rumors to the contrary, ePrescribing is still alive. We think that the modest 2015 growth in ePrescribing is pretty good, especially since we are at the tail end of the ePrescribing adoption curve. While the last mile may not be a cake walk, there are still many areas that can contribute to ePrescribing volume and adoption, such as prescriptions from laggards, dental care, discharge medications and long-term and post-acute care. Perhaps the biggest opportunities will come from increasing electronic prescriptions for controlled substances (EPCS) and specialty medications.
- EPCS adoption. EPCS grew substantially in 2015, fueled by the desire of all stakeholders to address the opioid epidemic and resulting state mandates. As a result, there was a 667% uptick in EPCS transactions—12.8 million in 2015, compared with 1.67 million in 2014. However, that growth was due mostly to New York’s I-STOP program, which mandates EPCS.
- EPCS Connectivity. About 80% of pharmacies (mostly chains) could receive ePrescriptions for controlled substances in 2015, which is slightly more than 2014. The number of providers who can electronically submit controlled substance prescriptions rose to 5.7% in 2015. While that’s a 359% increase over 2014, it’s still a disappointing overall connectivity rate. EPCS connectivity by pharmacies and physicians should rise as more states follow New York’s lead for mandatory EPCS. Legislation is a time-tested way to get folks off the starting blocks.
- Missing puzzle pieces. We were again surprised that we didn’t see anything about the formulary and benefit (F&B) file, which has been a major part of ePrescribing since back in the day and is critical for ePrior Authorization. There also was nothing about the real-time benefit check (RTBI). This up-and-coming transaction is a value add because of its potential for providing real-time, patient-specific formulary and benefits information at the point of care. Both the F&B and RTBI have implications for curbing costs and, arguably, improving health care by increasing formulary compliance and medication adherence. Research has shown that high out-of-pocket costs are a main reason why patients abandon prescriptions.
- Other transactions. In case you were unaware of what Surescripts has been up to, the Report highlights several newer products and services in the company’s portfolio. These include clinical messaging, electronic prior authorization (ePA) and medication history aimed at hospitals. Surescripts also is branching out into the realms of long-term and post-acute care (LTPAC). LTPAC is a huge growth area, which is ripe for ePrescribing and EPCS.
- Keep an eye out for specialty pharmacy. Specialty pharmacy was also missing. It’s important because specialty medications represent the fastest growing sector in the American healthcare system. Use of specialty medications is expected to jump by two-thirds in 2015 and account for half of all drug costs by 2016. Secondly, specialty pharmacies are just beginning to consider how to computerize their prescriptions and workflows.
- It’s a marketing brochure. The Report has evolved over the last decade or so from its humble beginnings as a yearly snapshot of ePrescribing adoption. Now it is slicker than ever. There are videos of providers, thought leaders and others, who comment on how Surescripts’ products improve patient care. There are interactive features, such as a return-on-investment calculator for physicians for ePA and an interactive map showing state rankings for EPCS enablement.
- The state ePrescribing adoption map isn’t quite what we expected. The Report contains a map indicating the estimated rate of ePrescribing use by state of medications in the five major therapeutic classes of drugs as defined by First DataBank. They are: heart and blood vessel, antibiotic and antiviral, brain and spinal cord, endocrine/hormonal and respiratory. This is a new approach that took us by surprise. If this format is kept, we hope other classes will be added. Furthermore, the map could be done differently (or a second map added) to improve usability, for example by condition instead of therapeutic drug class.
- The presentation of data. The interactive map approach is easy on the eye and a pretty cool feature. It certainly is what many users expect in this digital age of data sound bites. However, this approach obscures how much information the Report really contains because the user must do a lot of digging and individual analysis to make meaningful comparisons across states and regions. Why? The user must click on each state, record data of interest, collate it and analyze it. In the old days, much of this would be provided in chart form. Yes, charts are boring, but making users dig for the data could lead to less than fully optimal use of the Report.