There is ample evidence that e-prescribing improves patient safety, increases generic prescribing, and reduces drug costs for both plan sponsors and consumers. Physicians participating in e-prescribing initiatives see the benefits. Yet less than 10% of physicians use the technology.

A major reason for slow uptake by physicians is expense and lack of reimbursement for adopting a new system. E-prescribing is costly to implement, particularly for small physician practices. In addition to the cost of hardware and software, there also is time and cost involved in redesigning workflow, training, and converting files, along with a temporary decrease in efficiency.

Those at the forefront of e-prescribing have been involved in regional initiatives funded by the area’s dominant health plans or payers. The highly successful Massachusetts eRx Collaborative and Southeast Michigan E-prescribing Initiative (SEMI) are examples as shown in Table 46. The same has been true for physician adoption of electronic health records (EHRs). Large integrated medical groups with greater financial resources are the early adopters.

Increasingly, e-prescribing is used by physician practices within the context of EHRs, according to a 2008 report from the eHealth Initiative and the Center for Improving Medication Management. Both stand-alone e-prescribing systems and EHRs may be utilized to realize the functionality and benefits of e-prescribing. However, overall quality of care can be enhanced by implementing e-prescribing integrated with an EHR that has two-way electronic connectivity with pharmacies and pharmacy benefit managers.

Several recent developments may bolster momentum for both e-prescribing and electronic health records.

The Medicare Electronic Medication and Safety Protection Act of 2008 offers financial incentives to doctors who use qualified e-prescribing methods. This legislation also imposes financial penalties beginning in 2012 for doctors who do not e-prescribe.

The Centers for Medicare and Medicaid Services also recently launched a $150 million pilot project which offers physicians financial incentives to move to electronic health records. The program will help nearly 1,200 small practices in 12 cities and states switch from paper to digital record keeping.