Best Value for Money in Triptans

among the truly predominant e-prescribers. Second, the findings by Ross et al. are restricted to 2 intermediate outcome measures: the ratios of formulary prescription claims and generic drugs to total pharmacy claims. Possible administrative efficiency in the form of fewer calls between prescribers and pharmacies was not measured quantitatively but noted as a qualitative finding from a survey of some prescribers. There is also the administrative efficiency for the pharmacy in the entry of keystrokes by prescribers rather than pharmacy staff for prescription orders. But, others have observed from the current environment of e-prescribing that small independent pharmacies are slow to upgrade their pharmacy management systems to accept e-prescriptions because of large fees charged by software vendors; large chain pharmacies embrace e-prescribing at the corporate level, but local store support is low and there is inadequate training of pharmacy staff. Physician resistance to change, system cost, and inadequate planning to incorporate e-prescribing into the existing care process have been blamed for failures in introducing e-prescribing in health systems. The Centers for Medicare and Medicaid Services (CMS) acknowledged the receipt of about 100 comments in response to the CMS proposal in early February 2005 for e-prescribing standards to take effect prior to the start of the Medicare Part D benefit on January 1, 2006. William Jesse, CEO of the Medical Group Management Association (MGMA), wrote in his letter to CMS Administrator Mark McClellan that the MGMA contends that the benefits of e-prescribing compared with its costs are “simply not evident. ” The letter also called for CMS to “establish a quantifiable return on investment through survey research and a comprehensive cost-benefit analysis for all sizes of physician practices. ” The American Medical Association has been critical of the political agenda to mandate e-prescribing by physicians. Modern Healthcare’s 14th annual survey of information systems needs conducted in January 2004 found that 24% of surveyed organizations had a CPOE system either in operation or implementation, about the same number as the year before, in January 2003. Unlike 2003, however, in which 40% of those without a CPOE system in operation or implementation reported that they planned to add a CPOE system within the next year, in January 2004, only 26% expected to do so in the next year. Data from the National Health Care Survey, Centers for Disease Control and Prevention, suggest a less pronounced dissemination of information technology for office-based physicians. In 2003, only 7.9% of office-based physicians used CPOE, 17.2% had electronic medical records (EMR), and 73.2% used electronic billing for their-party claims. The CDC data support the Modern Healthcare survey data in the more widespread use of information technology in hospitals with 31% of emergency departments and 29% of hospital outpatient centers reporting use of EMR. Amid the pushback from some physicians and the apparent waning interest of health systems in e-prescribing, there is evidence of improved cost outcomes and efficiency in the use of e-prescribing. In the May 2005 issue of JMCP, McMullin et al. found that e-prescribing that included a clinical decision support system (CDSS) was associated with significant drug cost savings and reduction in the proportion of high-cost drugs in 8 therapeutic categories that were the target of CDSS messages to prescribers. Over 12 months of follow-up, the average cost per prescription was reduced by $2.57 (5.3%), and PMPM drug cost was reduced by $1.07 (5.4%) in the e-prescribing group compared with the control group. Average drug cost savings of $863 to $873 per prescriber per month overwhelmed the administrative cost of the e-prescribing system. Targeted highcost drugs in the 8 therapeutic categories were 17.5% lower in the intervention group (35.8%) compared with the control group (43.4%, P=0.03). So, an e-prescribing system with CDSS can influence prescribing and produce drug cost savings. While important to health systems at risk for pharmacy benefit costs, another factor seems to guarantee that e-prescribing will increase in frequency and soon overtake traditional prescribing, perhaps due to factors other than evidence that e-prescribing can be used to reduce direct drug costs. In the last year, Blackberry and other wireless communication devices have been breaking down barriers of resistance to change. The ubiquitous and loweffort features of this technology will transfer to clinician prescribing, and rather than resisting e-prescribing, clinicians will be demanding it. Yet, it will remain necessary to spend money on new and upgraded system software to integrate e-prescribing with the electronic medical record to overcome electronic silos of data that reside in pharmacies, at pharmacy benefit managers, or in data warehouses and are not available to clinicians at the point of care. What will shorten the timeline between the reality of today and the inevitability of tomorrow is studious examination of the work of pioneers in adapting and implementing IT solutions in health care settings. Among the many sources of this information is a compilation by GroupPOE, created in October 2002, entitled “Landmines and Pitfalls of Computerized Prescriber Order Entry. ” While nearly 3 years old, the recommendations and lessons contained in this document are still relevant and useful today.