Mandate e-prescribing, committee advises HHS secretary

A high-level advisory committee today asked the Health and Human Services Department to seek permission from Congress to mandate e-prescribing in the Medicare program.

Acknowledging that not all the necessary groundwork has been laid for a national move to e-prescribing, the American Health Information Community has laid out a series of conditions that should be met in the next year or two before a mandate could take effect.

The committee adopted the recommendation during a telephone meeting today. There was some opposition from doctors’ representatives, who said the recommendation was too strong, and from insurers, who called it too weak.

HHS Secretary Michael Leavitt, who heads AHIC, had urged the group to recommend the mandate as part of a strategy for gaining adoption of e-health records. E-prescribing is often described as the easiest and most rewarding element of health information technology for doctors, hospitals and pharmacies to adopt.

According to the letter from the committee to Leavitt, about 30 percent of retail pharmacies don’t have e-prescribing capabilities, and it is not clear how to ensure they get such capabilities in the near future. Some possibilities include action by Congress to require it and/or incentive payments.

Another roadblock comes from the Drug Enforcement Administration, which bars e-prescribing for controlled substances, such as powerful painkillers, that account for about 11 percent of prescriptions. Also, some states have paper-based requirements for narcotics prescriptions, such as requiring that they be written in triplicate.

If doctors have to write some prescriptions electronically and others on paper, “that creates nothing but chaos and confusion,” said AHIC member Douglas Henley, executive vice president of the American Academy of Family Physicians.

However, other AHIC members, including Kevin Hutchinson, chief executive officer of e-prescribing network SureScripts, said there are indications that DEA may be getting ready to accommodate e-prescribing in the face of growing political pressure. “I think we’re making headway,” Hutchinson said.

The AHIC letter also calls on the Centers for Medicare and Medicaid Services to provide incentives to doctors and pharmacies for using e-prescribing, early in 2008.

Although the letter calls for a national mandate, it says flexibility will be necessary in some cases when e-prescribing doesn’t make sense.

The letter drafted by an AHIC workgroup calls for HHS to require e-prescribing as a condition of participation by doctors in Medicare Part B. Because there are no other such conditions for doctors treating Medicare patients, that language was dropped during the meeting, leaving the requirement a mandate linked implicitly to Medicare.