What’s the Next Phase in E-Prescribing’s Evolution?

A recent blog post by staff members at the Office of the National Coordinator for Health IT looks back at successes in expanding e-prescribing rates across the country and also looks ahead at the work that still needs to be done. 

The authors, Meghan Gabriel, Tricia Lee Rolle and Chelsea Richwine, briefly describe the 20-year history of federal and state policy changes and incentives that have helped drive the adoption of e-prescribing. This started in 2003, when Congress passed the Medicare Modernization Act. In 2006, all states enacted laws to allow e-prescribing of most drugs that require a prescription.

Now, most prescribers have e-prescribing capability integrated in EHRs. Virtually all pharmacies can accept e-prescriptions, and 92% of prescribers e-prescribe, an 85 percentage-point increase from 2008 when only 7% of prescribers were sending e-prescriptions.

In addition, policy efforts to promote widespread electronic prescribing of controlled substances (EPCS) adoption have allowed real-time access to patient information to facilitate better-informed patient care decisions and has resulted in 82% of prescribers and nearly all pharmacies being EPCS-enabled.

So what issues are still being worked through to ensure e-prescribing continues to improve patient care and health outcomes? Additional functionalities that support patient safety and cost reductions such as prescription completeness and delivery of real-time benefit information are on the horizon, the ONC bloggers says. 


“Adding information about why a medication is prescribed enhances the completeness of prescriptions. Currently, e-prescriptions are required to have medication details, including the dosage, strength, quantity, and route of administration,” the authors note. “However, most e-prescriptions do not include the indication or reason for the medication, potentially limiting the ability of pharmacists to provide more personalized care for their patients. The goal is for e-prescribing to be more than a tool for sharing prescription info and one that can aid the coordinated care needed for comprehensive medication management and error prevention.”

There are also needs to further advance e-prescribing to better support bi-directional access, patient privacy and security, and mitigate data gaps regarding prescription services, ONC says.  The Health Information Technology Advisory Committee (HITAC), through its Taskforce on Pharmacy Interoperability and Emerging Therapeutics, recently submitted recommendations, including the electronic sharing of prescription information and associated assessment notes to determine prior authorization requirements at the point of care, supporting advanced interoperability to ensure coverage terms are available in real-time, and exploring comprehensive privacy policies to maximize data sharing where authorized.

ONC’s recently proposed HTI-2 rule also includes provisions to convey patient-specific cost and coverage information through a real-time benefit tool and include indication on e-prescriptions to continue to promote safe and effective patient care.