Access To Patient Information, Safeguards Against Commercial Bias
Keys To Electronic Prescribing, Expert Panel Says

Health Affairs Article Details Recommendations To Be Presented
To National Committee Developing Electronic Prescribing Policy

BETHESDA, MD — Physicians and other health care providers wanting to pursue electronic prescribing should look for systems that allow them to access patients’ computerized records and current medications, and can transmit prescriptions according to established standards, according to a new paper published today on the Health Affairs Web site.

The recommendations, made by an expert panel assembled by the RAND Corporation, also call on health care providers to disclose any sponsorship of electronic prescribing initiatives by third parties such as health insurers or drug manufacturers.

The panel assembled by RAND represented physicians, health care quality and consumer advocates, pharmacists, pharmacy benefit managers, nurses, economists, medical informatics experts, and insurers.

Douglas Bell, an associate natural scientist with RAND Health, who was lead author of the paper containing the recommendations, will present the findings today (Tuesday, May 25) at a meeting of the Standards and Security Subcommittee of the National Committee on Vital and Health Statistics in Washington, D.C. Under the Medicare Prescription Drug, Improvement, and Modernization Act (MMA), that committee has been asked to develop recommendations for national standards on electronic prescribing.

The panel developed sixty recommendations, rating them based on their ability to improve patient safety and health outcomes, help patients manage costs, maintain patients’ privacy, and promote physician acceptance. Fifty-two of the recommendations were rated by the experts as clearly positive for patient safety and health outcomes, and 43 were rated as achievable in the average clinician’s office within three years.

The panel designed the recommendations as a guide for providers to use in selecting electronic prescribing systems and manufacturers to use in their design, as well as to help policymakers seeking to promote the adoption of electronic prescribing.

“MMA contains provisions intended to accelerate the adoption of electronic prescribing both through grants and by authorizing third-party funding for electronic prescribing systems,” Bell says. “Qualifying systems will need to meet federal standards, which are to be developed with the goals of promoting safety, quality of care, and cost savings. Our results provide information that federal policymakers can use in developing standards that are likely to achieve these goals.”

The panel recommended that electronic prescribing systems should:

• Import patient identification and demographic data from electronic medical records used by the organization

• Provide the patient’s complete current medication list to prescribers who have care responsibility for the patient

• Display a list of medications appropriate to the diagnosis when it is entered

• Guard against efforts to promote specific drugs by third parties such as drug manufacturers or pharmacy benefit managers

• Distinguish alerts based on patient safety and health outcomes from those based on formulary adherence

• Transmit prescriptions electronically using established standards for data exchange

• Support compliance with federal health care privacy laws and methods for checking the integrity of stored data

Accompanying Bell’s article are perspectives by David J. Brailer, senior fellow for health information technology and quality of care at the Health Technology Center; Jonathan C. Javitt, adjunct fellow of the Potomac Institute for Policy Studies; and W. Ed Hammond, professor emeritus in the Departments of Community and Family Medicine and Biomedical Engineering at Duke University.

Bell’s article can be read at content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.305.

Brailer’s perspective: content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.318.

Javitt’s perspective: content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.321.

Hammond’s perspective: content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.325.

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Additional peer-reviewed papers are published weekly online as Health Affairs Web Exclusives at www.healthaffairs.org. Health Affairs Web Exclusives are supported in part by a grant from the Commonwealth Fund.

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©2004 Project HOPE–The People-to-People Health Foundation, Inc.