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The new Medicare drug bill encourages E-prescribing to improve patient safety and health, but advanced systems are key

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 began providing prescription drug coverage to Medicare enrollees in January 2006. The MMA includes provisions to foster electronic prescribing (E-prescribing) to improve patient outcomes and control health care costs. Although physicians have been slow to embrace E-prescribing, adoption may increase in 2006, when a new tide of pharmacy messages will arrive from patients entering the multi-tier drug coverage program under Medicare. Yet the E-prescribing systems they select may lack the advanced features needed to prevent medication errors and chronic disease complications, note Douglas S. Bell, M.D., of RAND, and Maria Friedman, of the Centers for Medicare & Medicaid Services, in an article supported in part by the Agency for Healthcare Research and Quality (HS13572).

Even the most basic E-prescribing systems could reduce miscommunication errors, for example, due to illegible handwriting. To optimize the return on Medicare drug spending, the researchers recommend the government consider additional incentives to encourage the use of advanced E-prescribing systems. In this article, they review the ways in which the E-prescribing rules proposed for Medicare implementation might or might not improve patients' health outcomes and control health care costs.

The researchers point out that most of the benefits of E-prescribing for health outcomes and health care costs depend on advanced features, such as alerts for potentially hazardous prescriptions and reminders for important omitted medications (frequent among older patients). However, one study recently showed that commercially available E-prescribing systems vary greatly in their implementation of these advanced features. What's more, the costs of implementing E-prescribing are a major barrier for physicians, with hardware and software costs of a basic E-prescribing system ranging from $1,500 to $4,500 per physician. More advanced systems cost up to $29,000 per physician in the first year and $4,000 each year thereafter.

See "E-prescribing and the Medicare Modernization Act of 2003," by Dr. Bell and Ms. Friedman, in the September 2005 Health Affairs 24(5), pp. 1159-1169.

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