NEW HAMPSHIRE GOES FOR THE GOLD IN E-PRESCRIBING

Volume 27, Issue 479 November 13, 2006

Cara Campbell

Many states are beginning to mine the efficiencies and quality improvements made possible by health information technology (HIT).

Now New Hampshire intends to be the first state to have all its health-care providers use one aspect of HIT: electronic prescribing of medications. On Oct. 13, Gov. John Lynch and the Citizens Health Initiative called on all in-state providers to be able to send prescriptions from office computers or hand-held “blackberries” to pharmacies by October 2008.

“Gov. Lynch believes e-prescribing will address at least two problems in health care—high costs and time,” said Dr. James Squires, the Initiative’s co-chair and a former New Hampshire senator.

In July, the Institute of Medicine (IOM) released a study estimating that problems with the prescription drug system—uncertainty about what the doctor prescribed, an inappropriate medication for the patient, wrong dosages or just the wrong drug—cost the health-care system $77 billion a year nationally. On a per-capita basis, that could mean up to $300 million a year in avoidable costs in New Hampshire.

Having statewide e-prescribing by 2008 is an aggressive goal, Lynch admitted, but he said it’s doable because it’s been adopted by the “the people who can make it happen.” By that, he means the members of the Initiative, including the New Hampshire Hospital Association, the New Hampshire Medical Society, pharmacists and the state’s major insurers.

Squires said he doubts state appropriations will be needed to prompt the spread of e-prescribing. Most pharmacies buy e-prescribing systems as software packages, and several health plans and pharmacy benefit managers are subsidizing the deployment of e-prescribing systems to physician offices. Federal regulations were explicitly changed to exempt this activity from restrictions that do not allow health-care organizations to give physicians goods or services that might be construed as kickbacks. Following this change, hospitals have begun to offer various HIT systems (including e-prescribing) to community-based doctors.

While many states are moving toward e-prescribing, three states have laws that effectively prohibit its implementation. West Virginia, for example, requires physicians’ handwritten signatures on prescriptions. Eight states don’t prohibit e-prescribing, but do not have supporting laws.

Squires hopes that e-prescribing will persuade providers to invest in another type of HIT—electronic medical records, which gather patient health information (including prescriptions, test results and decision-support tools) in one place so that they can be accessed almost instantly by health-care team members.

As an incentive to get providers to adopt HIT, Initiative members have been working with health insurers to develop “pay-for-performance” standards, which would allow higher reimbursement for higher quality care. "While we are still finalizing all the standards, one common pay-for-performance standard will be the use of electronic medical records and e-prescribing,” Lynch said.

Nationwide, a growing number of states are taking action to further the use of HIT. As of October 2006, 28 states had initiated HIT planning processes, and seven states had completed their plans and were in the process of implementation.

NCSL’s Project HITCh—for Health Information Technology Champions—supports state legislative decision-making about HIT. For details on state activities and links to some recent NCSL programs, go to www.ncsl.org/programs/health/forum/hitch/ or contact Kala Ladenheim, program director, at Kala.ladenheim@ncsl.org

Cara Campbell is an intern with NCSL’s Forum for State Health Policy Leadership.