By David May, MD, PhD, FACC, senior physician and founder of Cardiovascular Specialists, PA, in Coppell, Texas, president of the Texas Chapter of the ACC and a member of the Board of Governors’ Steering Committee.

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Like a Sergio Leone western, e-prescribing (e-Rx) has been viewed by many as a dark and foreboding landscape in which physicians must have a broad, sweeping view of the electronic health care vista alternating with intimate, close-up reflections on each patient encounter. In reality, e-Rx accomplishes neither of these things perfectly. It is, however, here to stay.

The concept of e-Rx is quite simple.  The ability to submit an accurate, understandable, legible prescription without typographical mistakes from the point of care to the pharmacy is a vitally important part of any safe health care system.  Because of how important it is, the development and facilitation of the e-Rx process is one of the key elements in the overall plan for the further advancement of the electronic health infrastructure for the U.S.

Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 provides the guidelines for the incentive program we now define as the e-Prescribing Incentive Program. It was implemented in 2009 as a stand-alone program in addition to the Physician Quality Reporting System (PQRS). Providers who wished to participate in the e-Rx program could but did not have to participate in the PQRS incentive program.

Two years post-implementation, where does the program stand? Let’s review the good, the bad and the ugly.

The Good
The electronic submission of a prescription from the point of care to the pharmacy reduces errors by providing accurate, dose-correct prescriptions without illegible handwriting in a timely fashion. It benefits providers and pharmacies by allowing 24-hour submission and its asynchronous communication eliminates the “phone tag” delay associated with telephone submission and the twisted, often illegible faxed-in prescription. For patients, medicines are available in a timely and expeditious fashion with accurate tracking available. In my private practice, we’ve seen fewer mistakes in prescriptions, faster turnaround time in the pharmacy, and incentive payments in 2009 and 2010 of 2% of our Medicare Part B professional reimbursement through the e-Prescribing Program.

The Bad
The implementation of e-Rx submission requires providers to alter their normal work flow and develop additional skills. In addition, the enhancing and maintaining staff training is mandatory. For example, in my practice, the nurses are responsible for making sure the prescriptions make it to the right pharmacy for the patient. We had to devote a lot of resources to training to make sure this happens for every prescription. With a little creativity though, we were able to make this a more enjoyable experience by implementing the training as a game.

In addition, e-Rx requires great attention to detail, in that if your Internet access is not reliable, electronic submission can be problematic. Due diligence is necessary to be certain that submission has “gone through” successfully, and this is a departure from handing a patient a prescription and being done with it.

The Ugly
Like the PQRS incentive program, e-Rx incentive “carrot” is rapidly changing to an incentive “stick.” The 2012 payment adjustment reporting period is Jan. 1 to June 30, 2011. Practices that have not submitted 10 e-Rx submissions per provider by June 30, 2011, will be penalized 1% of their Medicare professional fee reimbursement for 2012. In addition, registry submission of the e-Rx information is not allowed for this time frame. The e-Rx information must be submitted by claim with the appropriate G code and evaluation and management code.

The E-Prescribing Program may not be perfect, but unlike a Sergio Leone western, it’s a reality. In order to avoid a one percent (1%) decrease in the covered professional Medicare reimbursement for 2012, you must be e-prescribing before June 30 of this year. See www.cardiosource.org/HealthIT for more resources to get started.

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