Rural ERs lag in electronic prescribing: study

NEW YORK Fri Aug 12, 2011 4:20pm EDT

A pharmacist works in Great Falls, Virginia, July 29, 2009. REUTERS/Hyungwon Kang

A pharmacist works in Great Falls, Virginia, July 29, 2009.

Credit: Reuters/Hyungwon Kang

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NEW YORK (Reuters Health) - Emergency departments in rural hospitals may be behind their urban counterparts in switching to computerized drug prescriptions, a new study finds.

President Barack Obama has made information technology a cornerstone of his plan to cut costs out of the U.S. healthcare system. That includes not only electronic prescribing of medications, but completely digitizing patients' medical records so they can be easily accessed and shared among providers.

In 2009, Congress authorized up to $27 billion in government incentives to get doctors and hospitals to switch to "meaningful use" of health information technology. And by 2015, providers will face penalties if they don't switch.

One of the criteria for "meaningful use" is employing electronic systems to prescribe drugs, which is believed to curb medication errors and improve safety. The systems give doctors information on allergy warnings and potential drug interactions, among other things.

But the new study suggests that at least before 2009, rural ERs were lagging behind urban ones in adopting electronic prescribing.

Researchers found that in 2008, 30 percent of ERs surveyed in four U.S. states had "fully implemented" electronic prescribing.

But there was a large gap between urban and rural hospitals; 40 percent of urban ERs had electronic prescribing, versus only 6 percent of rural ones. Rural ERs that were relatively close to cities fared better -- with 21 percent having taken up electronic prescribing.

The study, reported in the Annals of Emergency Medicine, also found wide variation among the four states -- Colorado, Georgia, Massachusetts and Oregon.

Massachusetts was in the lead, with 44 percent of ERs having electronic prescribing. Oregon was next, at 34 percent, while Colorado and Georgia each had electronic prescribing in about one-quarter of ERs.

It's not clear why the disparities existed, according to the researchers, led by Dr. Daniel J. Pallin of Brigham and Women's Hospital in Boston.

The federal financial incentives laid out since, they write, "may lessen the urban-rural disparity and catalyze increased adoption across the board."

Since the 2009 act, another $32 million in federal funds have been earmarked to help rural hospitals catch up.

But Pallin's team also points out that changes were happening before any financial incentives were in place.

In Massachusetts, the number of ERs with electronic prescribing in 2008 was up nearly three-fold from 2005 -- when only 15 percent of ERs had fully implemented e-prescriptions. (Massachusetts was the only state in the study with information from 2005.)

The researchers suggest that federal dollars might be better spent if they were directed not just toward boosting the number of providers using new information technology, but also toward studying the effectiveness, and costs, of the various IT applications available to providers.

"We caution that 'more' is not always the only route to 'better,'" they write.

SOURCE: bit.ly/o1GYRW Annals of Emergency Medicine, online August 1, 2011.

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