Do Not Disturb

With EHRs, disruption of a physician's "chat, chart, and charge" workflow is unnecessary, says Fotsch. Physicians will use EHRs during an exam with patients, and if they can find valuable services one click away, or embedded within the EHR technology—easy access to patient education materials, coupons and other financial assistance, or samples—they'll use them, or their office managers and nurses will use them. Rose Crane, CEO at Epocrates, is also targeting the physician's workflow with that company's EHRs. Crane says the four criteria used by Epocrates when developing its EHRs were affordability, ease of use, a focus on the patient encounter for the physician-facing template, and uninterrupted workflow. "We are admittedly coming late to the [EHR] market, but I'd say that we've learned from a lot of the current EHR providers out there, and what physicians find problematic," says Crane. Epocrates announced the first phase of its EHR roll-out on July 27. The company will target small physician practices, rather than compete with the companies mentioned above.

The other major development within the new crop of EHR providers is access: PDR and Epocrates, both of which made their bones initially as a drug reference for physicians, have kept up with shift in technology platforms used by physicians, beginning with smartphones and now tablets. As such, the companies' EHR offerings utilize mobile and SAAS technology, which lets physicians bypass much, if not all, of the hardware installation, a key barrier to adoption. Additionally, drug updates, such as black box warnings, risk, and REMS information, are updated live in real-time. "The fact that box warnings aren't surfaced real-time in EHRs, and that EHRs don't contain the full updated FDA-approved labeling, is kind of astounding," says Fotsch, adding that with EHRs only recently being underwritten by the federal government, it's perhaps not entirely astounding. After talks with FDA in April, PDR, with its partners, launched an adverse events reporting service in June, which is incorporated into the EHR platform. Fotsch says physicians don't have time to report every adverse event they encounter with patients through the traditional channels, which is typically a phone call to a pharmaceutical company. In her keynote address at the PDR-sponsored PharmEHR Summit last April, Janet Woodcock, director of the Center for Drug Evaluation and Research (CDER) at FDA, advocated for not only adverse events reporting through EHRs, but also talked about incorporating REMS programs into EHRs. "REMS are very clunky, and not well integrated into the physician's workflow ... I think [REMS] can be integrated into the workflow through EHRs and electronic prescribing, and can have much more value for everyone." Woodcock said EHRs can provide a fail-safe for prescribers: "You shouldn't get your warfarin refilled for the first time if you haven't had an INR test in the intervening month," for example. It would also be useful, said Woodcock, to provide pharma-sponsored support services like financial assistance through EHRs.