Tipping the Balance of Power With Digital Patient Information

Mar 01, 2002

The integration and digitization of fragmented data is about to transform pharmaceutical sales and marketing strategies. And physicians are ready to adopt the new business model of an e-prescribing network.

Real-time e-prescribing, electronic patient medical records, and a push from insurers to reduce prescription costs have created the conditions required to motivate investment and business process change throughout the healthcare industry.

Together, those three forces will tip the balance of power in the prescribing process, reducing the physician's role and increasing the influence of patient choice and big payer formularies. Pharma sales and marketing managers must balance their strategies and resource priorities among physicians, patients, and big payers based on individual customer return on investment (ROI), and potential lifetime product profitability. To accomplish that, companies must invest in new relational business intelligence systems that let them answer increasingly complex questions in near real time.

This article describes how the end-to-end integration of prescribing data, patient medical records, and insurance approval systems will change the way patients and physicians make prescribing decisions. At the same time, pharma sales and marketing organizations must reassess their sales and marketing investment mix.

Heavy Congestion
Prescribing Problems The traditional prescribing pro-cess is highly fragmented and manual. (See "Heavy Congestion.") A 1999 study by the Institute of Medicine estimated that 90 percent of all US healthcare transactions took place by phone, costing the industry $280 billion annually, primarily for office staff and physician time as well as the telephone and fax charges. The same study estimated that every pharmacy call-back cost physicians practices $5–$7 to pull and review the chart and return the call. With the average physician writing 30 prescriptions a day and handling nearly another 30 requests for refills, the dollars add up quickly.

Historically, physicians spend more than 30 percent of their time making prescription deci-sions and doing follow-up reviews. They have to balance information received from pharma company reps, patients, payers, pharmacies, the research community, and their personal experience in clinical practice.

Over time, physicians develop a relatively small number of preferred treatments that typically constitute 75–80 percent of the prescriptions they write. Product launches that distribute samples, education, and promotional materials often represent the doctor's main chance to try out new therapies, evaluate their patients' experiences, and consider whether to add a new product to their preferred set.

Without additional input, most physicians will continue to prescribe treatments they know and trust. However, their behavior can be influenced. Recent studies indicate that 40 percent of US consumers research medication options on the internet. Nine out of ten times, when patients ask for a specific pharmaceutical during a visit with their doctor, they leave with the requested prescription in hand.

Managed care organizations and government formularies can influence doctor's prescribing preferences as well, but frequently, the system's complexity makes it difficult for doctors to make real-time connections between the patient's insurance plan and the insurer's formulary preferences or co-pay tiers. As a result, physicians often fail to prescribe according to formularies. Rather, the office staff handles pharmacy call-backs if a product is not on the approved list. Patient frustrations escalate when they are confronted with higher co-pays or out-of-pocket expenses for treatments with no way to understand or influence the potential tradeoffs between cost, effectiveness, and convenience.

E-Prescribing Vision The integrated digital prescribing era will create more collaborative physician–patient dialogues as manual systems become automated and tightly linked. The balance of power will be split more evenly among physicians, patients, and payers. E-prescribing systems available from such vendors as Allscripts provide physicians with handheld point-of-care devices that automatically display the prescription choices approved by the patient's insurer, including co-pay tiers and pre-approval requirements. The system can also provide Physicians Desk Reference information, including adverse reaction data, interaction warnings, and best practice prescribing guidelines.

Using a handheld computer, physicians can select a formulary product or request approval for off-formulary coverage. Prescriptions can then be printed, or, with more advanced systems, sent electronically to the pharmacy. Call-backs are eliminated because the system checks the patient's record for insurance eligibility and co-pay status. Pharmacies and doctors' offices participating in early e-prescribing trials noted a dramatic reduction in errors and call-backs, resulting in increased productivity and quality of life for both the physician's office and the pharmacy front desk. Hospital-based studies of e-prescribing consistently show errors decline by 50 percent or more.

Network Shortcut
Adding integrated electronic medical records (EMR) to the equation further reduces the trial and error associated with prescribing. Electronic systems can cross-check Rx choices against the patient's entire medical background, including drug allergies and other contraindications, by searching through multiple data sources such as pharmacies, other physicians, hospital records, and lab test results. Initially, those systems will take hold in care delivery communities that share scheduling, billing, referrals, and supply chain systems. Eventually, interconnecting local systems will help create a national information exchange.

The integrated digital prescribing process should encourage patients and doctors to discuss cost and efficacy information and allow patients to more actively participate in drug selection. Both parties can consider a medication's effectiveness, convenience, cost, and risks according to the patient's situation. Doctors will also have more time to discuss compliance and quality-of-care issues. (See "Network Shortcut.")

All Systems Ready Nearly 90 percent of US physicians use the internet either professionally or personally. About 20 percent use a handheld device, and several studies predict that, by 2005, as many as half of all US doctors will use such equipment as a core part of their clinical care delivery.

Over the next five years, as simple, secure, and affordable tools become more available, more physicians will adopt e-prescribing and EMR systems.

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