While primary care physicians in the UK have been using e-prescribing technology for quite some time, hospitals in the NHS are still relatively behind, despite having what appears to have relatively mature IT infrastructure otherwise.
That is why the news that the NHS is still rolling out digital prescribing as of this month may come as something of a surprise to U.S. healthcare organizations. The new program, which is doling out the equivalent of roughly $21.3 million in US dollars, is distributing the funds across 16 hospitals across England to foster the adoption of e-prescribing.
This funding is part of a roughly $104 million dollar effort to eliminate paper prescribing in hospitals and introduce digital prescribing across the whole NHS by 2024.
In contrast, Colin Banas, M.D., MSHA, Chief Medical Officer at DrFirst, offered these insights on the US market’s adoption of ePrescribing:
e-Prescribing is generally well accepted in the U.S., but there are significant gaps. Last year, e-prescribing was used for 80% of all prescriptions written in the U.S.—which represents steady growth over previous years, but this number is skewed by the high volume and e-prescribing rate of prescriptions for non-controlled substances (“legend” drugs), 86% of which were sent electronically. The numbers for electronic prescribing of controlled substances (EPCS) tell a different story. Only 38% of controlled drug prescriptions were prescribed electronically. We should see this percentage rise quickly, however, because of new state and federal mandates for EPCS. Over the next couple years, I expect the use of EPCS to catch up to what we see for non-controlled substances, and I expect e-prescribing rates for legend drugs to get much closer to 100%.
Banas added this insight about how COVID-19 has impacted ePrescribing in the US as well:
The pandemic seems to be increasing the use of e-prescribing for all types of medications. According to the Centers for Medicare & Medicaid Services, EPCS is expected to grow to 50% this year due in part to social distancing related to Covid-19. At DrFirst, we are seeing increases in e-prescribing for legend and controlled substances, also. Our mobile prescribing app, iPrescribe, processed twice as many prescriptions as it did the previous year.
It seems that while UK providers may be adopting this technology, there’s something of an enthusiasm gap. According to Loy Lobo, president of the digital health council for the Royal Society of Medicine, electronic prescribing has between a standard operating practice in primary care within the UK for more than a decade. However, the establishment of e-prescribing in NHS hospitals has been a much longer process. Lobo notes that while hospitals have been through a decade-long program of implementing EMRs in hospitals, there’s still a lot of work to be done.
In fact, just 50% of hospitals participated in the EMR rollout effort and implemented e-prescribing and other related functionality. Even at this late date, there are still many NHS hospitals that don’t have a mature EMR in place.
This was particularly interesting to hear after getting a current perspective on the UK’s other health system management issues. Last week, I served on a panel discussing the extent to which adapting to COVID-19 has or has not fostered greater resiliency In health systems. The panel, “COVID as a Catalyst for Change Part 6: From Rapid Change to Sustainable Practice,” was sponsored by Alphalake AI.
Our consensus was that given its decentralized healthcare delivery infrastructure, US systems may be better set up to be flexible and innovate freely. However, there’s also something to be said for the stability and capacity for careful change an entity like the NHS Trusts can deliver. (On this point, it’s interesting to note that over my past three decades covering healthcare, I’ve observed that the rigid, hierarchical US military has often been on the forefront of HIT innovation.)
In any event, it’s worth bearing in mind that long, slow, deliberate rollouts of critical technologies like e-prescribing come with benefits of their own. If nothing else, the kind of careful process UK healthcare leaders have undergone has to have put down roots in its system which won’t be easily uprooted as technology and administrative forces wax and wane over time.