A better way: leveraging a proven and utilized system for improving current medication reconciliation processes.

In this reply to the commentary, "A Call for a Statewide Medication Reconciliation Program," published in the October 2016 issue of The American Journal of Managed Care®, authors note that although they agree with the authors' assessment of the problem, they believe there is a proven and scalable solution to improve medication reconciliation that is already available to, and used by, clinicians.

Dispatch from the non-HITECH-incented Health IT world: electronic medication history adoption and utilization.

OBJECTIVE: To document national trends of electronic medication history use in the ambulatory setting and describe the characteristics and predicting factors of providers who regularly use medication history transaction capabilities through their e-prescribing systems. MATERIALS AND METHODS: The study used provider-initiated medication history data requests, electronically sent over an e-prescribing network from all 50 states and the District of Columbia. Data from 138,000 prescribers were evaluated using multivariate analyses from 2007 to 2013. RESULTS: Medication history use showed significant growth, increasing from 8 to 850 million history requests during the study period. Prescribers on the network for <5 years had a lower likelihood of requests than those on the network for 5 or more years. Although descriptive analyses showed that prescribers in rural areas were alongside e-prescribing, and requesting medication histories more often than those in large and small cities, these findings were not significant in multivariate analyses. Providers in orthopedic surgery and internal medicine had a higher likelihood of more requests than family practice prescribers, with 12% and 7% higher likelihood, respectively. DISCUSSION: Early adopters of e-prescribing have remained medication history users and have continually increased their volume of requests for medication histories. CONCLUSION: Despite the fact that the use of medication histories through e-prescribing networks in the ambulatory care setting has not been encouraged through federal incentive programs, there has been substantial growth in the use of medication histories offered through e-prescribing networks.

HITECH spurs EHR vendor competition and innovation, resulting in increased adoption.

The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted to increase electronic health record (EHR) adoption by providers and hospitals. Experts expressed skepticism about whether the program would indeed hasten adoption and could be implemented in time for the initial reporting period. Could EHR vendors meet the certification requirements, and could the industry innovate to meet small-practice needs? This study, in addition to documenting increased provider adoption, provides the first evidence of increased competitiveness and innovation in the EHR industry spurred by HITECH. For example, the number of EHR vendors certified for e-prescribing with Surescripts increased from 96 to 229 over the program's first 3 years. We also find that prescribers in small practices increasingly adopted lower-cost, Web-based e-prescribing and EHR applications at significantly higher rates (15%-35%) than did large practices (3%-4%), which generally have more human and capital resources to make significant investments. These findings suggest that EHR vendors were highly responsive to HITECH requirements and have been adapting their strategies to meet nuanced market needs, providing reason to be optimistic about the Programs' future.

E-prescribing adoption and use increased substantially following the start of a federal incentive program.

E-prescribing, or the electronic generation of a prescription and its routing to a pharmacy, is generally believed to improve health care quality and reduce costs. However, physicians were slow to embrace this technology until 2008, when Congress authorized e-prescribing incentives as part of the Medicare Improvements for Patients and Providers Act. Using e-prescribing data from Surescripts, we determined that as of December 2010, close to 40 percent of active e-prescribers had adopted the technology in response to the federal incentive program. The data also suggest that among providers who were already e-prescribing, the federal incentive program was associated with a 9-11 percent increase in the use of e-prescribing-equivalent to an additional 6.8-8.2 e-prescriptions per provider per month. We believe that financial incentives can drive providers' adoption and use of health information technology such as e-prescribing, and that health information networks can be a powerful tool in tracking incentives' progress.