The following letter will be posted (hopefully) in Secretary Leavitt's blog tomorrow, "pending moderation":(http://secretarysblog.hhs.gov/my_weblog/2007/11/health-it.html?cid=93215954#comments). I ask that those interested in fighting e-prescribing please post too...

Dear Secretary Leavitt:

I disagree with your stance to tie the needed physician pay fix for 2008 to the ownership of a CCHIT certified EHR. It is wrong and misguided to suggest to Congress that they take that course of action. You don't know how many physicians "in the trenches" you're continued push to cram HIT down the throats of physicians as another unfunded mandate.

Problems that I see with e-Prescribing from what I've read include:

--Physicians are made to again pay for a good deal of the technology together with pharmacists. Patients and insurance companies, those entities that benefit most, pay NOTHING.
--You want to replace the current PAPER and FAXING of prescriptions both of which still work well and are FREE with a $300 to $500 a year per license cost (not including the EHR cost), making it another unfunded mandate.
--30% of retail pharmacies do not have e-prescribing capabilities.
--The DEA has a ban on e-prescribing for controlled substances, which account for 11-13% of all prescriptions. In addition, some states have paper-based requirements for narcotics prescriptions.
--It takes approximately 6-12 months for a vendor to become certified in SureScripts, the most prominent company associated with e-prescribing. This expensive developmental cost, with is part of the CCHIT certification process, invariably is passed on to the physician consumer in the higher EMR prices.
--Many of my fellow docs lament the problem of having to carry a tablet PC or laptop with them to prescribe.
--Lastly, many patients, especially the elderly, prefer paper prescriptions which in the current bills before Congress may signify penalties to the provider.

I truly hope that Congress ignores your request, which is misguided.

If you wish, you can download my 65 page Powerpoint report on HIT called: "What Has Gone Wrong with the Direction of the Health Information Technology in the United States?" from here: http://www.emrupdate.com/files/folders/al_borges/default.aspx?PageIndex=2.

It makes for a good read. It covers CCHIT, P4P, and e-Prescribing from a physician's point of view and it offers suggestions on how to improve the HIT by taking a different path.

Sincerely,
Al Borges MD
Oncologist, Virginia