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1 2 MS. BERRY: Good morning. I'm Kate Berry. 3 I was asked to make a few brief remarks about the 4 landscape that relates to e-prescribing and some of 5 the success stories out there and some of the 6 challenges as well. 7 First of all, I applaud the direction that 8 the Alliance is heading with regard to the 9 recommendations on the table today. We believe 10 you're moving in the right direction. We encourage 11 you to drive it forward to help them identify and 12 address the barriers that are out there and to 13 provide some technical assistance, if you will, in 14 this regard. 15 In terms of the current environment, I 16 know you have a lot of background material to take a 17 look at. Electronic prescribing is happening today 18 in every state and D.C. It's legal everywhere. We 19 have transactions flowing through the network. Today 20 as we speak, the standards are in place to enable 21 this to happen in an interoperable way. It's a very 22 well established process to continue to improve upon 12 1 those standards. So the standards are definitely 2 well in place. There's an infrastructure that has 3 been built and SureScripts and RxHub are kind of the 4 cores of that infrastructures. 5 As I'm sure you know, the infrastructure 6 is definitely in place. SureScripts was formed by 7 the pharmacy industry and we represent the nation's Page 1

2 8 community pharmacies. There are 95 percent of those 9 pharmacies using certified software at this point. 10 And about 70 percent of those pharmacies are live on 11 the network receiving electronic prescriptions at 12 this time. So there's a well established pharmacy 13 readiness there. 14 In terms of the technology vendors there's 15 over 100 electronic prescribing and electronic 16 medical record systems that are certified today. 17 There are many, many options for physician practices 18 to get connected and utilize electronic prescribing 19 and take advantage of the infrastructure safety and 20 efficiency offered by the technology. 21 There's approximately 44,000 active 22 prescribers doing electronic prescribing today in a 13 1 fully electronic format and about 60 percent of those 2 prescribers are using electronic medical records 3 compared to four years ago when the vast majority of 4 those providers were using a stand-alone electronic 5 prescribing system. Today 60 percent are using 6 electronic prescribing in their electronic medical 7 record system. That's the direction that we see a 8 lot--that's where a lot of the growth is going to 9 come from within the electronic medical record 10 system. And actually, though, there's a program 11 that's been launched called the Get Connected Program 12 that the Center for Improving Medication Management 13 launched partnership with the National Medical Page 2

3 14 Society, which provides a resource to physicians who 15 want to learn more about how to connect their medical 16 records--their electronic medical records or if they 17 do not yet have technology, to get started with 18 electronic prescribing. So there's a lot of activity 19 and attention and growth happening in electronic 20 prescribing. 21 Friday, the Brookings Institute convened a 22 meeting to pull together many stakeholders in the 14 1 process and try to focus on what are the barriers and 2 how do we move this forward aggressively. There are 3 many organizations that are working to publish 4 electronic prescribing papers and many policymakers 5 focusing on this. I'm sure you're familiar with the 6 E-Meds bill, which provides centers for physicians to 7 get started with e-prescribing. 8 And just about a week or 10 days ago, the 9 governor of Arizona issued an executive order to 10 encourage electronic prescribing as well. So there 11 are many success stories. You know, you've probably 12 heard a lot about Massachusetts. The health plans 13 came together early on to provide financial incentive 14 around electronic prescribing. The health systems 15 have built an infrastructure to connect their 16 homegrown electronic medical records. Rhode Island 17 is another great story where you have a multi- 18 stakeholder coalition focused on e-prescribing. They 19 have published--the State Department of Health of Page 3

4 20 Rhode Island has published on their website all of 21 the physicians and prescribers who use electronic 22 prescribing in that community. So they're posted on 15 1 the website publicly. They are the first state to do 2 that. 3 We've also surveyed--they just late last 4 year surveyed prescribers who had not yet adopted 5 electronic prescribing to find out what are the 6 barriers here and you think in Rhode Island, which is 7 the first community where SureScripts launched a 8 network that it would be completely saturated and 9 everybody would be sick of hearing about electronic 10 prescribing. But interestingly, you know, in a 11 survey of non e-prescribers they found out that percent of those folks are interested. They need 13 more information and the two biggest concerns they 14 have are cost and usability, which is not a big 15 surprise. 16 It might be a big surprise that they need 17 more information. You'd think everyone has heard 18 enough about e-prescribing. But I do think it's 19 important to recognize that there are cost issues or 20 perceptions of cost issues that they're not able to 21 distinguish between the costs of electronic medical 22 records versus the cost of e-prescribing. So costs 16 Page 4

5 1 and concerns about usability are absolutely critical. 2 If you want to highlight--you know, there are some 3 misperceptions about there when you talk to 4 prescribers and physicians. I visit a lot of 5 clinician practices to talk with them about how 6 they're using e-prescribing, what they see as the 7 impact, how big a hump it was to get comfortable. 8 About a week ago I went to a small 9 practice. It was implementing electronic medical 10 records and very specifically around prescribing 11 within the medical record they stated that the small 12 practice they spent $250,000 to implement electronic 13 medical records and they had a return on that 14 investment in 18 months. And they said with regard 15 to the prescribing, they saved half an FTE per day. 16 It's real time and it enables them to eliminate some 17 of those redundant clerical paths said to be much, 18 much more efficient. 19 In this situation it's interesting because 20 they all utilize the technology and they do so 21 because everyone in the practice has profit sharing, 22 so they benefit by improving the bottom line. They 17 1 benefit personally. So I think it's interesting. 2 You hear a lot of this talk about financial 3 incentives and how financial incentives are important 4 to help stimulate electronic prescribing. 5 My message to you today is that those 6 financial incentives can take on a number of Page 5

6 7 different forms. Profit sharing--that's like there's 8 a health plan or employer or somebody paying for the 9 technology for that small business practice. They 10 personally made that investment and benefited from 11 the efficiencies that they got. 12 The barriers or the key challenges--and 13 you've heard this many times--costs. We can't 14 underestimate the issues around costs. Certainly, 15 there's a big challenge around practices trying to 16 figure out what to do. They need help figuring out 17 what to do, and even figuring out how to make it 18 work. This is one of the most important things that 19 I want to tell you today as well, which is you can 20 give them the technology, but they are going to have 21 trouble making it work. The prescribing process is 22 complex. Going from a paper process to an electronic 18 1 process is not a simple task. Figuring out how to 2 make it work and handling that is critical. 3 A few comments on what needs to happen to 4 dramatically accelerate electronic prescribing. I 5 think that financial incentives are important. As I 6 mentioned, those can take on a number of different 7 forms. We have a lot of examples in health plan 8 programs, employer-driven programs. There are 9 opportunities if we organize them and find ways to 10 get malpractice carrier discounts. It's a very 11 important opportunity there as well. 12 Education is critical. Education Page 6

7 13 resources, helping them figure out what to do, 14 helping them through those workflow and change 15 management and technical challenges that they face. 16 I think there's an opportunity as well to create some 17 transparency and accountability with physician 18 technology vendors. There's not a lot of 19 transparency as it relates to cost and functionality 20 and support and training and those kinds of things; 21 and this is something that not everyone is talking 22 about yet I would encourage you to think about how 2 we shine a spotlight, just as we're trying to do in 3 health care overall, to help consumers make more 4 informed decisions--how do we help providers make 5 more informed decisions about the technology that 6 they're selecting in their practice? 7 And then, finally, I think there's a need 8 for physician networking, a mentor program, if you 9 will, where those physicians who have been earlier 10 adopters and have lead the way in implementing 11 technology could be a tremendous resource to 12 physicians who are just trying to figure out what 13 path to take as it relates to electronic prescribing 14 and electronic medical records. 15 Then finally, I think there's an 16 opportunity to create a forum for stakeholders across 17 the many states to learn from each other. We've done 18 some of that type of work where you bring Page 7

8 19 Massachusetts and Rhode Island and take that to all 20 the other states who are trying to figure out how do 21 we accelerate this. So there is a very important 22 opportunity there Finally, I would be remiss if I didn't 2 mention that there is still some work to be done with 3 the DEA around controlled substances and there's a 4 lot of very important effort to make that happen. 5 The challenge is not allowing controlled substances 6 to be electronically prescribed forces multiple 7 workflows in the practice and in the pharmacy, so 8 it's definitely a challenge and a lot of work is 9 being done there. 10 With that, I'll close out and ask Tom to 11 make a few remarks. Page 8

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