Few facets of medicine and healthcare have experienced the rapid growth witnessed in Electronic Medical/Health Records (EMRs/EHRs) and ePrescribing over the past five years. Yet we regularly hear pundits speaking about whether EMRs are “ready” for pharma, and whether physicians and other providers will allow pharma to “play” in this space.
We’re happy to see the topic gaining so much press, but admit to being baffled by the debate about whether EMRs are “ready” for pharma. The evidence clearly supports EMRs as both a well-established method for engaging prescribers and patients and a significant growth opportunity.
The editors at PM360 also hear the ongoing chatter about EMRs and asked me to expand my regular column to provide an update on the current state of the industry as it relates to pharma, and more specifically to the pharma marketer.
How Important Is Interoperability?
We suspect we’ll be hearing the debate about whether to say “EMR or EHR” long after this issue hits print, but industry consensus is that it’s a medical record if it works just within the confines of a single provider’s office. Conversely, the system becomes a health record when information can readily be shared and understood between providers (called “interoperability”) and from provider to patient.
So does it matter which system a prescriber is using? If you are a patient that wants to have your information travel easily from a primary care provider to a specialist and from the office to the hospital and back, this distinction certainly matters. But for pharma marketers seeking to engage the prescriber and patient at the point of care, the distinction between the two types of systems—and whether or not different systems can easily talk to each other—is of much less importance.
Practically speaking, the ability to deliver messages to either the provider or patient does not depend on the level of interoperability a system possesses. So while we are happy that the industry is moving toward an improved ability to share information across practice settings, because that improves patient care and the knowledge a provider has at their disposal, this is not a distinction that matters to the pharma brand leader seeking to engage patients and providers.
We support interoperability because it is good for patients, providers and the healthcare system as a whole, but we advise our clients not to be concerned with this when considering whether or not to be active in the channel. They are separate issues, and we assure you that pharma can be very engaged with patients and providers long before EMR systems can engage each other.
eRx Reach And Growth in Scale
The 2013 edition of the National Progress Report and Safe-Rx Rankings, published by Surescripts, the nation’s largest network for ePrescribing, came to press just as we finished this article (Figure 1). We were happy to see that our past predictions of continued growth and scale were well supported by this most recent data. According to Surescripts:
- 73% of office-based physicians are now ePrescribers, up from 69% in 2012.
- 58% of eligible prescriptions are now routed electronically, with electronically routed Rxs now topping one billion for the first time in history. This represents a 32% increase in prescription volume compared to 2012, almost double the volume from 2011.
- Primary care, endocrinology and physicians treating cardiovascular disease have the highest rates of ePrescribing, with 80% or more of these physicians now engaged in ePrescribing on a regular basis.
- Routing of prescriptions to mail order pharmacies increased significantly in 2013, with a 31% increase in prescriptions to this channel. In fact, mail order prescriptions sent via EMR have grown from fewer than four million just five years ago to more than 63 million last year.
- 95% of all pharmacies are now capable of receiving ePrescriptions, and acceptance at chain pharmacies is almost universal, with 98% capable of accepting an eRx (the common abbreviation).
We also found the recent data published by the CDC to be aligned with the Surescripts report, with the CDC reporting that over 78% of physicians had some form of EHR as of 2013 (Figure 2). So when it comes to sheer volume, there is clearly more than ample opportunity in terms of prescribers writing and routing ePrescriptions and the pharmacies that fill them.
Myth: EMR Suppliers Won’t Work With Pharma
More than any other issue, we think this is where there is the greatest amount of misunderstanding. Pharma is accustomed to having almost all the companies within a particular “channel” ready to accept its “marketing” dollars, and admittedly that is not the case for EMRs today. But that doesn’t mean there aren’t abundant opportunities for pharma to become involved in a wide variety of programs, with a very significant number of EMR suppliers.
While it is true that some large EMR companies have taken a stance against working with pharma at present because they are focused on delivering capabilities to their provider clients, there are many companies that readily work with industry to engage both prescribers and patients. Also, the EMR industry is so fragmented that any one of these companies make up no more than about 10% of the overall population of EMR-using physicians. And those proportions drop to the single digits before we even reach the top five out of more than 600 different EMR platforms.
It is also important to note that there are many suppliers that elect to work with industry through companies that can serve as the connection between a pharma company and many different EMR suppliers, rather than going to the trouble of staffing their own pharma-focused sales and marketing efforts. Our company is an example of this type of company, which is often called an “aggregator.” By way of example, we maintain a relationship with more than 150 different EMR suppliers, from some of the largest in the industry to specialized, “niche” companies. And it is worth noting that some of the largest EMR suppliers are beginning to allow pharma-sponsored messages in their platforms for the first time in 2014.
In some ways, the current state of EMR suppliers and pharma is the opposite of what we see with healthcare providers and pharma sales forces. Many providers no longer see pharma representatives and the number that do see reps may continue to decline. But that doesn’t stop most pharma companies from continuing to field a sales force.
Conversely, the number of EMR companies willing to work with pharma continues to grow, but some pharma companies continue to wonder when it will be the “right” time to engage via this channel. It’s an interesting paradox that speaks volumes about the comfort of what we know versus the promise of what we are still discovering.
Electronic Channel—with Traditional Communications
Some marketers seem to equate EMRs with patient portals and other forms of electronic communication, such as mobile apps. The presumed link between an EMR and electronic communication is understandable, but waiting for these capabilities to be widely available for communicating with patients may result in lost opportunities for the brand.
A recent survey of more than 2,000 U.S. patients by the consulting firm Accenture noted that while patients often want pharmaceutical companies to reach them via digital and social means, those same patients often place a high degree of trust in printed materials given to them by their physician and have comparable rates of desiring printed information compared to electronic channels. Based on these facts and the need to reach large numbers of patients via their healthcare provider, we frequently recommend that our clients consider programs that allow them to deliver communications that are created via on-site printing within the physician’s office, but with the contents of the communication based on the needs of that particular patient and the product being prescribed.
For providers, on-screen communication is the norm, and Manhattan Research reports that 71% of physicians are interested in interacting with pharma within the EHR channel. Also, some of the debate about whether physicians will “accept” pharma sponsorship or information comes from those with no direct experience in offering these services to providers—an interesting but not necessarily informed source for commentary.
I anticipate continued debate about the role that pharma can play within EMRs and ePrescribing, and would not be surprised to hear people saying that the market will “begin to mature” every year for several years to come. But as with investing, the time to enter a market is often not when the market is mature, but rather when it is sufficiently established to offer a menu of reasonable options, yet with many years of growth still ahead. Personally, I think that describes EMRs and pharma perfectly.
So despite what we see and hear from some, there is ample evidence that the EMR channel is not one where pharma can merely “play”—but rather that it is one where pharma can have an active and even trusted voice that connects with providers and patients in a unique and helpful way.