Several times each week, a member of our staff gets this call or email: “We launched our drug, but now doctors can’t find it in their EHR!” Or, “Our drug looks wrong in the EHR!” Or, “The EHR is preventing doctors from prescribing our drug!”
These calls for help represent technology moving faster than the training and processes currently offered to most brand teams and sales forces. EHRs (electronic health records), e-prescribing systems, and related technologies are now widely used, but most companies are still launching products and forecasting sales as if they were operating 10 years in the past. Here are three effects of this, but we have a rather severe space limitation, so feel free to contact me at the email address in my bio if you want to discuss any of this in greater depth.
Nobody “Writes” Prescriptions Anymore…
Okay, so that exaggerates, but it’s not far off. These are the actual stats:
- 87% of physicians are using an EHR, as of the beginning of 2016.1
- 73% of prescriptions were electronic in 2016, rather than phoned in or pen-to-paper.2
- More than 95% of hospitals eligible for Medicare and Medicaid EHR incentives have achieved Meaningful Use of certified Health IT as of the end of 2016.3
This rapid shift to electronic prescribing and EHR use has had a dramatic impact on the preparation necessary to launch a new drug—and on what companies must alter in terms of expectations and practices as they launch either a new product or formulation. Here are three things that you really need to know (and possibly change in your organization) about EHR use.
1. Your Label (PI) Is Not Designed for EHRs and That Can Confuse Prescribers
Your product’s label (the PI) was designed for humans, not computers. There are some very smart people at a tiny handful of companies (compendia publishers) that try to interpret your label so that EHRs can make use of it and allow your drug to be e-prescribed. Those companies are willing to receive your input about your new product if you take some simple steps to prepare for that and follow their processes. But surprisingly, most drug manufacturers don’t prepare for or take advantage of that opportunity, and instead leave it up to these busy people and companies to create these interpretations without their input. That failure to prepare and properly engage is now sort of a “worst practice” for launch, yet a surprising number of manufacturers and product teams are still launching that way.
This probably happens because companies aren’t really experienced at this and don’t do it very often. But it can be done easily—and without much effort by the manufacturer—if you have the right assistance. The important thing to understand: Taking the steps to make sure your drug’s appearance and listing in an EHR makes sense to a prescriber is now a relatively inexpensive way to give your new product or line extension a better chance of success at launch.
2. Your Forecast Inputs Could Be Just Plain Wrong
The truth is, it’s going to take several weeks from the time your drug is approved until it is available within the great majority of EHRs and e-prescribing systems. You can’t change that very much, but you can prepare for it, allocate your resources differently at launch, and make realistic promises to your management and investors about when your drug will be available to prescribers.
The best marketers (and CFOs) are now using information about when products will appear in EHRs to create more realistic launch forecasts. That means they spend a lot less time trying to make excuses about things they cannot change, and instead focus on things over which they have control. Your forecasting people are only as good as the inputs you give them, and if you don’t understand what is and isn’t under your control, your inputs aren’t going to be very good.
3. Don’t Try to Beat the System. You Could Kill Someone. Really.
Sometimes, a well-meaning physician or staff member will attempt to bypass the systems in place to add a new drug or formulation to an EHR by just entering the drug data themselves in what is called a “manual” addition or a “custom medication.” The reality is that this usually doesn’t accomplish much, but it can create significant risks. We strongly advise against this practice except in very rare and controlled situations that involve a skilled IT department working in collaboration with the pharmacy department. It is almost always a bad idea in office-based settings for any commercially available drug.
New drug listings enter EHRs through the selected compendia publisher’s data in a very precise way. When that happens, the drug becomes available to e-prescribe but it also becomes available for functions such as drug-drug interaction checks and other patient safety features. When a drug is “manually” added, those features are generally bypassed, and that can be dangerous—even deadly. And to make matters worse, we frequently see situations in which the manually added drug listing creates confusion for prescribers when the “real” drug listing does appear in the EHR. It may work in a few cases, but it is not worth the risk to longer-term sales, and certainly not worth the patient safety risks it creates.
Okay, I’m out of space…here’s the bottom line: EHRs and the systems that “feed” them with data force you to change the way you prepare for and launch a new drug or line extension. But there are things you can do to prepare for this, and things you just shouldn’t do. If you want to learn more, just give us a call.