Why PrescribeIT failed: All the cost, none of the benefit for clinicians

Forcing Canadian physicians and pharmacists to bear the economic and other costs while failing to provide any benefits explains why the PrescribeIT, electronic prescribing system failed.That’s the conclusion from one of the first public presentations dealing with the Feb. 12 cancellation of the PrescribeIT program, delivered at the Future of Health Leadership, Informatics and Policy (FHLIP) conference in Toronto.Canada Health Infoway announced the electronic prescribing system would shut down May 29 after failing to reach the scale required for long-term sustainability. Established in 2018, reports indicated only 5% to 10% of prescriptions were being filled using the system.In his presentation at FHLIP, Dr. Karim Keshavjee, program director of health informatics at the University of Toronto Institute of Health Policy, Management and Evaluation delivered a fairly scathing review of the PrescribeIT program.His economic analysis compared the failed Canadian experience with e-prescribing compared to the success of e-prescribing programs in Denmark and the United States where mandates, incentives and penalties for non-use led to widespread adoption of the process.Dr. Keshavjee noted that despite investing millions of dollars to support the interoperability of health data, the Canadian healthcare system continues to rely on fax machines for exchanging prescriptions, referrals and clinical notes.“The government is spending and it still isn’t getting there. Something is wrong,” he said, adding the problem is not a technical one. “Despite technical progress, interoperability has consistently underdelivered,” he wrote in the paper prepared for his presentation co-authored with Felipe Cepeda.In contrast, Dr. Keshavjee said, in Denmark and the United States adoption of e-prescribing by providers is greater than 90%.The simplified reason for the failure of PrescribeIT, he said, was the failure of the providers (physicians and pharmacists) to see any benefit from the system. While these providers had to bear the costs for implementing and maintaining the system, he said, it was society that saw the benefits of having fewer medication errors and safer prescribing practises.Dr. Keshavjee speculated that while PrescribeIT might have found more uptake among physicians 20 years ago when they were not so busy, the increased workloads and subsequent burnout facing doctors today means they had no motivation to use a system from which they received no tangible benefits.He said the key takeaway message from the experience is that “provider incentives will drive adoption, not just data exchange capabilities.” In order to get health data interoperability, Dr. Keshavjee added, governments must show a “delicate balance” between mandating change and providing incentives.Pat Rich is a Canadian health journalist and former editor of the Medical Post. This item originally appeared on his blog site.

Why PrescribeIT failed: All the cost, none of the benefit for clinicians

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