Few Doctors Sign Off on Online Prescribing

Beginning in January, doctors who use e-prescribing for roughly half of all eligible prescriptions will receive a bonus of 2 percent of their negotiated Medicare payment. The program could cost Medicare $240 million next year, according to federal actuaries. In 2010, the bonus will be reduced to 1 percent, and in 2012 doctors still wedded to handwritten prescriptions will start paying penalties.

"This is the proverbial carrot and stick," said Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services. For the average Medicare physician, the 2009 bonus could total $1,600, he said.

"A lot of prescriptions end up on the dresser," Weems said. With e-prescribing, "the physician can check on patient compliance." And the electronic system helps elderly patients and individuals with multiple illnesses monitor their drug use.

By the time Julia and Jerome Lawrence make the short drive home from Benesh's office, their prescriptions have already been logged in at their mail-order pharmacy.

"This is so much more convenient," said Julia Lawrence, who helps manage her husband's 14 drugs and can now get a single printout of all his prescriptions. "I feel much better with all the information stored in the computer."

At his office outside Baltimore, Benesh and three colleagues tote laptops into the exam rooms. When it comes time to order a medication, each uses a secure password to access a patient's record complete with address, birth date, preferred pharmacy, insurance information and list of medications.

If Benesh types in a medicine to which the patient is allergic, a bright red alert pops up on the screen. "Proceed with extreme caution," it warns.

Reminders for refill requests also arrive electronically, which can be a handy reminder if the physician hasn't seen the patient in a while.

"If there's a patient I know asking for [cholesterol-lowering drug] Lipitor but they haven't come in to have their liver functions checked, I'll say no to the refill and ask them to come in," said Tamara Sobel, another physician in Benesh's group.

One glitch is that the computerized system does not automatically update when a patient finishes a course of medicine, such as a week-long dose of an antibiotic, so the doctor has to tell the computer it ran out before it can be prescribed again.

On the other end, Owings Mills pharmacist Dan Satisky worries about security.

"I know that some doctors give their password to an assistant or nurse," he said. "They could start sending in prescriptions."