The federal government and healthcare think tanks may be pushing doctors to adopt electronic prescribing, but many of them are still resisting — and with good reason, they say.

Dr. Yale Bickel of Long Beach Calif., is worried about increased security risks and the potential for fraud e-prescribing poses.

"I have no intention of prescribing electronically, despite the current state-of-the-art devices," he said. "Nor do I think it's safe despite so-called secure sites." Bickel, who was a pharmacist from 1955 to 1957 before attending medical school, says there were fraudulent prescriptions then, and they persist today. He is particularly concerned, he said, with the potential for prescribing over the Internet without good-faith examinations. "While they may be separate issues, I think they feed on each other, and I am a strong opponent of both."

Among the biggest barriers, says Dr. Jonathan Chang, an orthopedic surgeon in Monterey Park, Calif., is a lack of standards. Moreover, Chang noted, the pharmacies are not yet ready to handle electronic prescriptions even if a majority of doctors were prepared to go the electronic route.

A report released April 14 by the eHealth Initiative estimates $29-billion could be saved – if doctors switched to "e-mailing" their prescriptions to pharmacies. But it also pointed out that lack of standards was a serious deterrent to acceptance by physicians.

Dr. James Hay, a family physician, who works in what he calls a "tech-savvy" practice in Encinitas, Calif., said his practice is about to roll out an electronic medical report system that includes an e-prescribing component. He's unsure when the practice might take up electronic prescribing, he said.

"Most pharmacies really aren't ready," he said.

A Medicare reform bill passed late last year sets voluntary guidelines for doctors to adopt electronic prescribing by 2007. But many doctors are skeptical that the guideline can be met, and some are ruffled that the guideline was a requirement in one version of the bill.

"If it's a demand, it becomes an unfunded mandate," said Hay. Chang calls the original form of the Medicare reform bill, which set electronic prescribing as a requirement "unbelievable chutzpah by the federal government."

"The piece that is most difficult to resolve, and needs resolution prior to mass adoption, is not adoption of standards (which obviously is important), but rather an alignment of costs and benefits, such that the purchasers of this technology are appropriately incentivized," said Dr. Peter Basch, medical director, eHealth Initiative, an independent nonprofit group.

Among the incentives Basch suggests are a slight reduction in malpractice premiums, a slight upward adjustment in reimbursement and a subscription fee to eRx programs underwritten, or partially underwritten by a payer consortium.

While acknowledging the barriers to adoption, the eHealth Initiative's report "Electronic Prescribing: Towards Maximum Value and Rapid Adoption," released last month, urges forging ahead. E-prescribing will not only save money, it will result in better care for patients, the report says.

"All of us have been grappling with how to reduce medical errors and increase cost efficiencies in our healthcare system," said the co-chair of eHI's Design and Implementation Working Group, Dr. Patricia L. Hale. "Electronic prescribing systems can do just that."