• The IOM’s report on patient safety (IOM, 2004: Appendix E) proposed a set of functionality standards for EHRs in hospitals, nursing homes, and ambulatory care and for the personal health record. These standards were used as input to Health Level 7’s Electronic Health Record Functional Model (HL7, 2005).

In November 2001, the California Healthcare Foundation published a report on electronic prescribing that described a patchwork of laws governing the practice; for example, 11 states prohibited electronic prescribing by both in-state and out-of-state providers, and only 4 states allowed it with the exception of certain drug types (e.g., controlled drugs) (Kilbridge and Gladysheva, 2001). Laws in many more states are now favorable to electronic prescribing. By 2004, 43 states allowed prescriber-to-pharmacy electronic medication orders (NABP, 2004). Allowing electronic connectivity is not enough, however; some states require dispense-as-written requirements that cannot be met using electronic technologies.

In November 2005, CMS issued the final rule for electronic prescribing of drugs covered under Medicare Part D. This rule contains a preemption covering state laws that prohibit electronic prescribing; that prohibit the transmission of electronic prescriptions through intermediaries; that require certain language to be used, such as “dispense as written,” to indicate whether generic drugs may or may not be substituted; and that require handwritten signatures or other handwriting on prescriptions (FR, 2005). As the rule is currently drafted, the scope of preemption includes electronic prescribing for Part D–eligible individuals (whether or not they are enrolled in a Part D plan) for drugs that may be covered by Part D in at least some circumstances (FR, 2005). Thus the preemption does not cover electronic prescribing for those under 65 and for controlled substances.

The Medicare preemption would create different rules for Medicare and other payers—which would be costly for prescribers, pharmacies, and plans to address and administer—and limit the uptake of electronic prescribing. Hence, states should enact legislation consistent with and complementary to the Medicare Modernization Act’s electronic prescribing provisions and remove existing barriers to the practice. The DHHS and the Drug Enforcement Administration are working on ways to enable electronic prescribing to encompass controlled substances, an effort the committee believes to be important.

With a few exceptions, there is currently little or no oversight of community pharmacies related to medication safety. State boards do send sur-