By Ursula Pennell
© 2009 EMRConsultant.com
E-prescribing has been described as the solution to improved patient safety and reducing sky-rocketing medication costs. It is estimated that approximately 7,000 deaths occur each year in the United States due to medication errors. These errors are predominately due to hand-writing illegibility, wrong dosing, missed drug-drug or drug-allergy reactions. With approximately 3 billion prescriptions written annually, which constitutes one of the largest paper-based processes in the United States, the writing of prescriptions can be streamlined and efficient by using an e-prescribing system.
What is e-prescribing?
E-prescribing is simply an electronic way to generate prescriptions through an automated data-entry process utilizing e-prescribing software and a transmission network which links to participating pharmacies.
- Improved patient safety and overall quality of care:
- Illegibility from hand-written prescriptions is eliminated, decreasing the risk of medication errors and decreasing liability risks.
- Warning and Alert systems are provided at the point of prescribing: It has been documented that medication errors are often the result of inadequate access to current drug reference information. E-prescribing systems can provide an overall medication management process through drug utilization review (DUR) programs. DUR programs perform checks against the patient’s current medications for drug-drug interactions, drug-allergy interactions, diagnoses, body weight, age, drug appropriateness, correct dosing; contraindications, adverse reactions, duplicate therapy alert etc. and alerts the provider if interactions are found. E-prescribing software can also include such drug reference software programs as ePocrates Rx. Pro and the PDR.
- Access to patient’s medical history. Knowing the patient’s medical history at the time of prescribing can serve as an alert to drug inappropriateness.
- Reduces or eliminates phone calls and call-backs to pharmacies. Physician offices receive over 150 million call-backs from pharmacies with questions, clarifications and refill requests. According to HIMSS article on e-prescribing under Topics and Tools at their website almost 30 percent of the 3 billion prescriptions written annually require a call backs. This equals 900 million prescription-related telephone calls annually1. Medco® Health Solutions, Inc. conducted a survey in 2003 of Boston area physicians and 88 percent of those surveyed said they, or their staff, spend almost one-third of their time responding to phone calls from pharmacies regarding prescriptions. Medco reported that one practitioner in the survey indicated that in a time study of his four physician practice, the average phone call between a pharmacist and practitioner lasted eight minutes and was costing his practice more than $200 per week in wasted staff time2. These call-backs interrupt office flow and reduce productivity related to chart-pulls, re-filing charts, follow-up calls, faxing prescriptions etc.
- Eliminates faxes to pharmacies.
- Streamlines the refill’s requests and authorization processes. Refill authorization from the pharmacy can be a completely automated process and refills can usually be generated in one click. The pharmacist generates a refill request/authorization that is delivered through the network to the provider’s system, the provider then reviews the request, approves or denies the refill and the pharmacy system is immediately updated.
- Increases patient compliance. It is estimated that 20% of paper-based prescription orders go unfilled by the patient. E-prescribing systems expedite the filling of prescription at the pharmacy and drug literature can be printed for patients as well.
- Improves Formulary adherence. By checking with healthcare formularies at point-of-care, generic substitutions and generic first-line therapy choices are encouraged thus reducing patient costs.
- Increases patient convenience by reducing patient trips to the pharmacy and reducing wait times.
- Offers true Provider Mobility Full mobility can be attained when using a wireless network to write or authorize prescriptions anytime from anywhere.
- Improves reporting ability. Query reporting may be performed which would be impossible with a paper prescription system. Common examples of such reporting would be: finding all patients who have had a particular medication prescribed to them during a drug recall, the frequency of medication prescribed by certain providers etc..
Note: controlled substances are currently not permitted to be filled via electronic means. If a user attempts to send a controlled substance electronically – a system message informs the user that this medication can not be filled this way and offers options to print or fax.
What your practice needs to do to get started e-prescribing:
- Decide whether you wish to choose a stand-alone e-prescription software or a full EMR system which includes e-prescribing functionality.
- Choose an e-prescribing software vendor. The e-prescribing vendor will need to utilize a company which supplies the electronic prescribing network (hub or gateway for transmissions). There are a few different e-prescription networking companies. Among the industry leaders are SureScripts (http://surescripts.com/), RxHub (http://www.rxhub.net/index.html), and ProxyMed (http://www.proxymed.com/). It is unlikely that physicians would have any reason to have direct contact with the electronic networking vendor. SureScripts, the nation’s largest electronic prescribing network, provides a true, seamless electronic connection between physician offices and pharmacies. This network provides secure and reliable two-way transmissions between physicians and pharmacies. More than 85% of chain and independent pharmacies have tested and certified their systems to connect to the SureScript electronic prescribing network.
- Install an internet connection; high speed is highly recommended.
- Purchase hardware such as desktop PC’s, laptops, pocket PC’s, tablet PC’s , PDA’s utilizing a wired or wireless network.
- HIMSS – e-prescribing article under website
- Medco® Health Solutions, Inc. – News and Pressroom article on 2/7/2003
“Boston Area Physicians Embrace E-Prescribing Technology as a Tool To Improve Healthcare”.