By Ursula Pennell
© 2009 EMRConsultant.com
info@emrconsultant.com

E-prescribing Overview:

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.

  1. 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.
  2. 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.
  3. Eliminates faxes to pharmacies.
  4. 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.
  5. 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.
  6. 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.
  7. Increases patient convenience by reducing patient trips to the pharmacy and reducing wait times.
  8. Offers true Provider Mobility Full mobility can be attained when using a wireless network to write or authorize prescriptions anytime from anywhere.
  9. 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:

  1. Decide whether you wish to choose a stand-alone e-prescription software or a full EMR system which includes e-prescribing functionality.
  2. 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.
  3. Install an internet connection; high speed is highly recommended.
  4. Purchase hardware such as desktop PC’s, laptops, pocket PC’s, tablet PC’s , PDA’s utilizing a wired or wireless network.

References:

  1. HIMSS – e-prescribing article under website
  2. 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”.

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