A patient sits with her physician at the conclusion of her examination. He talks to her about a new medication she needs, opens up a file on his computer or smart phone, clicks on a drug and sends the prescription directly to the pharmacy. This is e-prescribing. Is it safe and effective, or are there problems with e-prescribing?

The use of e-prescribing shows dramatic growth. Both the benefits and the drawbacks should be considered. According to the 2009 National Progress Report on e-prescribing which is published by Surescripts, the operator of the largest e-prescription network, electronic prescriptions increased 181% from 2008-2009.

The government is pushing e-prescribing. This number will continue to grow based on the Centers for Medicare and Medicaid Services “voluntary” incentive program. Although it is voluntary now, the program forces physicians to adopt e-prescribing by transitioning from incentive payments to penalties on covered Medicare charges.

E-prescribing should get another boost as the Drug Enforcement Agency interim final regulations that took effect June 1, 2010, will allow for e-prescribing of controlled substances (typically narcotic pain-relievers) in the US. Pharmacies may not begin to receive these orders for another 6-18 months as the software vendors make the updates to computer systems that will allow prescribers to transmit the medication orders, intermediaries to process the prescriptions, and pharmacies to receive them. Furthermore, as the regulatory barriers to controlled substances become more streamlined patients may be more likely to receive prescriptions for them.

Benefits of E-Prescribing

E-prescribing can and will benefit quality of care. The following are just some of the ways.

• Prevents medication prescription errors caused by events such as illegible handwriting, look-alike or sound-alike drugs, drug-drug interactions, incorrect dosing, drug allergy reactions, duplication of drugs, etc. and, thereby, reduces health care and legal costs.
• Eliminates illegible prescriptions.
• Provides for real-time communications between doctors, pharmacies and patients.
• Provides critical drug alerts and patient specific information at the healthcare professionals’ fingertips.
• Provides drug pricing information.
• Provides payer coverage and preferred drug information.
• Creates a complete patient medication history.
• Reduces fraud and crime.
• Increases healthcare professional work efficiency and reduces administrative costs.
• Expedites refills.

Drawbacks of E-Prescribing

A new technology is not without its drawbacks. Some of the more notable issues with e-prescribing include:

• Accidental data entry errors such as selecting the wrong patient or clicking on the wrong choice in a menu of dosages or selecting conflicting directions of use.
• Inadvertently divulging protected health information on the internet through inadequate security practices. Hospitals and clinics should be protected with firewalls, use strict computer permission settings, and remain vigilant toward signs of intrusion.
• Inability to use electronic prescribing when power is out, when the exam room computer has failed, or when providing treatment outside of a standard health care setting.
• No standardization of current messaging and data structure for software which ultimately can result in inconsistent prescriber and pharmacy workflows.

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.

About the author: Dave Boblenz, PharmD, is a pharmacist with over 14 years’ experience.

Comments
As is true with any prescription, whether handwritten on a prescription pad or sent electronically to the pharmacy. Errors may be made in the drug selection, dosage and route of administration. The physician, nurse practitioner or physician’s assistant may fail to provide education about side effects or provide sufficient details to provide an informed consent about the risks of the medications.

In one study, doctors agreed to be recorded during patient visits as they prescribed drugs new to those patients. Here is the percent of time the doctors gave people the following critical pieces of information:
Reason for taking the drug: 87%
Name of the drug: 74%
How often to take it: 68%
How much to take each time: 55%
Side effects: 35%
How long to keep taking the drug: 34%

In addition to errors in prescriptions covered by a previous blog post, consider errors in filling e-prescriptions. The pharmacist or technician may have pulled the wrong drug off the shelf or provided the wrong dose. While e-prescribing reduces errors, it does not eliminate them.

References
Use of E-Prescribing Grows Dramatically
Physician Quality Reporting Initiative
Elizabeth Bewley, author of Killer Cure, Dog Ear Publishing, cites the study by Derjung, T., Heritage, J. Paterninti, D. et al, “Physician communication when prescribing new medications”, Archives of Internal Medicine 25 September 2006