Are E-Prescriptions Right For Your Practice?

Written by on March 29, 2013 in Features - No comments

ePrescriptionsWEBIt 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.

Electronic prescribing or e-prescribing (e-Rx) is the computer-based electronic transmission and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorization to a local or mail-order pharmacy. It has the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic health records (EHR).

Small and mid-size practices are leading the way, making up a sizeable chunk of the 58% of physicians using e-prescribing tools outside of the hospital.

Do E-prescriptions Actually Improve Patient Health?

According to a study by Surescripts, e-prescribing is linked to an increase in first-fill medication adherence and health care savings that could lead to $140 to $240 billion in health care savings and improved health outcomes over the next ten years.

Physicians adopting e-prescribing wrote out nearly 40% of their prescriptions electronically. This resulted in a 10% increase in patient first-fill medication adherence, which translates to fewer doctor visits and reduced risk of hospitalization.

When taking into account the 60/40 ratio of paper-to-electronic prescriptions, the study demonstrated prescription delivery rates rising to 81.8%, and 76.5% getting picked up. This is encouraging, considering how many prescriptions never make it to a pharmacy counter.

Benefits

The benefits of e-prescribing to both patients and clinicians include:

  • Improving patient safety and quality of care – Illegibility from handwritten prescriptions is eliminated, decreasing the risk of medication errors while simultaneously decreasing risks related to liability. Oral miscommunications regarding prescriptions can be reduced, as e-prescribing should decrease the need for phone calls between prescribers and dispensers. Electronic prescribing has the potential to eliminate most of these types of errors. Warning and alert systems are provided at the point of care. E-prescribing systems can enhance an overall medication management process through clinical decision support systems that can perform checks against the patient’s current medications for drug-drug interactions, drug-allergy interactions, diagnoses, body weight, age, drug appropriateness, and correct dosing. Based on these algorithms, the system can alert prescribers to contradictions, adverse reactions, duplicate therapies and flag lethal dosages and lethal combinations of drugs.
  • Reducing time spent on phone calls and call-backs to pharmacies – According to estimates, almost 30 percent of prescriptions require pharmacy callbacks.  E-prescribing can significantly reduce the volume of pharmacy call-backs related to illegibility, mistaken prescription choices, formulary and pharmacy benefits, decreasing the amount of time wasted on the phone. This ultimately impacts office workflow efficiency and overall productivity in a positive manner.
  • Reducing time spent faxing prescriptions to pharmacies – Both prescribers and pharmacists can save time and resources spent on faxing prescriptions through a reduction in labor costs, handling costs, and paper expenses waste due to unreliability.
  • Automating the prescription renewal request and authorization process – With e-prescribing, renewal authorization can be an automated process that provides efficiencies for both the prescriber and pharmacist. With limited resource utilization and just a few clicks on behalf of the prescriber, they can complete a medication renewal task while enhancing continuous patient documentation.
  • Increasing patient convenience and medication compliance – It is estimated that 20% of paper-based prescription orders go unfilled by the patient, partly due to the hassle of dropping off a paper prescription and waiting for it to be filled. By eliminating or reducing this waiting period, e-prescribing may help reduce the number of unfilled prescriptions and hence, increasing medication compliance.
  • Improving formulary adherence permits lower cost drug substitutions – By checking with the patient’s health plan or insurance coverage at the point of care, generic substitutions or lower cost therapeutic alternatives can be encouraged to help reduce patient costs. Lower costs may also help improve patient compliance.
  • Allowing greater prescriber mobility – Improved prescriber convenience can be achieved when using mobile devices that work on a wireless network, to write and renew prescriptions. Such mobile devices may include laptops, PDA’s, tablet computers, or mobile phones. This freedom of mobility allows prescribers to write/renew prescriptions anywhere, even when not in the office.

Challenges and Limitations

Challenges and limitations that may hinder the widespread adoption of e-prescribing practices are:

  • Financial Cost and Return on Investment (ROI) – The costs associated with purchasing, implementing, training staff and maintaining such a system may be beyond the means of small clinical practices, and is noted to be one of the greatest implementation barriers. As a result, large urban areas (large practices) may see the greatest ROI when compared to those in rural or inner city locations (small practices).
  • Change Management – Many underestimate the challenges pertaining to change management when transitioning from paper-based prescriptions to e-prescribing. This is especially true in busy practices where health care providers and associated staff are accustomed to their current management system. Staff accustomed to certain work practices may have particular aversions to the technology, so it may be difficult to get everyone on board immediately when introducing such a dramatic change.
  • Hardware and software selection – Choosing the right hardware platform and software applications can be a rather daunting task for practices, especially in regards to small and busy settings. Initiatives must be put into place to allow for effective and strategic planning prior to adoption.
  • Integrity of data input – Accidental data entry errors such as selecting the wrong patient or clicking on the wrong choice in a menu of dosages may occur. Software vendors should continually review user feedback and follow best practices in user interface design.
  • Security and Privacy – As with many eHealth solutions, privacy of patient information stored in electronic format may lead to the possibility of novel errors, such as inadvertently divulging protected health information on the internet through inadequate security practices. Instances of negligence may also arise, where employees may forward prescriptions to organizations outside its intended use. Therefore, hospitals, practices and pharmacies should be protected with firewalls, use strict computer permission settings, and remain vigilant toward signs of an intrusion.
  • System Downtime – Periods of system downtime may arise, either due to network-related issues, hardware failure, or loss of electricity. The inability to use electronic prescribing when the system is not accessible is of great concern, and must be addressed with the discussion of fall-back procedures and mechanisms when such situations arise.

How to Get Your Practice Started

  • Purchase hardware such as desktop PC’s, laptops, pocket PC’s, tablet PC’s , PDA’s utilizing a wired or wireless network.
  • Install an internet connection; high speed is highly recommended.
  • 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 several 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/).

In Conclusion

E-prescriptions not only fulfill Meaningful Use requirements, but it’s clear that they help reduce or prevent errors. They can aid in making your practice more organized and save your practice money. Furthermore, e-prescriptions assist your patients to adhere to their medication regimen, contributing to their improved health and satisfaction.

References:

http://www.emrconsultant.com/education/e-prescribing
http://www.poweryourpractice.com/do-eprescriptions-actually-improve-patient-health/
http://www.poweryourpractice.com/eprescribing-could-save-health-care-billions/
http://en.wikipedia.org/wiki/Electronic_prescribing

By Thomas Hibbard,
Creative Director, Med Monthly

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