A new study published online in the Journal of the American Medical Informatics Association shows that although electronic prescriptions are generally viewed as an important time-saving tool that improves patient safety by physician’s practices and pharmacies alike, they both have to overcome hurdles to realize the technology’s full benefit.
The study, funded by the U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ), shows that electronic prescribing, or e-prescribing, holds various potential benefits, such as helping to reduce the risk of medication errors due to illegible or incomplete handwriting.
The study, “Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies”, concentrated on one of the main aspects of e-prescribing – the electronic exchange of prescription data between physician practices and pharmacies, which saves time and money by restructuring the process of making new and repeat prescriptions.
The researchers, from the Center for Studying Health System Change, Washington, D.C. found that both physician practices and pharmacies showed a general positive attitude regarding new prescriptions by electronic transmission. However, they still experience some ongoing problems, such as renewing prescriptions, networking problems between physician offices and mail-order pharmacies, as well as manually entering certain information on prescriptions by pharmacists, particularly in terms of the name of the drug, quantity, dosage form, and patient instructions.
AHRQ Director Carolyn M. Clancy, M.D. commented:
“Physicians and pharmacies have come a long way in their use of e-prescribing, and that’s a very positive trend for safer patient care and improved efficiency. This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients.”
For their study, the researchers held 114 interviews with representatives from 24 physician practices, 3 mail-order pharmacies and 48 community pharmacies that were classified into local and national companies. All of them use e-prescribing.
They found that physician practices and pharmacies used the e-prescribing system considerably less often for electronic renewals than for new prescriptions, with over a quarter of the community pharmacies reporting not sending electronic renewal requests to physicians. Likewise, one-third of physician practices had e-prescribing systems that were either not configured to receive electronic renewals or only received them infrequently.
According to physician practices, some pharmacies that sent electronic renewal requests also backed up their requests by fax or phone, despite having already received an electronic response from the physician, whilst simultaneously, pharmacies reported that physicians often approved electronic requests by phone or fax or denied the request by mistake and sent a new prescription.
The authors observed that overcoming the hurdles of e-prescribing will become more urgent as a growing number of physicians implem the technology to take advantage of federal incentives.
As part of the HITECH Act of 2009, physicians are able to qualify for Medicare and Medicaid electronic health record incentive payments if they produce and send over 40% of all prescriptions to pharmacies electronically. This excludes prescriptions for controlled substances.
The researchers report other key findings, such as pharmacies noting that they sometimes need to manually edit certain prescription information, like the name of the drug, dosage and quantity. A common cause that both physicians and pharmacists reported was that physicians using e-prescribing must select medication with more specificity, and also decide about factors like packaging and drug form; decisions which were usually made by pharmacists for handwritten prescriptions.
When sending new prescriptions and renewals electronically to mail-order pharmacies, approximately three-quarter of practices reported problems.
Many practices reported uncertainties as to which mail order pharmacies accepted e-prescriptions, and thought that the process was unreliable even when a mail-order company did accept them. Almost half of the pharmacies pointed out that patient instructions generally had to be rewritten in order for patients to understand them.
The team conclude that these issues must be addressed through a collaboration of a large group of public and private stakeholders, including the federal government, e-prescribing standard-setting organizations, vendors and others.
Written by Petra Rattue