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e-Rx-ing. Are We There Yet?

Late last fall, a study group funded by the US Department of Health and Human ServicesAgency for Healthcare Research and Quality (AHRQ) released its report on electronic prescribing.  Advances in technology prompt a lot of Utopian notions among us all – some silly, some sound.  Who doesn’t imagine a world of seamless transitions, error-free transactions, effortless progress towards a perfect, ever-distant but eventually attainable goal?  How lovely it would be if our doctors could do everything  from evaluating to diagnosing to prescribing by email and text.  We would never again have to sit in their dingy waiting rooms.  No more inconvenience.  No office hours conflicting with our work schedules.  No mistakes.  Sleek Star Trek medicine is really on its way!

It may be on its way, but we have a long way yet to go – a very long way.  The study found that while physicians and pharmacists love the idea of e-prescribing – it should improve overall patient safety and save time – there remain a whole bunch of barriers to its general acceptance.  More to the point, what works in theory and on paper may not be quite so viable in the real and imperfect world we all actually inhabit.

E-prescribing has many potential benefits.  The risk of medication mix-ups caused by incomplete or illegible handwritten prescriptions might be reduced.  The electronic sharing of prescription information between medical practices and pharmacies will surely save time – and money, too – by refining and streamlining the process for filling new and renewal prescriptions.  But even this step has its challenges.

Doctors and pharmacists were generally okay with the electronic transmission of new prescriptions.  But prescription renewals, along with connectivity between medical offices and mail-order pharmacies and the manual entry of specific prescription information by pharmacists – especially drug name, dosage form, quantity and patient instructions – all still pose real problems.  This means that physician practices and pharmacies use e-prescribing for electronic renewals far less often than for new prescriptions.

About one-third of the doctors interviewed had e-prescribing systems that were not even set  up to receive electronic renewals (or only receive them very infrequently); more than a quarter of the community pharmacies said they did not send electronic renewal requests to doctors.  Some doctors reported that pharmacies they worked with sent renewal requests electronically, by phone and via fax as well, adding to the confusion – even after the physician had already responded electronically.  On their side, pharmacies reported that doctors often confirmed and approved electronic requests by phone or fax – or mistakenly denied a request and sent a new prescription.

The situation is bound to get worse before it gets better.  According to an AHRQ press release, physicians can qualify for Medicare and Medicaid electronic health record incentive payments by generating and transmitting more than 40% of all prescriptions to pharmacies electronically (excluding those for controlled substances) as part of the HITECH Act of 2009.  The pressure to adopt technology in response to federal incentives may create as many problems as it solves.  Indeed, throwing money at  problems does not necessarily (or often) make those problems go away, as history reminds us.  Other study findings include:

  • About three-quarters of physician practices reported glitches and problems sending in both new prescriptions and renewals to mail-order pharmacies.  Many practices were unsure which mail-order pharmacies actually accepted e-prescriptions.  The practices also believed that, even when a mail-order pharmacy did accept them, the whole process was unreliable.
  • Nearly half of all pharmacies reported that patient instructions typically needed to be rewritten so that patients could understand them.
  • Pharmacies noted the need to manually edit certain prescription information from time to time, information such as drug name, dosage and quantity.  One common cause reported by both doctors and pharmacists was that physicians must select medications with more specificity when e-prescribing, and include decisions about such details as packaging and drug form.  With handwritten prescriptions, such decisions were typically made by the pharmacists filling the prescriptions.

This study about e-prescribing concluded in the very same way that all such studies and reports conclude: with a reminder that all interested parties and stakeholders need to work together towards a solution everyone can live with.  Exactly.

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