Electronic Prescriptions are Safer Prescriptions

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Electronic Prescriptions are Safer Prescriptions

Medication errors are among the most common medical errors, causing harm to at least 1.5 million people every year. It is conservatively estimated that considering just Medicare patients at least 530,000 adverse drug events occur annually in the outpatient environment.

In an effort to help prevent medication errors, the Institute of Medicine recommended that all prescriptions in the US be written and received electronically by 2010.[1]

Electronic prescriptions offer several advantages over traditional hand written prescriptions that increase patient safety. These include:

  1. Improved legibility, reducing administration of incorrect medications and increasing compliance with prescribed medications.
  2. Complete and standardized “Sig” codes – Many physicians use unapproved abbreviations in their dosing instructions, resulting in medication errors. By selecting from a list of standardized dosing instructions, this risk is reduced.
  3. Integrated Drug – Drug Interaction checking – Most E-Prescribing software applications list all medications that a patient is taking, regardless of who prescribed them, and check for drug interactions when a prescription is written.
  4. Integrated Drug – Allergy checking – As with all medications a patient is taking, patient allergies are stored in E-Prescribing applications and reduce the risk of prescribing a medication that could cause an allergic reaction.
  5. Correct Patient Identification – Since the demographic information is complete, legible and transferred electronically between physician and pharmacy, the risk of prescribing or delivering medication to the wrong patient is reduced.

Electronic prescriptions also increase patient satisfaction by eliminating one trip to the pharmacy to deliver the prescription. E-Scripts can usually be electronically submitted to the pharmacy before the patient leaves the office.

Communications between pharmacies and physician offices account for an estimated 25% of pharmacists’ time and up to 20% of the workload of a physician’s office staff.[2]

Adapting to a new workflow associated with receiving electronic prescription refill requests usually requires some effort initially for physicians. Once the new workflow is established, it is normally faster and less expensive to complete. It usually results in better documentation than occurred with the old process of receiving and responding to a paper fax from a pharmacy.

Another benefit of many electronic prescription applications today is integrated formulary checking and automated generic drug substitution recommendations. This often includes cost comparisons, which can reduce overall medical costs and patient medication expenses.

Remaining barriers to adoption of this technology include getting the technology into the hands of physicians to permit E-prescribing, and getting all pharmacies connected to receive and send them. Currently, 97% of chain pharmacies and 27% of independently owned pharmacies e-prescribe.[3]

Another barrier is the inability currently to E-prescribe controlled substances. This is a major focus of a number of organizations that are working with Congress and the DEA to change current regulations to permit E-prescribing of controlled substances.[3]

In the future, it is anticipated that medication compliance can be enhanced by electronic notification to the prescribing physician that the patient did pick up a prescription. Also, physicians may be able to see a patient’s complete medication history, regardless of where it was filled or who prescribed the medication. This offers further opportunity to improve patient safety.

In summary, I believe the potential benefits of electronic prescriptions include greater patient safety, improved patient satisfaction and reduced costs to patients, physicians and pharmacies. If the barriers can be reduced, then I anticipate more physicians will adopt this technology to reduce the risk of medication errors for their patients.

Michael Atwood, MD

References:

1. IOM Committee on Identifying and Preventing Medication Errors. Preventing Medication Errors: Quality Chasm Series, July 2006

2. Sarasohn-Kahn, J and Holt, M. The Prescription Infrastructure: Are We Ready for ePrescribing?. Report prepared for the California Health Foundation, Jan. 2006

3. SureScripts, LLC. National Progress Report on E-Prescribing. Dec. 2007