E-prescribing

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E-prescribing

Introduction

In 2006 it was reported that the U.S. spends $2.1 trillion per year on healthcare services. This makes it one of the largest industries in the U.S. However, Americans fail to receive high-quality healthcare. A 2003 report indicated that Americans receive recommended clinical treatments only 55 percent of the time, and 11 percent of the time will receive treatments that may actually be harmful (McGlynn et al).


On April 24, 2004, President George W. Bush unveiled his plans for the future of America. Among initiatives for clean and reliable energy, access to high-speed internet, improved quality of education and training, he also announced his Health Information Technology Plan. With this plan, his goal is for every American to have an electronic health record by the year 2014 (White House, 2004). To make this vision a reality, President Bush established a new position within the Department of Health and Human Services (DHHS) called the National Coordinator for Health Information Technology (ONC). He appointed Dr. David Brailer to the position followed by Dr. Robert M. Kolodner in 2007 (ANSI, n.d.).


Electronic health records have the ability to eliminate errors due to illegible handwriting and allow physicians to share patient’s records with other providers. In conjunction with computerized provider order entry and electronic prescribing, electronic health records can alert providers to medications that may cause an adverse drug reaction or provide advice about which tests to order or medications to provide. This technology will make healthcare more effective, more efficient and improve quality of care.


Electronic Prescribing

In the United States, 3.5 billion prescriptions were filled in 2007 (Steinbrook, 2008). Medication prescriptions accounts for 13% of health care expenditures annually in the U.S. (Eslami et al., 2007). The Institute of Medicine announced in July 2006 their recommendation that all prescriptions be written electronically by 2010 (eHealth Initiative 2008). Medicare also announced that all Medicare Part D prescriptions must be transmitted electronically by January 1, 2009 (Surescripts, n.d.). Electronic Prescribing or e-prescribing is the use of a computerized system to enter and generate a prescription rather than writing it on paper. The prescription is then sent to the pharmacy over a secure network (Lapane et al., 2008). Prescriptions that have been created through an EHR then printed or faxed are not considered e-prescriptions (Steinbrook, 2008). This technology has the potential to reduce preventable ADEs by alerting providers to drug interactions and drug allergies (Lapane et al., 2008).


Many medication errors are a result of illegible handwriting, unclear abbreviations and unclear or ambiguous orders (eHealth Initiative, 2008). E-prescribing can improve patient safety and satisfaction by providing legible, formulary-adherent prescriptions resulting in decreased call backs to provider offices for clarification and faster prescription fulfillment. One study estimates that pharmacists make 150 million calls a year to physicians to clarify prescriptions (Kilbridge, 2001). Electronic prescribing can also help reduce medication spending by providing information on generic or other low-cost alternatives (Steinbrook, 2008).


Electronic prescribing adoption has had a slow but steady growth. In March 2008, about 40,000 physicians in the U.S. were writing e-prescriptions and nearly 73% of retail pharmacies were receiving them (Steinbrook, 2008).


In 2007, approximately 35 million prescriptions were transmitted electronically through the Pharmacy Health Information Exchange operated by Surescripts(Surescripts 2007). The eRX Collaborative, another e-prescribing program, reported 5 million prescriptions transmitted in 2007. They also reported that approximately 104,000 e-prescriptions (2.1%) were changed or cancelled as a result of a safety alert by the system (eHealth Initiative, 2008).


The eHealth Initiative and the Center for Improving Medication Management documented the phases and functions of e-prescribing to demonstrate its benefits and key features. Some of the benefits are the ability to access medication history and receive notifications when a medication has been picked up or left unfilled. Another benefit is providers can receive drug safety alerts when prescribing medications. However, a study in 2008 concluded that providers override the drug dose alerts and drug-drug alerts most of the time. Approximately 1 in 4 providers override drug dose alerts most of the time or always and 40% override drug-drug interactions most of the time or always. When asked about drug-allergy alerts, they were least likely to override the alert stating that the alerts are helpful, useful and a good reminder. Providers noted that drug-drug alerts are beneficial but, at times, unnecessarily excessive or trivial (Lapane et al., 2008).


Electronic prescribing has major benefits for providers and patients. Providers will benefit from decision support tools to assist them in prescribing medications and a decrease in the number of phone calls from pharmacies requesting clarification. Patients will receive lower costs, increased safety, and greater efficiency.



References

American National Standards Institute (ANSI). n.d.. Robert Kolodner Named National Coordinator for Health Information Technology. Retrieved August 21, 2008. http://www.ansi.org/news_publications/news_story.aspx?menuid=7&articleid=1475.

eHealth Initiative. June 2008. The consumer’s guide to e-prescribing. http://www.thecimm.org/PDF/eHI_CIMM_Consumer_Guide_to_ePrescribing.pdf

eHealth Initiative. June 2008. Electronic prescribing: becoming mainstream practice. http://www.thecimm.org/PDF/eHI_CIMM_ePrescribing_Report_6-10-08.pdf

Eslami, S., de Keizer, N.F., Abu-Hanna, A. 2007. The impact of computerized physician medication order entry in hospitalized patients – A systematic review. International Journal of Medical Informatics. 77: 365-376

Kilbridge, P.M., Welebob, E.M., Classen, D.C. 2006. Development of the Leapfrog methodology for evaluating hospital implemented inpatient computerized physician order entry systems. Qual. Saf. Health Care. 15: 81 - 84.

Lapane, K.L., Waring, M.E., Schneider, K.L., Dube, C., Quilliam, B.J. 2008. A mixed method study of the merits of e-prescribing drug alerts in primary care. Journal of Gen Intern Med. 23(4): 442-446.

McGlynn, E.A., Asch, S.A., Adams, J., Keesey, J., Hicks, J., DeChristofaro, A., et al. 2003. The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine.

Steinbrook, R. 2008. The (slowly) vanishing prescription pad. New England Journal of Medicine. 359: 115-117

White House: Office of the Press Secretary. April 24, 2004. President Unveils Tech Initiatives for Energy, Health Care, Internet. Retrieved August 19, 2008. http://www.whitehouse.gov/news/releases/2004/04/20040426-6.html.