Electronic prescribing

It was reported by the Institute for Safe Medication Practices (ISMP) in 2000 that fewer than 5 percent of physicians were writing prescriptions electronically. In a 2000 white paper entitled, A Call to Action Eliminate Handwritten Prescriptions within 3 Years, ISMP recommended the use of electronic prescribing by clinician order entry to reduce medication errors (ISMP, 2000). CPOE can help to reduce errors in the delivery and transcribing of orders to the pharmacy where the orders are filled. Order management can be used to control inventory and alert pharmacy staff (and even the patient) of the status of a prescription. For example, some national chain pharmacies have the capability of alerting the patient by phone or e-mail if a prescription is ready or if other action needs to be taken before the prescription can be picked up. The system should also be able to report results, such as the number of prescriptions filled, the revenue generated over a specified time, and medication error reports. 

The information technology demands of Part D remain unclear as they relate to electronic prescribing and its impact on pharmacy. Currently, pharmacies interact with PDPs electronically to determine eligibility and adjudicate claims. The MMA directed the Secretary of Health and Human Services to establish federal standards for e-prescribing. Five pilot studies conducted in 2005-2006 tested six standards, showing that three standards are ready for implementation. Standards related to prior authorization, structured... 

SIG (prescription instructions), and RxNorm (standard name, dose, and form availability) were not considered ready for implementation because of numerous approaches used in these three areas across health information technology. Electronic prescribing is not required under MMA, but plans are to have it available should providers choose to use it. As standards are developed, the adoption of e-prescribing is expected to improve patient safety by reducing prescribing and dispensing errors (Agency for Healthcare Research Quality, 2007). 

Agency for Healthcare Research Quality. 2007. National Resource Center for Health Information Technology. Electronic Prescribing, http //healthit.ahrq.gov/... 

Papshev D, Peterson AM. Electronic prescribing in ambulatory practice promises, pitfalls, and potential solutions. Am. J. Manag. Care 2001 7(7) 725-736. 

Dr. Peterson has concentrated his years of research in pharmacy management, managed care pharmacy, pharmaceutical care, and medication adherence. His more recent scholarly publications include A Survey of the Extent of Electronic Prescribing as Perceived by MCOs and A Meta Analysis of Interventions to Improve Medication Adherence. He has coauthored a book on therapeutics for mid-level practitioners entitled Advanced Pharma-cotherapeutics A Practical Approach. 

Direct order entry, or electronic prescribing, is not limited to the inpatient setting. Electronic prescribing encompasses till computer-driven automated processes used to write a prescription for a patient. Within the past few years, technological advances have allowed electronic prescribing to be performed in an ambulatory setting. This process is executed in many ways. Early versions of electronic prescribing devices consisted of a stand-alone computer terminal located at fixed points in physicians offices. These fixed terminals have expanded to use Internet web-based interfaces to access patient level information from a health plan, write prescriptions, and send prescriptions to a pharmacy to be filled. 

More recent advances in technology made possible by the personal digital assistant (PDA) have allowed physicians to electronically prescribe at the point of care. PDAs are handheld computers that typically run using a Windows- or other proprietary-based platforms. These PDAs use a touch-sensitive screen to maneuver through a menu-driven prescribing process that can execute a prescription in as little as three stylus taps. - The PDAs or other proprietary devices then upload the prescription via a network connection or modem to be printed, faxed, or electronically transmitted to a pharmacy. 

Electronic prescribing devices provide several sources of information to prescribers at the point of care provided to... 

Conversely, electronic prescribing has a few potential disadvantages. Most of these disadvantages stem from the potential of the technology to be used for other purposes... 

The receipt of a prescription can be subject to several market barriers. First, the pharmacy must have the electronic capability to receive the data. Second, the pharmacy must accept the patient s prescription drug plan and be willing to operate under the financial constraints imposed by the electronic prescribing provider. Finally, the potential exists for pharmacy benefit managers (PBMs) to use electronic prescribing technology to route prescriptions to preferred pharmacies such as mail order companies. 

Theoretically, it is possible that electronic prescribing devices will allow unimpeded access to physicians by whoever is willing to pay for that access. Physician detailing may become more prevalent through these devices and could possibly be confused with unbiased medication information. 

The advent of electronic prescribing will decrease pharmacists roles in many areas. In dispensing roles, pharmacists will have less responsibility for order entry, PBM formulary management, and disease protocol adherence. Furthermore, a large number of DUR functions will be taken care of before the patient s order is received in... 

The future appears very bright for electronic prescribing. Certainly, the upfront costs for implementing programs, and the refinement of hardware and software specifics are important issues to resolve. However, the benefits of improved care, streamlined workflow, and more efficient use of clinicians time are important enhancements that have continued to encourage expansion of these technologies. As wider audiences use these applications, continued research is needed to assess the use and refinements necessary to optimally apply these important systems. 

Venot, A. Electronic prescribing for the elderly will it improve medication usage. Drugs Aging 2001, 15 (2), 77-80. 

Komshian, S. Electronic prescribing system helps physicians avoid errors and offer better service. Phys. Comput. 2000, 12-15. 

Electronic prescribing has been a much sought after goal by the health care industi y. Electronic prescribing would... 

Barriers to electronic prescribing generally circulate around issues of connectivity and ease-of-use issues with physicians, and the cost of implementing this technology in both physician practice and pharmacies. For a seamless system to work, the prescribing physician must have... 

CMS will promulgate electronic prescribing standards no later than April 1, 2008. 

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