E-prescribing improves communication between doctor, patient, pharmacist

Electronic prescribing (e-prescribing) increases patient safety, experts say. This tool not only eliminates interpretation errors from handwritten prescriptions, it creates a communications bridge between the physician, pharmacist and patient.

And its use has been steadily increasing since its adoption, according to a National Progress Report issued annually by Surescripts. In 2011, it was estimated that close to 60 percent of physicians in office-based practices were e-prescribing. According to the 2012 Medical Economics Continuing Study, that number has jumped to 67 percent.

The Health Information Technology for Economic and Clinical Health Act, which was enacted in 2009 as part of the American Recovery and Reinvestment Act, installed e-prescribing as a core menu item for attesting to meaningful use. In addition, the Medicare Electronic Prescribing Incentive program requires eligible professionals (including physicians) to report e-prescribing activities at least 10 times each year for 2011 and 2012 or find their payments reduced in 2013-2014. So as you can see, the government is serious about e-prescribing as well. If you’re not already e-prescrib­­ing, you probably will be soon.

Preventing drug errors

Erika Bliss, M.D., president and CEO of Qliance, a Seattle-based network of “direct practice” clinics (aka, direct primary care medical homes) that don’t accept insurance and that currently charge patients less than $100 per month for unlimited primary care, says she “can’t imagine not having it at this point.”

Qliance has been “electronic” from the beginning. The network never has used paper charts. All five clinics are connected through a Web-based electronic health record (EHR) system. And according to Dr. Bliss, e-prescribing was extremely important from the start.

“It was a ‘must-have,’ ” she says, “so we chose an EHR system that had it built in.”

Dr. Bliss advises primary care physicians who aren’t already e-prescribing to begin immediately. At minimum, she says, if you’re not ready to implement a full EHR with built-in e-prescribing capabilities, at least install one of the free stand-alone e-prescribing systems.

“From a patient safety perspective, I don’t think there’s any excuse not to e-prescribe, especially when there are free products out there,” Dr. Bliss says. “We’re well past the point now where you can justify written prescriptions for so many reasons. First of all, they’re totally unsafe, because most people don’t write that clearly. They’re also very easy to misinterpret.”

To make matters worse, Dr. Bliss says, when written prescriptions are faxed to pharmacies, a pharmacy technician must manually enter them into the pharmacy’s electronic systems, inviting even more errors.

“Anytime you have any sort of transcription happening in a chain of information transfer, you’re at a very high risk of making mistakes, and, unfortunately, they happen all the time,” she says.

The most common errors, Dr. Bliss adds, involve incorrect refill information being input into the pharmacy systems, even though the prescription itself is properly transcribed. That mistake can seem pretty harmless, she says, but it wastes the time of practices, patients, and the pharmacy.

Check the database

When you’re searching for e-prescribing software, whether it’s a stand-alone product or one that’s integrated into an EHR, Dr. Bliss says it’s important to investigate the database from which the program is pulling information.

“There are different databases out there,” she says, “and some of them are better maintained than others. They’re more reliable.”

Dr. Bliss says various “bells and whistles” associated with the different e-prescribing systems drives their cost. She notes, however, that certain “must-have” capabilities are critical for the databases to be truly useful in care settings. For example, she says, any database connected to an e-prescribing system must be capable of drug-drug, drug-allergy, and drug-disease interactions checking.

“Whatever the e-prescribing system is,” Dr. Bliss says, “it has to be based on a database that’s relational in such a way that it can pick (International Classification of Diseases, Ninth Revision) codes out of a patient’s chart, compare them with its database, identify any interactions, and then present that information to you.”

Dr. Bliss

Stand-alone vs. integrated systems

Once a system is installed in your practice, patient information must be input into the e-prescribing system. Input information generally includes patient demographics and allergy and problem lists.

“You can start to see the argument for installing a complete EHR rather than a stand-alone e-prescribing system,” Dr. Bliss says, “because if you’re going to input all that patient data, you might as well be putting it into a full EHR.”

Because she personally experienced what can happen when an e-prescribing system doesn’t present a potential medication interaction danger, Dr. Bliss now recommends that physicians not only consider e-prescribing systems that are fully integrated, but that they also look for systems that feature all three types of interaction-checking.

Dr. Bliss recounts an incident in which she was preparing to administer an injectable nonsteroidal anti-inflammatory drug (NSAID) to a patient who had come to see her in her office, not recalling that the patient was allergic to NSAIDs and could experience a severe drug-allergy interaction.

Because Dr. Bliss was administering the injection in the office, it was considered a procedure, and she had ordered the drug using Current Procedural Terminology (CPT) codes.

“I was just about to give it to her when my assistant read her allergy list and alerted me to the interaction,” she says.

An investigation into why her e-prescribing system had failed to alert her to the drug-allergy interaction revealed that the system had been built without the ability to match CPT codes to the medication database. “The vendor had not connected the CPT codes to the interaction engine,” Dr. Bliss says. “Therefore, the system couldn’t tell me I was about to administer a drug that my patient was allergic to.” Since then, the EHR vendor has made the necessary connections so the proper interaction alerts are triggered, she said.

“The whole point of having electronic systems is not to save you time,” Dr. Bliss contends. “It’s about having better data, better access to data, and having safety checks to prevent people from making avoidable mistakes.” DT