E-prescribing is health care technology designed to improve prescription accuracy, increase patient safety and reduce costs, while also enabling secure, real-time, bi-directional, electronic connectivity between clinicians and pharmacies.
It gives prescribers a secure means of electronically accessing health plan formulary, patient eligibility and medication history at the point of care and securely transmitting the prescription electronically into the pharmacy’s computer system.
A key driver for adopting e-prescribing is to improve patient safety by generating legible prescriptions that have been checked at the time of prescribing against the patient’s electronic medication profile for possible harmful interactions. This is important because medication errors and adverse drug events (ADEs) contribute to approximately 7,000 deaths a year, with an estimated cost for drug-related morbidity and mortality exceeding $77 billion a year.
About 91% of community pharmacies and 34% of office-based providers have electronic prescription-routing capability.
Impact of e-prescribing
Studies show that e-prescribing significantly reduces medication errors and substantially improve patient safety by alerting physicians of risks related to drug interactions and other potential medication problems.
Among a sample of 3.3 million prescriptions reviewed, a severe or moderate drug-to-drug alert was sent to physicians for 33%, resulting in 41% of those prescriptions being changed or canceled by the prescribing doctor. More than 100,000 medication allergy alerts were presented and 41% were acted upon.
Advantages
The benefits of e-prescribing are well documented:
- Patient safety
- Avoidable errors associated with written prescriptions include selection of an incorrect or unavailable drug, dosage form or dosage; duplication of therapy; omission of information; and misinterpretation of the order because of illegible handwriting.
- These errors, if caught before being processed, often require additional communication between the pharmacist and the provider, which delays patient care. Indecipherable orders alone account for 150 million calls from pharmacists to providers in the U.S each year.Furthermore, undetected mistakes can lead to patient harm or even death.
- Patient safety
- Cost benefits
- Point-of-care decision support software can lead to an average cost that is $4.12 lower than expected based on a comparable number of prescriptions written by providers not using software.
- These savings were due to alerts that informed providers of more cost-effective therapies, suggested discontinuation of unnecessary high-cost medications and recommended therapy optimization before permitting transmission of the prescription to a pharmacy.
- Cost benefits
- Access to prescription records
- Have prescriptions in electronic storage is vital for emergencies, such as a natural disaster. Pharmacists and providers can retrieve medication records to avoid lapses in medication adherence. What’s more, drug management is more efficient when a pharmacy has e-prescribing capability because they can trace certain medications to specific patients and expedite delivery of pertinent information.
- Access to prescription records
- Improved workflow
- E-prescribing benefits the patient in terms of goal achievement and prevention of drug errors. It also helps community pharmacists streamline prescription processing and reduce wait times. Calls to clarify unreadable prescriptions can be eliminated and give the pharmacist more time to counsel patients.
- All of these improvements tend to lead to greater patient satisfaction — creating greater retention and increased revenue.
- Improved workflow
- Other advantages
- Providers have reported less time spent verifying handwritten orders, easier access to a patient’s insurance coverage information and peace of mind concerning transmitted orders. Also, providers may be eligible for reimbursem*nt if they are compliant with formulary programs.
- Insurance companies have reported cost savings due to better formulary adherence, reduced therapeutic duplication and prevention of ADEs.
- Employers have been shown to benefit financially from reduced health care costs and healthier employees.
- Other advantages
Disadvantages
Although e-prescribing eliminates certain errors, it can also reintroduce problems, such as omitted or inaccurate information leading to incorrect drug selection, wrong patient and incorrect directions.
- Clarification of inaccuracies
- A study comparing traditional prescriptions with e-prescriptions found that e-prescriptions necessitated more pharmacist interaction with the provider because of missing, inaccurate, or unclear information.
- As with traditional prescriptions, errors associated with e-prescriptions are not always detected by the pharmacist, which can result in decreased safety, as well as patient harm.
- Clarification of inaccuracies
- Software design issues
- E-prescribing software may increase the likelihood of errors due to drop-down menus, poor screen design and automatic filling functions. Also, some design features may impede efficient workflow, leading to care gaps, errors or lack of clarity.
- Software design issues
- Cost disadvantages
- There are added costs due to start-up, maintenance and transaction fees. While large chain pharmacies are able to negotiate lower transaction fees, smaller chain and independent pharmacies often pay more to utilize e-prescribing software.
- Cost disadvantages
Future of e-prescribing — and why businesses should migrate
Innovation, standards, and regulations have set the stage for widespread e-prescribing in the future. In 2018, the Centers for Medicare & Medicaid Services issued a final rule adopting the National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard v2017071 for E-Prescribing and Medication History for Medicare Part D. It contains hundreds of improvementsfor patient safety, workflow efficiency, and prescription accuracy.
The industry’s efforts to adopt this complex standard over the past several years have been impressive. While virtually all pharmacies and most electronic health records software vendors now support the new standard, there is more that can be done. Organizations still using the old standard should seriously consider completing migration.
Prioritizing migration
Reasons to prioritize migration to e-prescribing include:
- Increased information sharing: Expanding the patient instructions field from a maximum of 140 characters to a maximum of 1,000 characters allows providers to share comprehensive patient instructions and eliminate delays in pharmacies. Also, compounded medications with up to 25 different ingredients can now be sent electronically and prescribers can share patient allergies, preferred language and international addresses with the pharmacy.
- Reduce administrative burdens and increases patient safety: New standards allow the provider and pharmacy to remain better aligned to improve patient safety and reduce inefficient and time-consuming faxes and phone calls. Prescribers can also cancel a prescription electronically, while pharmacists can electronically request prescriptions for medications that they have not previously dispensed. All of these workflow improvements free up prescribers and pharmacists to spend more time with patients.
Given this, migration is essential for anyone using e-prescribing or medication history transactions. Because migration can take time, it’s important to get started now — or risk being left behind.
Typically, full migration takes about six months. The best way to ensure success is to collaborate with a healthcare technology company offering EHR connectivity that offers e-prescribing. They can provide guidance about how to migrate to the latest standard.
Significant technological advances, like e-prescribing, reflect the healthcare industry’s commitment to increasing safety, expanding interoperability and improving the quality of care. In today’s complex healthcare environment, it’s important for all stakeholders to keep pace with technological changes—or be left behind.
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