Electronic Prescribing

A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist. Commonly, the term prescription is used to mean an order to take certain medications. Prescriptions have legal implications, as they may indicate that the prescriber takes responsibility for the clinical care of the patient and in particular for monitoring efficacy and safety.

As a prescription is nothing more than information among a prescriber, pharmacist and patient, information technology can be applied to it. Existing information technology is adequate to print out prescriptions. Medical information systems in some hospitals do away with prescriptions within the hospital. There are proposals to securely transmit the prescription from the prescriber to the pharmacist using smartcard or the internet. Within computerized pharmacies, the information on paper prescriptions is recorded into a database. Afterward, the paper prescription is archived for storage and legal reasons.

This systems appropriate with ARRA HITECH. On February 17, 2009, President Obama signed ARRA (The American Recovery and Reinvestment Act) into law. The Health Information Technology for Economic and Clinical Health Act (HITECH), represents an investment of more than $19 billion towards healthcare IT related initiatives, and is a focal point of ARRA. HITECH calls for the Office of the National Coordinator for Health Information Technology (ONCHIT) to develop methods and systems that will determine how providers will access HITECH benefits, and to work with other government agencies to develop criteria to be used to define an EHR (Electronic Health Record).

HITECH mandates that such standards will be final no later than December 31, 2009. The standards will provide guidelines EHR companies must meet in order for their product to be considered an “approved” EHR. And it is better if this EHR has CCHIT certification. The Certification Commission for Healthcare Information Technology or CCHIT is an independent, voluntary, private-sector initiative whose mission is to accelerate the adoption of health information technology by creating an efficient, credible and sustainable certification program. They are currently the only recognized certification body for electronic health records and have established a testing program for determining which EHRs meet their certification standards.

Pharmacy information systems are a potential source of valuable information for pharmaceutical companies as it contains information about the prescriber's prescribing habits. Prescription data mining of such data is a developing, specialized field.

Many prescribers lack the digitized information systems that reduce prescribing errors. To reduce these errors, some investigators have developed modified prescription forms that prompt the prescriber to provide all the desired elements of a good prescription. The modified forms also contain pre-defined choices such as common quantities, units and frequencies that the prescriber may circle rather than write out. Such forms are thought to reduce errors, especially omission and handwriting errors and are actively under evaluation.

Electronic prescribing is the electronic transmission of prescription information from the prescriber's computer to the pharmacist's computer. Voicemail is not electronic prescribing. Sending a facsimile is not electronic prescribing.

E prescribing software can make getting patients the medications they need a safer and more efficient process. Prescribers have access to time-saving tools and features during the process of writing the prescription that provide alerts for drug interactions, duplicate therapies, and allergy warnings. E prescribing software is designed to replace other approaches to prescribing - e.g. handwritten prescriptions, computer-printed prescriptions and computer-faxed prescriptions that can be considered outdated or error-prone. The durability and accessibility of the patient's medication profile is another significant safety benefit. Healthcare often consists of multiple caregivers that each share and coordinate the medical treatment given to the patient. Electronic prescribing software helps to centralize critical information and make it available to the decision-makers in the patient's care.

While safety benefits are significant, they are not realized immediately with each deployment of the technology. Prescribers must overcome the learning curve and reshape their office workflows around the prescriptive process. Office staff must become familiar with new ways of communication - and sometimes roles change. Pharmacies have multiple systems in place that have to manage the new electronic communication. Breakdowns in any of these areas can lead to errors.

By exchanging prescription information electronically, e-prescribing software can help reduce the risk of medication errors associated with poor handwriting, illegible faxes and additional key strokes. Complex, hard-to-use software and insufficient attention to the deployment process mitigate these benefits.

E-prescribing also has the potential to improve beneficiary health outcomes. For providers who choose to invest in e-prescribing technology, the adoption could improve quality and efficiency and could show promise in reducing costs by actively promoting appropriate drug usage; providing information to providers and dispensers about formulary-based drug coverage, including formulary alternatives and co-pay information; and speeding up the process of renewing medications. E-prescribing also may play a significant role in efforts to reduce the incidence of drug diversion by alerting providers and pharmacists of duplicative prescriptions for controlled substances.

E-prescribing has the potential to empower both prescribers and pharmacists to deliver higher quality care and improve workflow efficiencies. Prescribers give a handwritten prescription to the patient or fax it to a pharmacy or other dispenser. Pharmacists can have a difficult time reading handwritten prescriptions and may have little or no information about the patient’s condition for which the prescription is written. According to some estimates, almost 30 percent of prescriptions require pharmacy callbacks. This translates into less time available to the pharmacist for other important functions, such as educating consumers about their medications. A potential benefit of e prescribing software in preventing errors is that each prescription can be checked electronically–and quickly–at the time of prescribing.