pranab's blog

Electronic prescribing or “e-prescribing” is simply an electronic way to generate prescriptions through an automated data-entry process utilizing e-prescribing software and a transmission network which links to participating pharmacies. A more formal definition could be E-prescribing means the transmission, using electronic media, of prescription or prescription-related information between a prescriber, dispenser, pharmacy benefit manager, or health plan, either directly or through an intermediary, including an e-prescribing network. E-prescribing includes, but is not limited to, two-way transmissions between the point of care and the dispenser. It is estimated that approximately 7,000 deaths occur each year in the United States due to medication errors. These errors are predominately due to hand-writing illegibility, wrong dosing, missed drug-drug or drug-allergy reactions. With approximately 3 billion prescriptions written annually, which constitutes one of the largest paper-based processes in the United States, the writing of prescriptions can be streamlined and made efficient by using an e-prescribing system. Also, e-prescribing could be the solution to improve patient safety and reduce medication costs due to better formulary compliance also improving utilization of generics. The benefits of ePrescribing are spread across all participants in the healthcare system, including physicians, office staff, patients, pharmacies, and health plans service providers. Providers benefit from ePrescribing by:

• Obtaining real-time information about potential drug-drug and drug-allergy interactions. This minimizes calls from pharmacies and reduces potential adverse drug events.
• Reducing handwriting interpretation errors, estimated to cause 9% of all medication errors.
• Seeing plan formulary requirements (prior authorization, quantity restrictions, non-covered drug, and drug tier) at the point of care, giving the patient faster access to cost-effective care.
• Seeing a patient’s dispensed drug history, thereby enabling the prescriber to make clinically appropriate decisions at the point of care.
• Knowing when an FDA Safety Alert has been issued, and allowing them to generate a report of all patients on the drug without needing to pull patient charts.
• Increasing the convenience and efficiency of the prescription-writing process.

Office staff benefit from ePrescribing by:

• Reducing calls from pharmacies regarding non-covered medications and handwriting questions.
• Speeding the prescription renewal process by reducing the need to pull patient charts. Case studies suggest a savings of 1-2 hours/day for office staff.
• Eliminating calls from patients who are requesting an alternative covered medication or need the prescriber to request prior authorization.

Patients benefit by:

• Having lower out-of-pocket costs when prescribers respond to ePrescribing formulary messages
• Saving time at the pharmacy by having prescriptions sent prior to patient arrival, and reducing the potential for two trips because prescribers more frequently adhere to health plan requirements.
• Reducing potential for adverse drug events caused by drug-drug or drug-allergy interactions, mistaken handwriting, or incorrect dosage.
• Increasing compliance with prescribed treatment because care is cost-effective and convenient.

Pharmacies benefit by:

• Reducing phone calls to physicians regarding handwriting interpretation, non-covered drugs, and prior authorization requirements.
• Improving customer relationships by speeding the time it takes patients to obtain prescriptions.
• Reducing data entry when prescriptions are received electronically.
• Reducing potential errors caused by handwriting misinterpretation and keystroke errors.

Payers/Employers benefit by:

• Maintaining affordability by increasing utilization of generic and preferred brand drugs.
• Reducing costs associated with adverse drug events.
• Increasing patient compliance with prescribed treatment plan.
• Increasing provider efficiency by allowing providers to spend more time on patient care.

A “qualified” e-prescribing system must be capable of performing all of the following functions:

• Generating a complete active medication list incorporating electronic data received from applicable pharmacy drug plan(s) if available
• Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks (safety checks include: automated prompts that offer information on the drug being prescribed, potential inappropriate dose or route of administration, drug-drug interactions, allergy concerns, or warnings or cautions)
• Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any)
• Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan

To get started with e-prescribing, please take the following steps:

1. Decide whether you wish to choose a stand-alone e-prescription software or a full EHR or EMR system which includes e-prescribing functionality.
2. Choose an e-prescribing software vendor. The e-prescribing vendor will need to utilize a company which supplies the electronic prescribing network (hub or gateway for transmissions). There are a few different e-prescription networking companies. Among the industry leaders are SureScripts (http://surescripts.com/), RxHub (http://www.rxhub.net/index.html), and ProxyMed (http://www.proxymed.com/). It is unlikely that physicians would have any reason to have direct contact with the electronic networking vendor. SureScripts, the nation’s largest electronic prescribing network, provides a true, seamless electronic connection between physician offices and pharmacies. This network provides secure and reliable two-way transmissions between physicians and pharmacies. More than 85% of chain and independent pharmacies have tested and certified their systems to connect to the SureScript electronic prescribing network.
3. Install an internet connection; high speed is highly recommended.
4. Purchase hardware such as desktop PC’s, laptops, pocket PC’s, tablet PC’s , PDA’s utilizing a wired or wireless network.

Although there are a few barriers like cost, Prohibition on use of e-prescribing for controlled substances and Technical limitations, the benefits substantially out number them making e-Prescription highly recommendable.

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