Electronic prescribing
Encyclopedia
Electronic prescribing or e-prescribing is the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patients team of healthcare providers to facilitate knowledgeable decision making .
is based on standards set forth by NCPDP
. The prescriber must have access to computer software developed for this purpose. For example, most electronic medical record
systems include e-prescribing features. Orders are usually placed in the exam room while seeing the patient.
New prescription orders are not the only type of message that can flow over the network connection. Other types of messages may include:
in health care, estimating that this leads to several thousand deaths each year. Causes of medication errors include mistakes by the pharmacist incorrectly interpreting illegible handwriting or ambiguous nomenclature, and lapses in the prescriber's knowledge of desired dosage of a drug or undesired interactions between multiple drugs. Electronic prescribing has the potential to eliminate most of these types of errors. The computer can ensure that clear and unambiguous instructions are encoded in a structured message to the pharmacist, and decision support systems can flag lethal dosages and lethal combinations of drugs.
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.
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 in preventing errors is that each prescription can be checked electronically–and quickly–at the time of prescribing.
. Standards for transmitting, recording, and describing prescriptions have been developed by the National Council for Prescription Drug Programs, in particular the SCRIPT
standard, which describes data formats. Elsewhere in the world, health care systems have been slower to adopt e-prescribing standards.
Until recently in Canada, it was the position of Health Canada that, to allow for e-prescribing ,amendments to Part C of the Food and Drugs Regulations made under the Food and Drugs Act, regulations made under the Controlled Drugs and Substances Act and possibly regulations made under Personal Information Protection and Electronic Documents Act would be required. After further review, Health Canada has concluded that there are currently no regulatory impediments to moving ahead with electronically generated and transmitted prescriptions and that these are permissible to the extent that they achieve the same objectives as written prescriptions. Provinces and territories wishing to proceed with e-Rx are obligated to ensure that electronic prescriptions meet existing regulatory requirements and achieve the same objectives as written prescriptions. For example, there must be evidence of a genuine practitioner/patient relationship, and in the case of controlled substances, pharmacists filling prescriptions must verify prescriptions are signed by the practitioner before selling or providing drugs containing controlled substances to a patient. Health Canada has collaborated with Canada Health Infoway on the development of a technical document entitled Ensuring the Authenticity of Electronic Prescriptions, in order to provide advice about how to ensure the authenticity of electronic signatures. Although this document (and annexes) was not subject to widespread consultation, it could be of use to provincial and territorial Ministries of Health in moving forward with e-prescribing.
How it works
Electronic prescribing is a form of computerized physician order entry. In the US, e-prescribing health information technologyHealth information technology
Health information technology provides the umbrella framework to describe the comprehensive management of health information across computerized systems and its secure exchange between consumers, providers, government and quality entities, and insurers...
is based on standards set forth by NCPDP
NCPDP
The Scottsdale, Arizona-based National Council for Prescription Drug Programs was founded in 1977 as the extension of a Drug Ad Hoc Committee that made recommendations for the US National Drug Code . NCPDP is a not-for-profit, ANSI-accredited, standards development organization with over 1575...
. The prescriber must have access to computer software developed for this purpose. For example, most electronic medical record
Electronic medical record
An electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...
systems include e-prescribing features. Orders are usually placed in the exam room while seeing the patient.
- The prescriber logs on to the system and authenticates their identity. This important step ensures that no one may impersonate an authorized prescriber and generate illegal prescriptions. Authentication requires two of the following.
- Presenting something you know, such as a passwordPasswordA password is a secret word or string of characters that is used for authentication, to prove identity or gain access to a resource . The password should be kept secret from those not allowed access....
- Presenting something you are, such as a fingerprint, retinal scan, or other biometric identification
- Presenting something you have, such as a magnetic card or physical security tokenSecurity tokenA security token may be a physical device that an authorized user of computer services is given to ease authentication...
- Presenting something you know, such as a password
- The prescriber looks up the patient in the system
- A drug is chosen, with parameters including strength, quantity, directions, days supply, and number of refills
- The patient's active medication list and known allergies are reviewed for potential adverse drug reactions
- The software may suggest alternative drugs that are either more effectiveEfficacyEfficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...
or less costly - Select a pharmacy that will process the order, and place the order
- The order flows over an encrypted connection to the pharmacy. The connection may be direct peer-to-peerPeer-to-peerPeer-to-peer computing or networking is a distributed application architecture that partitions tasks or workloads among peers. Peers are equally privileged, equipotent participants in the application...
, but usually it is indirectly routed over a commercial network of pharmacies such as SureScripts or eRx Network. Orders take the form of standardized electronic messagesMessage passingMessage passing in computer science is a form of communication used in parallel computing, object-oriented programming, and interprocess communication. In this model, processes or objects can send and receive messages to other processes...
that both the prescriber's system and the pharmacist's system must implement. - The order appears in the pharmacists computer system, where it may be filled.
- The patient shows up at the pharmacy to pick up and pay for their medications.
New prescription orders are not the only type of message that can flow over the network connection. Other types of messages may include:
- Notice from the pharmacist that the order has been filled or refilled
- Request from the pharmacist for additional refills, and response from the doctor either authorizing or denying the request
- Change the prescription parameters
- Cancel the prescription
- Check that the patient's insurance coverage will pay for the medications
Benefits
In 2000, the Institute of Medicine identified medication errors as the most common type of medical errorMedical error
A medical error may be defined as a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.-Definitions:As a general...
in health care, estimating that this leads to several thousand deaths each year. Causes of medication errors include mistakes by the pharmacist incorrectly interpreting illegible handwriting or ambiguous nomenclature, and lapses in the prescriber's knowledge of desired dosage of a drug or undesired interactions between multiple drugs. Electronic prescribing has the potential to eliminate most of these types of errors. The computer can ensure that clear and unambiguous instructions are encoded in a structured message to the pharmacist, and decision support systems can flag lethal dosages and lethal combinations of drugs.
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
Copayment
In the United States, the copayment or copay is a payment defined in the insurance policy and paid by the insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after...
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
Drug diversion
In the terminology of the United States Drug Enforcement Administration, diversion is the use of prescription drugs for recreational purposes. The term comes from the "diverting" of the drugs from their original purposes...
by alerting providers and pharmacists of duplicative prescriptions for controlled substances.
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 in preventing errors is that each prescription can be checked electronically–and quickly–at the time of prescribing.
Disadvantages
A new technology is not without its drawbacks. Some of the more notable issues include:- Accidental data entry errors such as selecting the wrong patient or clicking on the wrong choice in a menu of dosages. Software vendors should continually review user feedback and follow best practices in user interface designUser interface designUser interface design or user interface engineering is the design of computers, appliances, machines, mobile communication devices, software applications, and websites with the focus on the user's experience and interaction...
. - Inadvertently divulging protected health informationProtected health informationProtected health information , under the US Health Insurance Portability and Accountability Act , is any information about health status, provision of health care, or payment for health care that can be linked to a specific individual...
on the internet through inadequate security practices. Hospitals and clinics should be protected with firewalls, use strict computer permission settings, and remain vigilant toward signs of an intrusion. - Inability to use electronic prescribing when the power is out, when the exam room computer has failed, or when providing treatment outside of a standard health care setting.
- Instances of negligence where employees may forward prescriptions to organizations outside its intended use.
- Inability to effectively use clinical decision support systems due to the erroneous triggering of pop-up alerts with ill-defined software.
- The costs associated with purchasing, implementing, supporting and maintaining such a system may be beyond the means of most small clinical practices, and noted to be one of the greatest implementation barriers
- Require pharmacists to alter workflow and increase awareness of new types of errors associated with e-prescribing, in order to best target their activities to reduce clinical risk.
Government incentives
In the United States, the HITECH Act promotes adoption of this technology by defining e-prescribing as one meaningful use of an electronic medical recordElectronic medical record
An electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...
. Standards for transmitting, recording, and describing prescriptions have been developed by the National Council for Prescription Drug Programs, in particular the SCRIPT
SCRIPT (medicine)
SCRIPT is a standard promulgated by the National Council for Prescription Drug Programs for the electronically transmitted medical prescriptions in the United States.-Adoption:The first version of SCRIPT was approved in 1997...
standard, which describes data formats. Elsewhere in the world, health care systems have been slower to adopt e-prescribing standards.
Until recently in Canada, it was the position of Health Canada that, to allow for e-prescribing ,amendments to Part C of the Food and Drugs Regulations made under the Food and Drugs Act, regulations made under the Controlled Drugs and Substances Act and possibly regulations made under Personal Information Protection and Electronic Documents Act would be required. After further review, Health Canada has concluded that there are currently no regulatory impediments to moving ahead with electronically generated and transmitted prescriptions and that these are permissible to the extent that they achieve the same objectives as written prescriptions. Provinces and territories wishing to proceed with e-Rx are obligated to ensure that electronic prescriptions meet existing regulatory requirements and achieve the same objectives as written prescriptions. For example, there must be evidence of a genuine practitioner/patient relationship, and in the case of controlled substances, pharmacists filling prescriptions must verify prescriptions are signed by the practitioner before selling or providing drugs containing controlled substances to a patient. Health Canada has collaborated with Canada Health Infoway on the development of a technical document entitled Ensuring the Authenticity of Electronic Prescriptions, in order to provide advice about how to ensure the authenticity of electronic signatures. Although this document (and annexes) was not subject to widespread consultation, it could be of use to provincial and territorial Ministries of Health in moving forward with e-prescribing.
See also
- Clinicians Guide to e-Prescribing
- Electronic Prescriptions for Controlled SubstancesElectronic Prescriptions for Controlled SubstancesElectronic Prescriptions for Controlled Substances was originally a proposal for the DEA to revise its regulations to provide practitioners with the option of writing electronic prescriptions for controlled substances. These regulations would also permit pharmacies to receive, dispense, and archive...