Sunday, September 12, 2010

E-Prescribing Issues

As reported in the Creighton University’s Center for Health Services Research and Patient Safety newsletter, e-prescribing affects pharmacists and the pharmacy setting . The article explains that while financial and organizational incentives have been developed to support physicians’ office settings and hospitals, pharmacies face a financial disincentive.

The authors Kim Galt Pharm.D., PhD, Associate Dean for Research in the School of Pharmacy and Health Professions, and Director of CHRP along with Mark Siracuse Pharm.D , Ph.D, Associate Professor in the School of Pharmacy and Health Professions, wrote the article to specifically explain the problems from the viewpoint of the pharmacist.

To begin with, every e-prescription has a transaction fee incurred to the pharmacist. These fees typically range from $.25 to $.35 and can even go as high as $.75 per prescription depending upon the contract that the pharmacist has with the transaction company.

In addition, pharmacists must also invest in compatible pharmacy system software to receive and accurately display the electronic prescription in the pharmacy. There are no federal or state incentives or private payer incentives to assist pharmacists with the financial burden.

Today, pharmacists report on continuing problems that they have while adapting to e-prescribing. While pharmacists agree that e-prescribing has many benefits such as the reduction of errors, there are still pharmacies that are not yet equipped to receive either email or direct exchange from the prescribers.

The authors reported that their research found that there are still many errors that occur with e-prescribing in the current stage of development. Some of these errors occur at the time of prescribing with the selection of the wrong drug, dose, instruction, or even prescribing the medication for the wrong patient.

These errors were often attributed to the wrong drop down menu selection in the software system. Also there may be incompatibilities between the physician’s software application and the pharmacist’s software application in drug product identification reports concerning errors.

The authors see the adoption of e-prescribing by pharmacies to be a gradual process. However, they conclude that this process is not likely to keep pace with the federal agenda timeline since there is a lack of a viable fiscal policy related to e-prescribing for pharmacists.

According to Dr. Siracuse, there are also other interrelated barriers that need to be dealt with such as the EHR status in the physician’s office and related workflow issues, cost issues, and for physicians and some pharmacies, regulatory and standards issues.

However, other studies have been conducted on e-prescribing concerning issues on the topic. AHRQ has conducted several studies on e-prescribing that looked at the time element when using e-prescribing concerns doctors and pharmacies. An article appearing in AHRQ’s September 2010 issue of “Research Activities”, discusses how a study also partly funded by AHRQ, shows that although it has been shown that e-prescribing improves safety, it also means that there is a small increase in physician prescribing time.

According to the researchers, this means that a provider seeing 20 patients per day spent 6 minutes longer if all prescriptions were e-prescribed than if handwritten, an increase of 20 seconds per patient. The study funded in part by AHRQ was conducted at a multispecialty health system with 16 ambulatory care sites in Washington State.

However, another study funded in part by AHRQ, concentrated medication errors while using e-prescribing. The researchers found that physicians who switched from paper prescribing to e-prescribing reduced their error rate nearly sevenfold, from 42.5 to 6.6 per 100 prescriptions by the end of one year.

This study concluded that the use of e-prescribing eliminated all illegibility errors among adopters, going from 87.6 legibility errors per 100 prescriptions at baseline to none at one year. This study was conducted with 12 adult primary care practices located in a predominantly rural and suburban region of upstate New York. More details on the study are presented in the June 2010 “Journal of General Internal Medicine”.