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Switching to Electronic Prescribing (e-Rx)

Electronic prescribing or e-prescribing (e-Rx) is not an entirely new concept in the healthcare industry.  It focuses on computer-based electronic generation, transmission and filling of a prescription, taking the place of paper and faxed prescriptions.  It allows a physician, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy.

In a nutshell, E-prescribing outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy.  It is meant to reduce the many risks associated with the traditional prescription script writing and it is also one of the major reasons for the push for electronic medical records in the healthcare industry. 

Compared to paper-based prescribing, electronic prescribing can enhance patient safety and medication compliance, improve prescribing accuracy and efficiency, and reduce health care costs through averted adverse drug events and substitution of less expensive drug alternatives. This is of key importance because in 2000, the Institute of Medicine identified medication errors as the most common type of medical error in the health care industry, estimating that this leads to several thousand deaths each year.  E-prescribing also has the potential to improve beneficiary health outcomes. For providers who choose to invest in electronic-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, and speeding up the process of renewing medications. E-prescribing also plays a significant role in efforts to reduce the incidence of drug diversion by alerting providers and pharmacists of duplicative prescriptions for controlled substances.

In a recent article in the New York Times, a study found that 1 in 7 hospitalized patients suffer some form of error in care.  Nearly 1/3 of those mistakes are related to drugs – which can lead to longer hospital stays, unnecessary suffering, permanent damage, or in the worst case death.  The adoption of electronic prescribing can drop error rates in prescriptions by 60%.  That’s the percentage produced by PLoS Medicine, who tracked medication errors in two Australian hospitals before and after installing e-prescription systems. 

“People can actually read the prescribing orders now,” Johanna Westrbook, the director of the Centre for Health Systems and Safety Research at the University or New South Wales said.  “You’re not relying on trying to interpret handwriting.” 

Incomplete and unclear prescriptions, which added up to the hundreds during the months before the e-prescribing systems were installed, dropped to single digits in both hospitals.  But not only does e-prescribing eliminate poor penmanship; There is a high possibility that a doctor might get the dose wrong, or choose a drug that interacts harmfully with another medicine.  The computerized system partnered with e-prescribing software includes data about each patient and a set of rules for proper dosing, allergies, and drug interactions.

Leapfrog requires hospitals to test their systems to see if the pre-programmed rules actually catch harmful mistakes.  They unknowingly feed in fake patients and fake prescription orders – some of which contain fatal errors.  Across the board, about 1/3 of the errors slipped through. 

The adoption of e-prescribing and electronic medical records means more accurate, error free medical care.  There are many options when it comes to adopting a new system; there are stand alone e-prescription software as well as a full EMR which includes the e-prescribing functionality.  More than four out of five e-prescriptions are done through software as part of an EMR, 83 percent compared to 17 percent done using stand-alone systems. 

Next doctor visit, make sure you find out if your script is part of the electronic prescription process.  It could be a matter of life or death.