- 1 Introduction
- 2 Growth of electronic prescribing
- 3 Why ePrescribing?
- 4 Improving Ambulatory Office Workflow, Efficiency and Reducing Prescribing Error Through the Use of E-Prescribing CPOE
- 5 Introduction
- 6 Workflow
- 7 Business models
- 8 E-prescribing of Controlled Substance (EPCS)
- 9 Reviews for E-prescribing
- 10 References
- 11 References
- 12 References
Electronic prescribing systems, which allow a physician or other healthcare professional who is licensed to prescribe medications, to create digital prescriptions, have made significant changes in the way most prescriptions are written in the U.S. Electronic prescribing (ePrescribing) has shown benefits for providers and patients, and is predicted to show more benefits as more sophisticated clinical decision support systems are linked to ePrescribing. Clinical decision support systems, when used alongside ePrescribing, enhance patient safety by reducing prescribing errors. While improving patient safety is a crucial healthcare goal in itself, reducing prescribing errors will also decrease healthcare costs. EPrescribing improves convenience for patients when they elect to have a digital prescription sent electronically to their pharmacy of choice. Healthcare providers benefit by having a decrease in the number of phone calls from pharmacies requesting clarification, and may be able to save time by creating a list of "favorite" prescriptions that they write frequently.
No more illegible prescriptions
Electronic prescribing or e-prescribing improves patients safety and satisfaction by providing legible prescriptions. Many medication errors are a result of illegible handwriting, unclear abbreviations and unclear or ambiguous orders (eHealth Initiative, 2008). This results in decreased call backs to provider offices for clarification and faster prescription fulfillment. One study estimates that pharmacists make 150 million calls a year to physicians to clarify prescriptions (Kilbridge, 2001). Electronic prescribing can also help reduce medication spending by providing information on generic or other low-cost alternatives (Steinbrook, 2008).
Growth of electronic prescribing
Electronic prescribing adoption has had a slow but steady growth. An alternative, drchrono's free Electronic prescribing has allowed doctors to signup for a free way to write scripts using iPad and iPhone. In March 2008, about 40,000 physicians in the U.S. were writing e-prescriptions and nearly 73% of retail pharmacies were receiving them (Steinbrook, 2008).
In the United States, 3.5 billion prescriptions were filled in 2007 (Steinbrook, 2008). Medication prescriptions accounts for 13% of health care expenditures annually in the U.S. (Eslami et al., 2007). The Institute of Medicine announced in July 2006 their recommendation that all prescriptions be written electronically by 2010 (eHealth Initiative 2008). Medicare also announced that all Medicare Part D prescriptions must be transmitted electronically by January 1, 2009 (Surescripts, n.d.). The prescription is then sent to the pharmacy over a secure network (Lapane et al., 2008). Prescriptions that have been created through an EHR then printed or faxed are not considered e-prescriptions (Steinbrook, 2008). This technology has the potential to reduce preventable ADEs by alerting providers to drug interactions and drug allergies (Lapane et al., 2008).
In 2007, approximately 35 million prescriptions were transmitted electronically through the Pharmacy Health Information Exchange operated by Surescripts(Surescripts 2007). The eRX Collaborative, another e-prescribing program, reported 5 million prescriptions transmitted in 2007. They also reported that approximately 104,000 e-prescriptions (2.1%) were changed or cancelled as a result of a safety alert by the system (eHealth Initiative, 2008).
The eHealth Initiative and the Center for Improving Medication Management documented the phases and functions of e-prescribing to demonstrate its benefits and key features. Some of the benefits are the ability to access medication history and receive notifications when a medication has been picked up or left unfilled. Another benefit is providers can receive drug safety alerts when prescribing medications. However, a study in 2008 concluded that providers override the drug dose alerts and drug-drug alerts most of the time. Approximately 1 in 4 providers override drug dose alerts most of the time or always and 40% override drug-drug interactions most of the time or always. When asked about drug-allergy alerts, they were least likely to override the alert stating that the alerts are helpful, useful and a good reminder. Providers noted that drug-drug alerts are beneficial but, at times, unnecessarily excessive or trivial (Lapane et al., 2008).
In a report of eHealth initiative it was estimated that ePrescribing could save up to $29 bn for the US healthcare systems, $27 bn can be saved directly by sending the prescription electronically to the pharmacy, detecting medication duplication in prescription when different doctors prescribe the same medication and alerting prescribers to a cheaper generic alternatives, The other $2 bn may be saved indirectly through decreasing prescription error and subsequently additional intervention and visits cost.
ePrescribing when combined with clinical decision support systems at point of care can improve the safety of prescription as demonstrated in many studies, one of these studies was a randomize controlled trial (RCT) intended to evaluate the use of handheld systems with a clinical decision support to improve the safety of Non steroidal anti-inflammatory agents prescriptions  and concluded that the use of such systems led to a fewer unsafe treatments.
As many of the medical errors are medication errors, ePrescribing can help in reduction of these errors by appropriately offering timely decision support capabilities, proactively detect errors such as drug-drug interactions and drugs that is known to stimulate hypersensitivity reactions for an individual by making use of her/his electronic health record, Also the use of automated prescribing mechanism will lead to preventing the use of unacceptable abbreviations as a potential source of medication errors.
More above avoiding errors is Rational prescribing and the, Rational prescribing is the alignment of prescribing practice and evidences, and a study here shows how an electronic intervention (as one of many other interventions) improved he quality of prescription (of antihypertensive medications).
Another potential benefit of ePrescribing is to do some tasks for physicians, one of the most prominent task is dose calculation specially for children and some drugs where the dose is weight dependent, previously these calculations were done manually and were liable to human error, the study here shows the great benefit of using ePrescribing in ambulatory settings to calculate pediatric dose .
Away from benefits behind incorporating clinical decision support; the electronic transfer of the prescription from clinical setting like offices of general practioners directly to community pharmacies, and the idea here finds a great acceptance from the three major stakeholders involved in prescribing process, the physician, the pharmacist and the patient . Our ultimate objective is to produce a prescription with a high quality, however quality of prescription is not correlated to increased expenditure on pharmaceuticals; certainly it will be a cumulative result of safe and rational prescribing.
Improving Ambulatory Office Workflow, Efficiency and Reducing Prescribing Error Through the Use of E-Prescribing CPOE
“The current system of prescribing and dispensing medications in the United States has widespread problems with safety and efficiency”.3 Yet drug therapy is an integral component of many ambulatory treatment regimens recommended for chronic and acute medical conditions. Americans made 906.5 million outpatient visits in 20001 and half of the US population takes one prescription daily, with one in six taking three or more a day.2 This includes 3.27 billion prescriptions and more than 10% of the national health spending.2 In the Crossing the Quality Chasm article, The Institute of Medicine challenged us to create a new system that is safe, effective, patient-centered, timely, efficient and equitable. Our current ambulatory prescribing and dispensing systems do not meet those criteria. There appears to be one glaring weak link; inadequate implementation of ambulatory computerized patient ordering entry (ACPOE) systems for medications. i.e. electronic prescribing (eRx).
To the patient the prescriptive process seems quite simple. They are given a written prescription, take it to the pharmacy (or mail it in), pay the allotted amount due, receive and consume the medications. In all reality there is a complex and convoluted system that manages the drug industry’s transactions including the retail or mail order pharmacy, pharmacy benefit manager, payer, manufacture, wholesaler as well as technology venders for transaction networks, clinical information databases and software. This is further complicated by a serpentine economic trail of rebates and incentives. From the point a person turns in their prescription to when they pick it up, the processes are all electronic and have proven effective managing 3.27 billion prescriptions a year! Yet this process currently starts with a paper prescription process greater than 85% of the time.1 This is the “weak link” where the majority of ambulatory medication errors occur. Converting the prescribing process from paper to an electronic process is often referred to as the “final mile” for ambulatory electronic medication management.2.
Because of the immense potential seen for ePrescibing to reduce errors and cost, Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 was passed requiring the ePrescribing process adhere to specific standards.3,4 Subsequently President Bush has called for linking reimbursement rendered for medical services covered by government sponsored plans to ePrescribing. A 2007 report issued by the Health and Human Services suggested that “electronic prescribing is still in its infancy” however the findings are encouraging. Although there is still work to be done implementing the remaining standards, the report encourages “interested stakeholders to fully adopt and implement electronic prescribing in order to reap its many potential benefits”.3
Errors in the medication process include prescribing, transcribing, dispensing, consuming and monitoring. Estimates suggest there are 8.8 million ambulatory adverse drug events (ADE) a year, of which 2.1 million are preventable and 130,000 are life threatening.3 Preventable prescribing and transcribing errors include illegible written prescriptions, incorrect dosing, drug/allergy, drug/drug and drug/condition errors. Estimates vary on just how many of these ADE would be averted depending significantly on the software functionalities and human factors.1
Unfortunately making a business case for implementation of health information technology in an independent primary care office has been difficult. The vast majority of the savings from ePrescribe go to the purchasers and payers of health services, not the physician.1,3 Physicians will, however, migrate to eRx when they perceive the benefit to their practice outweigh the costs. The primary physician office benefits and costs are in the financial, productivity, service and hassle areas. It is anticipated that as eRx systems are able to meet these needs, adoption will increase.
- Aim: Our mission is to improve the office workflow efficiency and safety within the ambulatory prescription process of a primary care office within six months.
- Reduce total telephone calls by 25%
- Reduce drug/allergy prescribing errors to zero
- Increase patient satisfaction to medication refill times by 50%
- Develop and implement a staff satisfaction survey tool
These address the efficiency, safety, and patient-centered goals of the IOM quality improvement initiative.
Processes and Prioritization
- Process affected: Office workflow and efficiency
- Measure: Phone calls
- Process affected: Prescriptive safety
- Measure: Cancelled prescriptions
- Process affected: Patient satisfaction
- Measure: Patient satisfaction to medication refill times
- Plan: Get baseline measure of phone calls, plot flow diagram of current workflow process and idealized workflow for patient refills
- Do: Reengineer office workflow so that prescription refills initate at the pharmacy
- Study: Measure phone calls after reengineering and plot phone calls before and after reengineering on p chart.
- Act: Institute reengineered workflow and initiate e-prescribing
- PDSA 2 - Reiterate above, but in addition, measure cancelled rx thru e-prescriptive process
- PDSA 3 - Reiterate, and institute patient satisfaction tool
Electronic Prescribing and Medication Adherence and Compliance:
Electronic Prescribing (e-prescribing) is the use of health information technology to transmit prescriptions. It is a common component of electronic medical records and has been recognized as an effective tool in reducing medication errors and improving the quality of patient care. As cited in other articles, the benefits of e-prescribing include the following:(1)
1.) Elimination of handwritten prescriptions, decreasing medication errors 2.) Reduces communication time between the health care provider and the pharmacy 3.) E-prescribing tools frequently offer real time access to drug formularies, current prescriptions, and allergy information for the patient 4.) Medication errors can be further decreased through the use of drop down menus 5.) Generic and preferred brand medications can be easily offered as alternatives, decreasing health care costs
While e-prescribing is projected to be an important tool in improving health care quality, its effect on medication adherence has only recently been studied. One of the potential benefits of e-prescribing is that it allows for the selection of medications that are best suited for the patient’s health condition, payment method and streamlines the prescription process, allowing for quicker delivery of the prescription to the pharmacy of choice. Because e-prescribing offers these components, it is reasonable to surmise that medication adherence and compliance may increase with e-prescriptions. The reviews below summarize some of the evidence to date regarding electronic prescribing and medication adherence and compliance.
∙ The rate of primary medication adherence (the rate of filling a new prescription) was analyzed using e-prescribing transactions, pharmacy claims, and provider characteristic files drawn form the eRx Collaborative database in Massachusetts.(2) A total of 195,930 e-prescriptions were written for 75,589 patients during the study period (1 year). The overall primary medication adherence rate was reported as 77.5%, amounting to 151,837 prescriptions filled. There was no control group in this study to compare primary medication adherence rates given that this was not the focus of the study.
∙ Another survey study conducted amongst private practices in New York examined primary medication compliance and the perceptions of the participating providers. The study reports that the primary noncompliance rate was 15%.(3)
∙ Two cohort studies were performed at an integrated health network in Pennsylvania to study primary medication adherence rates of hypertension and diabetes. Primary medication adherence for hypertension were reported as 83% while diabetic e-prescriptions reported an 85% rate of medication adherence.(4,5)
The results of the above studies are show that medication adherence continues to be a problem in electronic prescribing systems. Further investigation is needed to determine chronic medication adherence and compliance rates and other factors that may be affecting medication filling rates. In fact, results from European studies report much lower rates of noncompliance and nonadherence, ranging from 2-6%(6,7). This suggests that other factors such as socioeconomic concerns may be affecting medication fill rates despite the increased efficiency and quality of the electronic prescribing system.
Medical errors are one of the leading causes of death in the United States today. A study in 1997 by the Institute of Medicine shows that at least 44,000 Americans die each year as a result of medical errors and the number may be as high as 98,000 . The problem of reducing medical errors is multi-faceted and there is no single answer that will solve this problem. Instead, this large and complex problem requires thoughtful integration of different solutions. Electronic prescription is one step in that direction. Electronic prescription is the transmission of prescriptions electronically from the physician to the patient or pharmacy.
Levels of electronic prescribing: There are different levels at which an electronic prescription system can be implemented. The higher the level of sophistication, the greater the potential benefits as there is more linkage of relevant patient-specific information. However, the cost of implementation also increases with the level. Each successive level typically contains all of the functions in the levels below it.
- Level 1: This is an elementary system consisting of an electronic reference handbook containing drug information, dosing calculators and formulary information. The information is available only if the physician explicitly looks for it.
- Level 2: Provides generally used dosage guidelines in electronic form.
- Level 3: Patient unique data such as their allergy and formulary information can be stored. This allows the prescriber to have this important information at her fingertips. It also allows for basic clinical decision support (CDS) such as drug-allergy checking, provided that the software supports it.
- Level 4: Medication history for the patient is maintained. This provides the data for drug-drug interaction checking, again provided that the software supports this more complex level of clinical decision support. It also provides reminders for medication renewal.
- Level 5: Electronic linkage between the prescriber's office, a hospital, or other place of patient care and at least one pharmacy (in practice, a large network of pharmacies). Prescriber can transmit the prescription in a digital form that is suitable for consumption by the system at the pharmacy chosen by the patient.
- Level 6: Integrated into an electronic medical record (EMR). If the patient's problem list (a list of diseases and medical problems) and laboratory results are available as structured data in the EMR this allows the possibility of more complex CDS including drug-disease and drug-lab interactions.
The majority of electronic prescriptions are generated within an electronic health record and transmitted over the internet using a secure protocols which are specialized for prescribing. Typically a pharmacy will have a software application which is able to receive the information and integrate it into the pharmacy's system. In a typical electronic prescription system, the physician office and the pharmacies enrolled are connected by a special network such as a health information network. The physician makes a diagnosis and enters the medication data into the electronic prescription systems. A criteria check, such as the formulary compliance and drug to drug interaction, is performed before the prescription gets to the pharmacist. The pharmacy receives this prescription either by fax or through a software application. The pharmacist then conducts a claims check of subscriber eligibility and determines whether the drug is on the formulary and how much it costs.
Studies suggest that by using electronic prescription national savings could be as high as $27 billion3, mainly due to ADE prevention and better utilization of drugs, guided by the system . Some of the key benefits of electronic prescription:
- Sending prescriptions electronically eliminates the problems associated with illegible handwriting. This leads to reduction in medical errors as well as number of phone calls between the pharmacy and physician.
- Avoiding ADE: Prescription systems can check for internal inconsistencies such as excessive dosage or for conflicts with the patient’s known allergies. They can also prevent drug to drug interaction.
- Automatic Refill: Since the prescription is already present in the system, the doctor has to go online and approve the refill.
Business Models of electronic prescription: Electronic prescription can be implemented using two different business models, namely transaction fee-based and sponsorship-based model.
- Transaction fee-based: A fee is charged for each transaction. So higher the volume of transaction, higher the revenue generated.
- Sponsorship–based: In this model a pharmaceutical company might pay for the majority of the costs for system purchase and the physician pays a nominal monthly fee for using the system.
Standards: Currently there are two messaging standards in the United States that support ePrescribing functions:
- NCPDP SCRIPT Standard: SCRIPT is a standard created to facilitate the electronic transfer of prescription data between pharmacies and prescribers in real time. A pharmacy or a clinic can initiate communication. Pharmacy Initiated Messages can be refill requests, renewal authorizations, change requests, filled notifications or responses to cancel the request. Physician Initiated Messages can be new prescriptions, responses to a refill request, response to a change request, cancellation request messages. A prescription sent using the SCRIPT standard consists of header, physician, patient, drug and trailer data segments. 
- HL7 version 3 Standard: Health Level Seven (HL7) is commonly used to communicate medication orders within a hospital and with clinical pharmacies within an enterprise. 
Electronic prescription has come a long way since 1998 when Drs. Schiff and Rucker wrote in the American Medical News: "Physicians should never again write a prescription. Given the explosion of scientific information and advances in computer technology, prescribing medications on a blank piece of paper will soon seem as antiquated as ordering tinctures of botanicals in Latin." 7 Electronic prescription will become /has become a required standard for transmitting prescriptions.
E-prescribing of Controlled Substance (EPCS)
In 2011, the Executive Office of the President declared current prescription drug misuse and abuse as an epidemic constituting a major public health and public safety crisis (Office of National Drug Control Policy, 2011). The non-medical use of prescription drugs is increasing as shown by the National Vital Statistics Report, Vol 59, No 4, published on March 16, 2011, which indicated that drug-induced deaths now exceed motor vehicle accident deaths in the United States (DEA’s Office of Diversion Control, 2011). Additionally, about half of the emergency department visits in 2009 were related to abuse or misuse of pharmaceuticals involving painkillers, and over one-third of these visits involved drugs to treat insomnia and anxiety.
E-prescribing of controlled substance (EPCS) is now allowed by federal law. Historically, the law required that prescribing of controlled substances must be issued in writing, which meant that prescriptions for controlled substances must be paper prescriptions. The DEA has been moving at a slow pace towards e-prescribing for controlled substances because they have a much higher risk of diversion and thus require strict safeguards to prevent misuse and abuse compared to non-controlled substances. Because of the availability of advanced technology and electronic applications’ security capabilities, and with the goal of promoting accuracy and efficiency, the DEA amended its regulations to allow practitioners to issue electronic prescriptions for controlled substances. The DEA’s Interim Final Rule for EPCS became effective on June 1, 2010. The details of this rule will be described in the next section below.
Challenges for Implementing EPCS
The essence of the Interim Final Rule is that Schedule II prescriptions can now be issued and processed electronically, in addition to the traditionally-required paper format. Schedules III, IV, and V can still be communicated by phone, by fax, or in written form (DEA’s Office of Diversion Control, 2010). Due to the increase in internet security breaches in general, there was a growing concern about EPCS. Therefore, there are many DEA requirements under this new rule. Below are the highlights of the DEA requirements summarized from the article “Electronic Controlled Substances Prescriptions” on the US Pharmacist website (Vivian, 2010):
- Technology: The hardware and software used by pharmacy must meet the minimum security measures. This means that it must be able to import, display, and store the required contents of a controlled substance prescription accurately and consistently.
- Assurances: The pharmacy must be certified either by a third party audit or a DEA-approved certification organization to ensure the compliances to the DEA requirements, and to report any limitations on its use for controlled substance prescriptions (DEA’s Office of Diversion Control, 2011).
- Preliminary Reports: In order to use an application for EPCS, the pharmacy must have a written copy of the application provider’s approval of compliance with the DEA regulations.
- Limited Access: There must be an access control in place to limit the access to the technology that a pharmacy uses to record the receipt, processing, and dispensing of information for electronically prescribed controlled substances medication orders.
- Intermediaries: An electronic prescription must be transmitted electronically from the prescriber to the pharmacy through an intermediary, which is any technology system vendor that receives and transmits an electronic prescription between the practitioner and the pharmacy.
- Transmission: The contents of a prescription must not be altered during transmission. This only applies to intermediaries and not the changes made to the prescription after it is received by pharmacy.
- Changes after receipt of an electronic prescription: There are conflicting instructions from the DEA regarding whether and how the changes can be made to the prescription after it has been received. This has caused a lot of confusion and the DEA has acknowledged the issue and will resolve it in the future.
- Identity Proofing Prescribers: Prescribers must undergo an identity proofing procedure to obtain their two-factor authentication credential or digital certificate.
- Two-Factor Credentialing: To log on to the e-prescribing application, prescribers must use two-factor authentication, which could be any two of something like a password, a token, or biometric identification.
- Simultaneous Electronic and Hard Copy Prescription: In the case that a pharmacy receives both electronic and paper prescription, or when the e-prescription is transmitted to one pharmacy and the patient presents a paper prescription at another pharmacy, one must be voided.
- Records: All records of the e-prescription must be maintained electronically.
- Security Failures: An internal audit report of potential security incidents of the pharmacy system is required to be generated daily.
Aside from the challenge of meeting all of the stringent requirements established by DEA above, there was another concern from prescribers. A survey conducted at a regional health system reported that more than one-third of the respondents indicated that it would be too burdensome to carry a security authentication token at all times, and that it would discourage the adoption of EPCS. However, other than carrying a token, most prescribers thought of e-prescribing measures as a small inconvenience, and that the advantages still outweighed the burden (Thomas, 2011).
In summary, it remains to be seen how well the prescribing community will respond to the new rule. The process described by the rule is very complex and it requires implementation efforts of all stakeholders to ensure a robust and efficient EPCS process.
Current Status of EPCS
The DEA effectively addressed the diversion issue of controlled substances and the persecution of violators with the Interim Final Rule, while also being more responsive to the burden of providers and pharmacies and workflow issues. Providers who are already using e-prescribing can streamline their practices by following the same e-prescribing workflow for controlled substances as well (American College of Rheumatology, 2012).
As of December 2011, there are no software systems ready and certified yet 1. The Interim Final Rule introduces new challenges, and it will take some time for software developers to implement two-factor authentication in their applications, to update their systems and intermediary network to allow prescribers to transmit and process the prescriptions, and for pharmacy systems to receive them. Pharmacy systems need to be certified by a DEA-approved entity, and prescribers need to complete the identity proofing process and use two-factor authentication every time they create a prescription for controlled substances electronically (American College of Rheumatology, n.d.). Due to these challenges, not all states have authorized EPCS, especially for Schedule II controlled substances.
In March, 2011, DrFirst, the leading e-prescribing solution provider in the U.S., announced that it created EPCS Gold, which is a turnkey solution that significantly reduces technology development, auditing, and certification costs for vendors to legally offer EPCS to their clients. They also announced that two months later DrFirst and its partners (over 160 HIT vendors) would launch e-prescribing of controlled substances to their prescribers nationwide. A posting on the DrFirst website stated, “Currently 20% of written prescriptions are for controlled substances, which means 20% of physicians have not fully received the benefits of e-prescribing to allow them to make an informed decision when it comes to increased patient care” (Froehlich, I, 2011). DrFirst’s releasing of EPCS Gold may also lead other companies to follow suit and provide tools and infrastructure to support EPCS.
In September 2011, Surescripts, the largest e-prescription network in the U.S., announced that it upgraded its nationwide network to support EPCS. Additionally, it had begun the initial certification of prescriber software vendors and pharmacy applications for EPCS. It was also mentioned that certified vendors and pharmacies began their initial deployment of EPCS in the states in the United States where EPCS is legal (Cronin, 2011). Despite the fact that DrFirst and Surescripts have facilitated the implementation of EPCS, even a major state like California still has not fully incorporated EPCS in its healthcare system. Surescripts’ 2010 annual Safe-Rx rankings ranked California the 45th in the United States for the second year in a row (Wacker, R., 2012). In California, even though most community pharmacies are connected for e-prescribing, only 16% of eligible prescriptions are routed electronically by 25% of physicians (Lim, S., Groom, T., Elson, M., Caplan, R., 2011). In 2010, over 22 million prescriptions in California were electronically transmitted between providers and pharmacies, representing an increase from less than 2% in 2007 to 16% in 2010 (Wacker, R., 2012). However, a large number of prescriptions are still in paper format and are manually processed. Even though California still hasn’t accomplished much in terms of adoption of e-prescribing, there are many other states that have implemented EPCS successfully. For example, in Massachusetts which is ranked 1st in the United States, there were 11,005 physicians actively e-prescribing, 1,038 pharmacies enabled for e-prescribing, and 77.35% of patients with available prescription benefit/history information.
In May 2012, Surescript issued an update on industry progress in implementing EPCS as follows: “As states align their rules with those of the DEA, Surescripts will allow prescriber vendors, prescribers, pharmacy vendors, and pharmacies to transmit and receive EPCSs in those locales. As of this date, prescribers registered in eight states have issued DEA-compliant EPCSs: California, District of Columbia, Massachusetts, Maryland, Michigan, Texas, Virginia, and Washington.” (Whittemore, K., 2012).
Additionally, Surescripts also provides National Progress Report on E-prescribing for 2010 on its website. Below are the statistics for Electronic Prescribing Adoption from this report.
- Prescribers: The number of prescribers routing prescriptions electronically grew from 156,000 at the end of 2009 to 234,000 by the end of 2010 representing about 34 percent of all office-based prescribers.
- Payers: At the end of 2010, Surescripts could provide access to prescription benefit and history information for more than 66 percent of patients in the U.S.
- Community and Mail Order Pharmacies: At the end of 2010, approximately 91 percent of community pharmacies in the U.S. were connected for prescription routing and 6 of the largest mail order pharmacies were able to receive prescriptions electronically.
Despite the significant benefits, the DEA Interim Final Rule has also introduced new challenges in implementing EPCS. It will take some time for software developers to implement two-factor authentication in their applications, to update their systems and intermediary network to allow prescribers to transmit and process the prescriptions, and for pharmacy systems to receive the prescriptions. Pharmacy systems need to be certified by a DEA-approved entity, and prescribers need to complete the identity proofing process and use two-factor authentication every time they create an electronic prescription for controlled substances. It is certainly true that “successful e-prescribing depends on the continuing evolution of standards and the implementation efforts of individual stakeholders to ensure that robust and well-performing e-prescribing processes are the rule rather than the exception.” Wacker (2012). As technology advances, there may be ways to implement trust between the systems that send and receive e-prescriptions so that some of the steps that users have to perform today can be simplified or eliminated. It would also help if the DEA would simplify the requirements for EPCS so that more prescribers and the pharmacies will be able to use e-prescribing and reap its benefits, without sacrificing security and privacy. Hopefully, we will soon be able to implement robust e-prescribing processes so that 100% of prescriptions in the United States can be successfully transmitted electronically and all stakeholders can reap the full benefits of e-prescribing for general drugs and controlled substances.
Reviews for E-prescribing
- General practitioners' use of computers for prescribing and electronic health records: results from a national survey
- Creating Cost-effectiveness analysis of a hospital electronic medication management system
- The Influence that Electronic Prescribing has on Medication Errors and Preventable Adverse Drug Events: an Interrupted Time-Series Study
- Gabriel MH, Swain M. E-Prescribing Trends in the United States. ONC Data Brief, no.18. Washington, DC: Office of the National Coordinator for Health Information Technology, July 2014.
- Anderson, Jr., H., Stubstad, J., Hardy, M. (2011). Valid Prescription, Electronic Prescriptions, When is a Signature Required (?) and What is a Qualifying Signature?
- True eRx – “All Electrons, All the Time”. (n.d.) E-prescribing. American College of Rheumatology. Retrieved from http://www.rheumatology.org/practice/office/hit/erx.asp
- E-Prescribing: Electronic Prescribing of Controlled Substances. (2012). American College of Rheumatology. Retrieved from http://www.rheumatology.org/practice/office/hit/erx.asp
- Electronic prescriptions for controlled substances. Interim final rule with request for comment: questions and answers for prescribing practitioners [as of 03/31/2010]. DEA’s Office of Diversion Control. Retrieved from http://www.deadiversion.usdoj.gov/ecomm/e_rx/faq/practitioners.htm.
- Electronic Prescriptions for Controlled Substances Clarification (2011). DEA’s Office of Diversion Control, Notices 2011. Retrieved from http://www.deadiversion.usdoj.gov/fed_regs/notices/2011/fr1019.htm.
- Epidemic: Responding to America’s Prescription Drug Abuse Crisis. Office of National Drug Control Policy, Executive Office of the President of the United States, 2011.
- Froehlich, I. (2011). DrFirst Makes Access to E-Prescribing Of Controlled Substances Technology Available to 160 HIT Vendor Partners Nationwide Through EPCS Gold. Retrieved from http://www.prweb.com/releases/E-Prescribing/03/prweb5179154.htm
- Lim, S., Groom, T., Elson, M., Caplan, R. (2011). California ePrescribing Gap Analysis. Cal eCONNECT, Inc. 14.
- Thomas CP., Kim M., et al (2011). Prescribers’ expectations and barriers to electronic prescribing of controlled substances. J Am Med Inform Assoc. 2011 Sep 21.
- Vivian, J. (2010). Electronic Controlled Substances Prescriptions. US Pharm. 2010;35(7):65-68.
- Wacker, R. (2012). E-prescribing in CA: why aren’t we there yet. California Healthcare Foundation.
- Whittemore, K.(2012). Surescripts Report: Majority of Physicians Meeting Stage 1 Meaningful Use E-Prescribing Measure Today, Many Already Meeting Proposed Stage 2 Measure. Retrieved from http://www.surescripts.com/news-and-events/press-releases.aspx
Submitted by (Lek Taylor)
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Submitted by Revati Venkatesh
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Submitted by (Sujani Kakumanu)
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