Difference between revisions of "E-prescribing"

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Electronic prescribing has major benefits for providers and patients.  Providers will benefit from decision support tools to assist them in prescribing medications and a decrease in the number of phone calls from pharmacies requesting clarification.  Patients will receive lower costs, increased safety, and greater efficiency.
 
Electronic prescribing has major benefits for providers and patients.  Providers will benefit from decision support tools to assist them in prescribing medications and a decrease in the number of phone calls from pharmacies requesting clarification.  Patients will receive lower costs, increased safety, and greater efficiency.
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== Introduction ==
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The emergence of [[EMR|electronic health records (EHR)]] has subsequently led to the emergence of other electronic systems to be used in the clinical settings, as anyone might think the primary goal of theses systems is to harmonize the electronic workflow in the clinical settings, but these systems have proven to have an important role in improving the service provided and subsequently the health care in general.
 +
 +
One of these systems are ePrescribing systems, which by the use of clinical decision support systems have made a significant change in the way the service is provided which we will discuss later in this paper, but let's first explore the benefits of ePrecribing systems in various types of clinical settings.
 +
 +
== Why ePrescribing? ==
 +
 +
In a report of eHealth initiative[1] 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 [2] 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 [3].
 +
 +
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 [4].
 +
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.
 +
 +
 +
==Refrences==
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 +
# Janice Hopkins Tanne, Electronic prescribing could save at least $29bn, electronic communication and health care News. Report can be accessed www.ehealthinitiative.org
 +
# ETA S. BERNER, EDD, et al, Improving Ambulatory Prescribing Safety with a Handheld Decision Support System: A Randomized Controlled Trial, J Am Med Inform Assoc. 2006
 +
# T Porteous, C Bond, R Robertson, et al, Electronic transfer of prescription-related information: comparing views of patients, general practitioners, and pharmacists, British Journal of General Practice, March 2003.
  
 
== References ==
 
== References ==
Line 28: Line 56:
 
http://www.thecimm.org/PDF/eHI_CIMM_ePrescribing_Report_6-10-08.pdf
 
http://www.thecimm.org/PDF/eHI_CIMM_ePrescribing_Report_6-10-08.pdf
 
# Eslami, S., de Keizer, N.F., Abu-Hanna, A.  2007.  The impact of computerized physician medication order entry in hospitalized patients – A systematic review.  ''International Journal of Medical Informatics''.  77: 365-376
 
# Eslami, S., de Keizer, N.F., Abu-Hanna, A.  2007.  The impact of computerized physician medication order entry in hospitalized patients – A systematic review.  ''International Journal of Medical Informatics''.  77: 365-376
# Kilbridge, P.M., Welebob, E.M., Classen, D.C.  2006.  Development of the Leapfrog methodology for evaluating hospital implemented inpatient computerized physician order entry systems. ''Qual. Saf. Health Care''.  15: 81 - 84.
+
# Kilbridge, P.M., Welebob, E.M., Classen, D.C.  2006.  Development of the Leapfrog methodology for evaluating hospital implemented inpatient computerized physician order entry systems. ''Qual. Saf. Health Care''.  15: 81 - 84.
 
# Lapane, K.L., Waring, M.E., Schneider, K.L., Dube, C., Quilliam, B.J.  2008.  A mixed method study of the merits of e-prescribing drug alerts in primary care.  ''Journal of Gen Intern Med''.  23(4): 442-446.
 
# Lapane, K.L., Waring, M.E., Schneider, K.L., Dube, C., Quilliam, B.J.  2008.  A mixed method study of the merits of e-prescribing drug alerts in primary care.  ''Journal of Gen Intern Med''.  23(4): 442-446.
 
# McGlynn, E.A., Asch, S.A., Adams, J., Keesey, J., Hicks, J., DeChristofaro, A., et al.  2003.  The Quality of Health Care Delivered to Adults in the United States.  ''New England Journal of Medicine''.
 
# McGlynn, E.A., Asch, S.A., Adams, J., Keesey, J., Hicks, J., DeChristofaro, A., et al.  2003.  The Quality of Health Care Delivered to Adults in the United States.  ''New England Journal of Medicine''.

Revision as of 22:40, 6 October 2011

Electronic prescribing (e-prescribing) is the use of a computerized system to enter and generate a prescription rather than writing it on paper.

Introduction

Electronic prescribing or e-prescribing improves patients safety and satisfaction by providing legible prescriptions. 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).

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).

Many medication errors are a result of illegible handwriting, unclear abbreviations and unclear or ambiguous orders (eHealth Initiative, 2008).

Electronic prescribingadoption has had a slow but steady growth. 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 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).

Benefits of electronic prescribing

Electronic prescribing has major benefits for providers and patients. Providers will benefit from decision support tools to assist them in prescribing medications and a decrease in the number of phone calls from pharmacies requesting clarification. Patients will receive lower costs, increased safety, and greater efficiency.

Introduction

The emergence of electronic health records (EHR) has subsequently led to the emergence of other electronic systems to be used in the clinical settings, as anyone might think the primary goal of theses systems is to harmonize the electronic workflow in the clinical settings, but these systems have proven to have an important role in improving the service provided and subsequently the health care in general.

One of these systems are ePrescribing systems, which by the use of clinical decision support systems have made a significant change in the way the service is provided which we will discuss later in this paper, but let's first explore the benefits of ePrecribing systems in various types of clinical settings.

Why ePrescribing?

In a report of eHealth initiative[1] 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 [2] 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 [3].

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 [4]. 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.


Refrences

  1. Janice Hopkins Tanne, Electronic prescribing could save at least $29bn, electronic communication and health care News. Report can be accessed www.ehealthinitiative.org
  2. ETA S. BERNER, EDD, et al, Improving Ambulatory Prescribing Safety with a Handheld Decision Support System: A Randomized Controlled Trial, J Am Med Inform Assoc. 2006
  3. T Porteous, C Bond, R Robertson, et al, Electronic transfer of prescription-related information: comparing views of patients, general practitioners, and pharmacists, British Journal of General Practice, March 2003.

References

  1. American National Standards Institute (ANSI). n.d.. Robert Kolodner Named National Coordinator for Health Information Technology. Retrieved August 21, 2008.

http://www.ansi.org/news_publications/news_story.aspx?menuid=7&articleid=1475.

  1. eHealth Initiative. June 2008. The consumer’s guide to e-prescribing.

http://www.thecimm.org/PDF/eHI_CIMM_Consumer_Guide_to_ePrescribing.pdf

  1. eHealth Initiative. June 2008. Electronic prescribing: becoming mainstream practice.

http://www.thecimm.org/PDF/eHI_CIMM_ePrescribing_Report_6-10-08.pdf

  1. Eslami, S., de Keizer, N.F., Abu-Hanna, A. 2007. The impact of computerized physician medication order entry in hospitalized patients – A systematic review. International Journal of Medical Informatics. 77: 365-376
  2. Kilbridge, P.M., Welebob, E.M., Classen, D.C. 2006. Development of the Leapfrog methodology for evaluating hospital implemented inpatient computerized physician order entry systems. Qual. Saf. Health Care. 15: 81 - 84.
  3. Lapane, K.L., Waring, M.E., Schneider, K.L., Dube, C., Quilliam, B.J. 2008. A mixed method study of the merits of e-prescribing drug alerts in primary care. Journal of Gen Intern Med. 23(4): 442-446.
  4. McGlynn, E.A., Asch, S.A., Adams, J., Keesey, J., Hicks, J., DeChristofaro, A., et al. 2003. The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine.
  5. Steinbrook, R. 2008. The (slowly) vanishing prescription pad. New England Journal of Medicine. 359: 115-117
  6. White House: Office of the Press Secretary. April 24, 2004. President Unveils Tech Initiatives for Energy, Health Care, Internet. Retrieved August 19, 2008. [1]