Electronic prescribing systems in pediatrics: the rationale and functionality requirements

== Electronic prescribing systems in pediatrics: the rationale and functionality requirements. American Academy of Pediatrics Council on Clinical Information Technology, Gerstle RS. Pediatrics. 2007 Jun;119(6):1229-31. ==

Background/Summary

In a Policy Statement by the American Academy of Pediatrics' (AAP) Council on Clinical Information Technology, the organization supports the implementation and use of electronic prescribing (e-prescribing) by physicians as a method to improve patient safety, in line with other national efforts to improve patient safety (e.g., the Institute of Medicine, the Institute for Safe Medical Practices, and the Leapfrog Group). Citing a reduction in transcription errors (due to illegibility), the use of clinical decision support (for drug-drug and drug-allergy interactions) and dosage calculators, the streamlining of insurance processes, and the potential to diminish malpractice risk, the AAP states "there is sufficient evidence supporting the ability of e-prescribing systems to prevent medical errors and enhance patient care" with the caveat that this and other novel systems require monitoring over time.

Recommendations

(1) Federally sponsored research should be conducted to determine characteristics of e-prescribing systems that are most beneficial in preventing errors and enhancing patient care in both inpatient and outpatient settings. Accurate data on the incidence and scope of prescribing errors, adverse drug events, and near-miss errors must be available. Regulations should be promoted to facilitate no-fault, anonymous adverse drug event reporting systems as an enabling step toward understanding and intervening to prevent medical errors.

(2) Because safety for children is paramount, e-prescribing systems used for the care of children should include, at a minimum, pediatric-specific decision support such as weight-based dose calculations and alerts and pediatric drug information and formulation options. When possible, e-prescribing systems should be implemented as part of a robust electronic health record. Such implementations offer advantages well beyond those of freestanding e-prescribing systems. When implementing a stand-alone e-prescribing system, thought should be given to the potential future need to transfer data to, or interface the e-prescribing system with, an electronic health record.

(3) The AAP supports federal legislation that would unify state regulations and allow for e-prescribing and digital transmission of all prescriptions (including controlled drugs) directly to pharmacies and require all pharmacies to accept digitally transmitted and signed prescriptions. The AAP supports a process for the development of standards for the transmission of be part of federal and state initiatives to reduce medical errors. Efforts to encourage larger insurers to underwrite such systems should continue—with demonstration projects to document the cost savings to them by the adoption of e-prescribing systems.

(4) Despite significant benefits to medical and liability insurers, patients, and pharmacy benefit managers, e-prescribing applications are an office-practice expense that generates a disproportionately small or no pediatric practice revenue; therefore, the AAP believes adoption of e-prescribing technology would be hastened by the offering of incentives such as pay-for-performance bonuses to practices that routinely use e-prescribing systems that incorporate clinical decision-support alerts.

(5) Because practitioners in rural or low-income areas may face financial and system barriers and, in many cases, do not have access to the network infrastructure to support e-prescribing systems, federal grant and loan programs should be available to support system enhancements such as Internet access and start-up costs.

Implementation

Federally funded research and federal grants and loans for e-prescribing systems (Recommendations 1 & 5) may be implemented by providing research grants through the National Library of Medicine, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, and other federal and local agencies. Minimum standards for e-prescribing systems (Recommendation 2) may be implemented by educating providers before purchase of such systems on the required elements through published reports such as the accompanying technical report. Such reports should also be shared with standards-development organizations to encourage the inclusion of minimum requirements into the development of these standards. Federal legislation on e-prescribing (Recommendation 3) requires action by the collaborative action of the Drug Enforcement Administration to develop standards for the secure digital transmission of category II controlled substances and enable federal legislation that takes precedence over the restrictions placed by state regulations. Incentives for purchase (Recommendation 4) should be part of federal and state initiatives to reduce medical errors. Efforts to encourage larger insurers to underwrite such systems should continue—with demonstration projects to document the cost savings to them by the adoption of e-prescribing systems.

Comment

Via a Policy Statement, the AAP provides a strong set of recommendations supporting the implementation of e-prescribing. Perhaps the most unique recommendation recognizes the importance of the use of clinical decision support in the form weight-based prescribing, the standard by which the majority of pediatric prescribing is performed and which is uncommon in other fields of medicine.