Difference between revisions of "Overview of electronic prescription"

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Submitted by Revati Vankatesh
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Revision as of 13:48, 26 May 2009

Introduction: 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 [1]. 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 prescription: There are different levels at which an electronic prescription system can be implemented. The higher the level of sophistication, the greater the benefits as there is more linkage of relevant patient information. However, the cost of implementation also increases with the level.[2]

Level 1: This is an elementary system consisting of a reference handbook containing drug information, dosing calculators and formulary information. The information is available only if the physician explicitly looks for the information.

Level 2: Allows searching for a drug name and gives generally used dosage details.

Level 3: Patient unique data such as allergy, and formulary information can be stored. So the physician can prescribe drugs according to the specific needs of the patient. The system also provides alerts for drug allergies.

Level 4: Medication history for the patient is maintained which enables alerts for drug to drug interaction. It also provides reminders for renewal.

Level 5: Linkage between the physician’s office and pharmacy. Physician can transmit the prescription to the location of the pharmacy specified by the patient.

Level 6: Integrated with an electronic medical record, which enables disease management and access to lab tests, problem list and diagnosis.

Workflow: The physician office will require a Windows, or Macintosh system to run the required communication software, and network access to send electronic prescriptions. The Pharmacy may have a software application or a fax machine depending on the level of the 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 [3]. Some of the key benefits of electronic prescription: 1.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. 2.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. 3.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. 1.Transaction fee-based: A fee is charged for each transaction. So higher the volume of transaction, higher the revenue generated. 2.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:

1. 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. [5]

2.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. [6]

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.

References:

[1] Kohn LT, Corrigan JM, Donaldson M, editors. To err is human: building a safer health system. Washington, DC: Institute of Medicine; 1999.

[2] Danni R, Medical office pharmacology: Review for medical assistant students and professionals [monograph on the internet]. Washington D.C: MAPharma.com:c2003[cited 2008 May 20]. Available from

http://www.mapharm.com/prescr_parts.htm

[3] Duncan P, National expert panel weighs in on essentials of electronic prescribing design and implementation [monograph on the Internet]. Washington, D.C: eHealth Initiative, Foundation for eHealth Initiative:c2008 [updated 2004 April 14; cited 2008 April 15]. Available from http://www.ehealthinitiative.org/news/eRXReportpressrelease.mspx

[4] Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000;160:2741-2747

[5] ncpdp.org [homepage on the internet]. Scottsdale, Arizona: National Council for Prescription Drug Programs, Inc. (NCPDP): c2005[cited 2008 May 20 ] Available from: www.ncpdp.org

[6] HL7.org[homepage on the internet]. Ann Harbor, MI: Health Level Seven, Inc.c1997-2008[cited 2008 May 20] Available from: http://www.HL7.org


Submitted by Revati Venkatesh