E-Prescribing Favored Despite Hurdles

Although community pharmacies reported satisfaction with e-prescribing systems, pharmacies continue to report difficulties with e-renewals and routing and receipt of new prescriptions, according to a study published in the May 2012 Journal of the American Medical Informatics Association.

Researchers conducted 114 telephone interviews with 24 physician practices, 48 community pharmacies, and 3 mailorder pharmacies that used the Surescripts e-prescribing service to transmit or receive scripts. The interviews occurred during a 7-month period in 2010 and included inquiries about IT systems, implementation and use of e-prescribing features, routing of new and renewed prescriptions, pharmacy processing of new prescriptions, facilitators of and barriers to effective transmission, and processing at pharmacies.

More than one-half of the community pharmacies estimated that they received less than 15% of prescriptions electronically. National pharmacies were more likely to receive a higher proportion of electronic prescriptions. Factors contributing to the low e-prescribing rate included many physicians not transmitting any prescriptions electronically and pharmacies receiving computer-generated prescriptions that were faxed or printed.

The authors found that e-prescriptions were not always faster. One-third of participating physician practices and pharmacies said that patients would arrive to pick up orders before the pharmacy received an e-prescription. Although physician participants attributed this to inadequate training and experience, pharmacists were more likely to point to physician delays in transmitting the e-scripts. Pharmacies typically resolved transmission problems by calling for verbal orders.

Physician practices and pharmacies reported that electronic renewals were filed inconsistently and were more difficult to integrate into pharmacy work flow. More than one-fourth of participating community pharmacies did not send e-renewal authorization requests because they lacked the functionality or opted against using the feature to avoid fees.

Several pharmacy participants found inefficiencies in the e-renewal process and reported sending multiple requests for the same prescription even after a physician responded to an electronic request. Pharmacists explained that other means of follow-up are necessary if physicians do not respond promptly to e-renewals, especially because the Surescripts system does not allow pharmacies to send duplicate e-renewal requests.

The authors also noted that communications between physicians and mailorder pharmacies were less likely to be electronic than with community pharmacies. They attributed the difference to transmission and computer limitations, particularly with the physician offices. In addition, mailorder pharmacy participants noted that few e-prescribing vendors were Surescripts certified for either new or renewal prescriptions filed with mailorder pharmacies. As a result, most e-prescriptions were faxed.

Many pharmacies received e-prescriptions sent to their pharmacy systems directly, allowing them to skip manual entry. However, a small portion of pharmacies reported entering the scripts manually after receiving them electronically. Most of the participating pharmacies reported implementing systems with automated processing.

Pharmacists and physicians reported that medications must be selected very specifically when e-prescribing. With hand-written prescriptions, pharmacists make decisions about packaging and drug form that can save patients money. With e-prescribing systems, pharmacists must fill the e-prescriptions as inputted.

Despite the challenges, physicians and pharmacists were satisfied with e-prescribing overall, noting improvements in efficiency and patient safety, the authors said.