The Pitfalls of E-Prescribing

Pharmacists and physicians say electronic prescribing has potential to save time and reduce errors, but that systems currently in use are flawed.

It’s become an all-too-familiar scenario for community pharmacists: during an appointment with a sick patient, a physician prescribes a drug, explaining that she’ll send the prescription electronically. Moments after the check-up ends, the patient stops in at a nearby pharmacy, expecting to pick it up.

Then come the words every pharmacist dreads: “My doctor said it’d be ready when I got here.”

In one-third of community pharmacies, the exchange happens at least once a day, a new study reports. Resolving it takes more than simply waiting a few extra minutes for the script to arrive. In many cases, the pharmacist is forced to call the physician for verbal orders—an extra step that wastes time and negates the purpose of electronic prescriptions.

Scripts lost in cyberspace are just one of the pitfalls exposed in a recent report detailing flaws in e-prescribing, which is now in use by more than half of all physician practices. The research, funded by the US Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ), focuses on the transmission of prescriptions from physicians to pharmacies.

WEIGH IN: Is your practice plagued with e-prescribing problems? Share your thoughts in the comments below or cast your vote in our news poll.

This handoff of prescription data is at the heart of e-prescribing’s potential to save time and advance patient safety, according to AHRQ director Carolyn M. Clancy, MD. It’s also a source of daily frustration for pharmacists and physicians, researchers reported November 18 online in the Journal of the American Medical Informatics Association.

In more than 100 interviews with physician practices and pharmacies nationwide, researchers at the Center for Studying Health System Change found that e-prescribing’s major flaws and inconsistencies are concentrated in 3 critical areas. These include prescription renewals, connectivity between physician offices and mail-order pharmacies, and manual entry of prescription information by pharmacists.

Among the study’s other key findings:

• In practice, e-prescribing use is inconsistent at best. Despite broader adoption of e-prescribing thanks to federal incentives, the extent to which it is used by individual practices varies. In general, pharmacies and physicians are less likely to use e-prescribing for prescription renewals than for new prescriptions. The report also found that many physicians are unsure about whether mail-order pharmacies accept electronic prescriptions.
• Electronic requests breed miscommunication and information overload. Both pharmacies and physicians reported receiving or mistakenly sending duplicate or conflicting messages via fax, phone, and e-prescribing systems. One physician said, “Sometimes the patient will call, the pharmacy will fax, and send something via Surescripts, all for the same patient, the same prescription, on the same day. That is cumbersome.”
• “Shortcut” features need tweaking. Timesaving features are often more trouble than they’re worth. For example, fields that complete automatically often require additional follow-up calls or manual entry by pharmacists to clarify a physician’s orders, verify quantities and sig codes, or provide patient-friendly instructions.

Despite these and countless other glitches outlined in the report, most physicians and pharmacists expressed satisfaction with e-prescribing—when it’s working properly. Smoothing out the kinks in e-prescribing systems should be the focus of health IT initiatives going forward, according to the study’s authors.

“Physicians and pharmacies have come a long way in their use of e-prescribing, and that’s a very positive trend for safer patient care and improved efficiency,” said Dr. Clancy. “This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients.”

For other articles in this issue, see:

• 4 Drugs Cause Most Hospitalizations in Seniors
• Polypharmacy Linked to Erectile Dysfunction