E-Prescribing: We Haven't Reached The Pot Of Gold Yet

By Dewey Howell, MD, Vice President of Clinical Applications, First Databank (FDB)

For many years, e-prescribing loomed as an over-the-rainbow, off-in-the-distance goal. Spurred on by government initiatives such as the Medicare Improvements for Patients and Providers Act (also known as the “eRx incentive” program) and the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program (also known as “meaningful use”), e-prescribing has finally become the norm. In fact, 90 percent of pharmacies in the United States now accept electronic prescriptions and 70 percent of physicians use e-prescribing, according to the Office of the National Coordinator of Health IT.

With this level of adoption, the industry is well on its way toward enjoying the benefits associated with e-prescribing. Indeed, a study published by the Online Research Journal: Perspectives in Health Information Management shows e-prescribing is resulting in improved:

• Patient safety by helping to eliminate adverse drug events (ADEs) related to medication prescriptions. The study found that with e-prescribing, error rates decreased from 42.5 per 100 prescriptions to 6.6 per 200 prescriptions.
• Efficiency by enabling prescribers to spend less time clarifying issues such as prior authorization and refill requests.
• Cost savings due to increased medication adherence. The study cites an analysis that projects $140 billion to $240 billion in cost savings over 10 years.

Time To Put Your Feet Up?
So, after working diligently to reach this watershed moment, the first impulse for many players in the industry might just be to rest on this decidedly worthy laurel.

The problem: all is not well in the prescribing world. Recently, for example, the Centers for Disease Control and Prevention (CDC) announced almost half of Medicare beneficiaries with high blood pressure are not taking medications prescribed to them for the condition, which could lead to a variety of undesirable health outcomes.

And that is just the most recent statistic pointing to the less than optimal use of medications by patients across the country. Consider these other findings from the CDC as well:

• More than 700,000 individuals are seen in hospital emergency departments for ADEs each year in the United States and about 120,000 of these patients need to be hospitalized — often for ADEs that could have been thwarted.
• Antibiotics account for almost one out of five emergency department visits for ADEs. And, almost four out of five ED visits for antibiotic-associated ADEs are due to allergic reactions.
• Older adults are nearly seven times more likely to be hospitalized after an emergency visit, but most of these hospitalizations are due to just a few drugs that require careful monitoring such as blood thinners, diabetes medications, seizure medications, and heart medications.
• The nation’s opioid epidemic continues to wreak havoc. Opioids including prescription pain relievers and heroin killed more than 28,000 people in 2014, more than any year on record. At least half of all opioid overdose deaths involve a prescription opioid.

Or Dig In Your Heels?
With all of these less-than-desirable prescription drug outcomes, the desire to improve the prescribing practices in the healthcare industry runs deep. While today’s “basic” use of e-prescribing — which primarily centers on sending prescriptions from Point A to Point B — has brought increased efficiency and enhanced patient safety, the technology could be leveraged for much more. Healthcare organizations need to begin to focus on not only adopting e-prescribing but making the most of it.

More specifically, the prescribing and treatment process can be improved by adding a variety of advanced clinical functions into the electronic mix:

• Medication Histories: Having access to a patient’s complete medication history at the point of care can, of course, help caregivers make better clinical care decisions. With medication history integrated into the e-prescribing solution, clinicians can immediately discern what prescriptions the individual is currently taking as well what drugs the patient has taken in the past. As a result, they can quickly reconcile medications and reduce drug-drug interactions, duplicate therapy, and reduce costly ADEs and associated readmissions. Such functionality could help improve care considerably, as many medication errors result from inadequate medication reconciliation.
• Drug Formularies: With access to drug formulary information, providers will know at the point of care if they are prescribing a medication that is covered by the patient’s insurance, making it possible to provide the most appropriate, as well as the most cost efficient, prescription. Without access to this information, patients might neglect to fill the prescription due to cost. Or, the pharmacist might need to call the clinician about a substitute, adding time and cost to the prescribing process. With drug formulary information in e-prescribing tools, the need for pharmacist calls drops and patient compliance with medication orders increases.
• Controlled Substances: With an electronic system that supports prescribing controlled substances, physicians can more expediently check patients’ comprehensive drug histories. Indeed, when providers leverage systems that include controlled substances, they can create electronic links to the Prescription Drug Monitoring Programs, electronic databases that collect designated data on substances dispensed in the state. As such, they can identify patients who are going from doctor to doctor for drugs — frequently addictive pain relieving opioids.
• Drug Knowledge: E-prescribing systems that fully exploit drug knowledge capabilities will also help clinicians make better care decisions. Such knowledge can lead clinicians to make dosing decisions based on minimum/maximum dosing, and check dose ranges based on patient-specific data; check for drug-disease decision support including indications, contraindications, and side effects; detect drug-interactions including drug-drug, drug-allergy, drug-food, and duplicate therapy; identify drugs through drug images and imprints; and provide patient education, patient medication instructions, prioritized label warnings and practical counseling messages.

Adding these advanced clinical functions to e-prescribing systems will empower healthcare organizations to go beyond the initial efficiency and patient safety results achieved with e-prescribing and truly enhance clinical care and patient outcomes. As more leaders recognize the importance of these advanced clinical functions, the industry as a whole can move beyond the rudimentary use of e-prescribing and can fully leverage the power of the technology and optimize its overall value.

About The Author

Dewey Howell, M.D., Ph.D., is vice president of clinical applications at First Databank (FDB), a provider of clinical drug knowledge, where he focuses on developing health IT applications to support medication-related decisions. Howell also leads product development for FDB MedsTracker®, a web-based, clinical workflow solution that interfaces with healthcare IT systems and supports medication reconciliation and electronic prescribing. Howell joined FDB in August 2013, through the acquisition of Design Clinicals, a healthcare IT company he founded. Howell, a practicing family physician turned healthcare IT software developer, received doctorates in Immunology and Medicine at Baylor College of Medicine in Houston, TX.