E-Prescribing Software: Not A Cure All

By Ken Congdon, editor in chief, Health IT Outcomes

Another study has emerged that calls into question the effectiveness of information technology at solving the healthcare industry's problems. This study titled, "Errors Associated With Outpatient Computerized Prescribing Systems," was recently published online in the Journal of the American Medical Informatics Association, and explored the error rates associated with the e-prescribing systems in use by physicians today. On the surface, the data doesn't look good. Of the 3850 computer-generating prescriptions examined in the study, 452 (11.7%) contained at least one error. According to the researchers of this particular study, this figure is comparable with the data that exists on handwritten prescription error rates.

However, before you start condemning e-prescribing as another technology initiative doomed to failure, there is some key data uncovered by the study that deserves a closer look. First, error rates varied widely — from 5.1% to 37.5% — depending on the type of e-prescribing software that was used. Therefore, the top systems did outperform pen and paper prescribing methods, while system design or implementation may have been the cause for poorly performing e-prescribing systems. Second, the most common error cited by the study was omitted information, such as drug dose, duration, and frequency — which accounted for 60.7% of all reported errors. This error is a result of human oversight, rather than a function of the technology. Furthermore, most e-prescribing technologies can actually be programmed to prevent these types of omissions from ever occurring. In other words, the software can prevent a physician from completing an e-prescription unless all the information required for that script is entered into the system.

Tips For E-Prescribing Success

The data generated by this study once again proves that technology, in and of itself, does not solve problems. Without the proper processes and support behind the technology, it will be doomed to fail. This is exactly what I believe has occurred in many instances throughout the United States. Many physicians have rushed into implementing e-prescribing solutions as a result of the monetary incentives offered by the federal government. As the data shows, many of these systems aren't achieving desired outcomes. It's clear that simply implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful use does not decrease medication errors.

So, what can you do to ensure your e-prescribing solution does what it is intended to do and significantly reduces medication error rates? First, ensure that the software you implement is capable of the following functions:

• Generating a complete active medication list incorporating electronic data received from applicable pharmacy benefit managers;
• Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks;
• Providing information related to the availability of lower-cost, therapeutically appropriate alternatives (if any); and
• Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan (if available).

Second, ensure that the e-prescribing system you implement is optimized to include the appropriate levels of clinical decision support for your environment. Work with your physicians to determine which fields absolutely need to be completed before sending a script and install the proper safeguards without making the software too slow or cumbersome to use.

Third, if possible, ensure the e-prescribing software is integrated with your EMR. This will allow you to access key drug interaction data (e.g. allergies, other medications used, etc.) directly from the patient record and alert physicians to potential adverse drug events.

Finally, and most importantly, ensure you allow ample time for physician training on the e-prescription system. Training is breezed over because of the time it takes, but if your physicians aren't on-board with or comfortable using the new system, it will never deliver the results you desire.

Have a comment or feedback for Ken on this article? He can be reached directly at ken.congdon@jamesonpublishing.com.