Electronic prescribing

Electronic prescribing or e-prescribing is a physician’s use of real-time, patient-specific clinical and economic information, for consenting patients, to:

• Prescribe the most medically appropriate and cost effective prescription at the point of care, and
• Transmit the prescription electronically to the patient’s pharmacy of choice. Pharmacies can also request refills by sending an electronic refill request to the physician office for approval.

By eliminating paper, phone and fax from prescribing, electronic prescribing can make getting patients the medications they need a safer and more efficient process. E-prescribing is designed to replace other approaches to prescribing - e.g. handwritten prescriptions, computer-printed prescriptions and computer-faxed prescriptions that can be considered outdated or error-prone.

By exchanging prescription information electronically, e-prescribing can help reduce the risk of medication errors associated with poor handwriting, illegible faxes and additional key strokes.

E-prescribing also has the potential to improve beneficiary health outcomes. For providers who choose to invest in e-prescribing technology, the adoption could improve quality and efficiency and could show promise in reducing costs by actively promoting appropriate drug usage; providing information to providers and dispensers about formulary-based drug coverage, including formulary alternatives and co-pay information; and speeding up the process of renewing medications. E-prescribing also may play a significant role in efforts to reduce the incidence of drug diversion by alerting providers and pharmacists of duplicative prescriptions for controlled substances.

E-prescribing has the potential to empower both prescribers and pharmacists to deliver higher quality care and improve workflow efficiencies. Typically, providers give a handwritten prescription to the patient or fax it to a pharmacy or other dispenser. Pharmacists can have a difficult time reading handwritten prescriptions and may have little or no information about the patient’s condition for which the prescription is written. Contacting the provider by phone to clarify the prescription often results in delays for the patient and is time-consuming for both the provider and dispenser. According to some estimates, almost 30 percent of prescriptions require pharmacy callbacks. This translates into less time available to the pharmacist for other important functions, such as educating consumers about their medications. A potential benefit of e-prescribing in preventing errors is that each prescription can be checked electronically–and quickly–at the time of prescribing.

In addition to the potential for saving time, the Institute of Medicine - through its November 1999 report - To Err is Human: Building A Safer Health System has noted that widespread adoption of e-prescribing could eliminate thousands of adverse drug events each year.

From the physician's point of view, there are several problems/obstacles to e-prescribing:

1. The doctor has to pay for it, and the cost of the electronic system is not worth the financial gain, if any, to the doctor.
2. As it now stands, the doctor cannot e-prescribe Class-II narcotics, and certain other drugs.
3. If the drug is not on the patient's formulary, but requires a higher co-payment, or a brand-name rather than a generic, then permission has to be obtained from the HMO or drug management co., which still wastes time.