LIS 4930
Health Informatics
Dontrail Brinson William Davenport Gina Iacuzio Kevin Nanns Bryan Valentine Cheryl Werner
[Electronic Prescribing]
Electronic prescribing is an amazing technology that will almost erase all medical errors from happening. There are some drawbacks to this tool. The technology costs a lot, doctors won’t adopt unless they have tech support, and mainly there is no standardization. IT companies need to work with these healthcare facilities to alleviate the problems. Medical errors should be a thing of the past.
Contents
Introduction 3
What is Electronic Prescribing? 3
Case Studies 4
Benefits and Problems of Electronic Prescribing 6
Solutions for Electronic Prescribing 8
Future of Electronic Prescribing 11
Conclusion 14
References 15
Introduction
Traditionally, healthcare professionals had to prescribe patient’s medication either by writing a script, calling in a prescription to patient’s pharmacy, or faxing the prescription to the pharmacy. The use of scripts is often prone to prescription errors that can have life threatening consequences. Healthcare professionals have been known to have difficult to read handwriting that pharmacists cannot decipher. This causes a pharmacist to either fill a prescription incorrectly or not fill the prescription at all. If the physician is not readily available to confirm the prescription, the patient may have to wait a day or longer for a critical prescription. Because the healthcare workforce is very rich with diversity, a language barrier causes communication with pharmacists difficult to understand. Different cultural vernacular and accents are a cause of communication barriers. The advancements in technology have provided the health care industry with electronic prescribing that can resolve many errors that are prone to outdated methods such as faxing, handwriting scripts, and telecommunications.
What is Electronic Prescribing?
Electronic prescribing is in essence, the writing of prescriptions with the assistance of computers. This could mean that the individual is using a hand held PDA and touch screen to input/write the prescription, or alternatively it could be typed in using a laptop or even a full sized computer. Electronic prescribing can also be referred to as a means of sending prescriptions electronically from a doctor to a pharmacy. However, in either case, for it to be truly electronic prescribing paper must not be used. (Spooner, 2005)
Currently, there is no standard to how electronic prescribing is setup technically. While almost any computer can be successful in running the electronic prescribing system, touch screen hand held electronics have been the focus of many of the programs. Most companies have their own version of a system that they believe is the superior way to handle it with many different systems catering to a specific field of health. In most cases however, the system is setup with a bunch of drop down menus and check boxes. With these, doctors input all of the required information. With the variety of programs out there that offer electronic prescription solutions, there are many different avenues that are able to be taken, however there are several components that are required for that system to be successful if it is to technically be sufficient.
The system must first and foremost have all of the patient’s base records. This includes name gender, age, and race. The system should also be able to display the complete medication list from both the doctor's office, but also every other office that the patient is visiting. It should also have a set of recommended medication for each medical diagnoses, protect against allergy conflicts, provide assistance when calculating doses, and to make the system as intuitive for the doctors as possible. (Bell, 2004)
After the information is inputted into the system, then the electronic prescription is electronically sent to a pharmacy where the patient can then pick up their medication. Medication that the patient knows is both correct and safe.
Case Studies
Since there are over three billion prescriptions written each year in the U.S., clinicians are always searching for a way to make this process easier while ensuring patient safety. Electronic prescribing seems to be a smart solution. With more and more physicians adopting E-prescribing, it is becoming much easier to actually see the results, findings, and their opinions of what does and does not work. The publishing and distributing of Case Studies is very helpful in aiding clinicians in choosing the best company or software to go with as well as providing them with concrete evidence to back up the companies’ claims of increasing productivity and overall patient care. Due to this increased access to statistics directly correlating to improvements made, “40% [of physicians] express a future interest in electronic prescribing” (Marcinko, 2004)
One of the most important things healthcare professionals will look for before choosing to adopt e-prescribing is its ability to benefit patients. Improving patient safety, well-being, and satisfaction is a common goal among all clinicians and is very much desired when switching from pen and paper to e-prescribing. The most common problem with written prescriptions is the possibility for error, ranging from either the inability to read the handwriting to a severe drug interaction. The health industry is constantly looking for ways to decrease these errors and using an e-prescribing system that addresses these problems is the way to go. One example of a system in use would be the use of the ViewSonic Wireless Tablet Client used at the Riverside Medical Clinic in California. Physicians are provided with the hardware and software to write “electronic prescriptions that can then be faxed, printed, or e-mailed to patients or directly to pharmacies” as well as “[identifying] possible drug interactions and whether drugs are covered by a patient’s insurance plan.” (ViewSonic V210 Helps Medical Clinic Write A Better Prescription, 2006) It is important to provide these doctors with a way to write prescriptions while in the room with the patient and have it immediately sent to the pharmacy, greatly improving productivity.
Reducing prescription errors and increasing patient safety is another important aspect health professionals will look for in an e-prescribing vendor. According to the Institute of Medicine, “preventable medication errors result in more than 7,000 deaths each year in hospitals alone and tens of thousands more in outpatient facilities.” (Make No Mistake: Medical Errors Can Be Deadly Serious, 2000) This is a very serious problem and e-prescribing vendors are searching for ways to address this issue, by providing software that will help to decrease the possibility of errors. Studies have found that “overall prescribing errors have been reduced by about 83% when using electronic prescription systems”, proving to be a good choice for clinicians. (Bollen, 2001) One such vendor, Health Communication Network, an Australian company providing e-health solutions to medical companies, was very effective in decreasing the number of prescription errors and fall rates in one study done at a residential aged care facility. Prescribing in such a facility was seen as more unsafe than in other facilities due to the complexity and number of the medicines the patients were taking. (Bollen, 2001) This leads to an increased chance for major and severe drug interaction as well as a slower recovery time. Providing this facility with prescription management software not only helped reduce medical errors but “improved awareness of safety and quality issues with regard to medication usage.” (Sardinha, 1998)
Looking to change the way prescriptions are prepared and accessed, healthcare professionals are seeking to implement electronic prescription software complete with the capability to check for interactions with other drugs, diseases, or allergies as well as ensure the correct dosage is given. Major patient based concerns lie with improving patient safety and overall care as well as reducing the chance for error and drug interaction.
Benefits and Problems of Electronic Prescribing
A huge benefit to electronic prescribing is the PocketScript program. This will enable physicians, through a wireless handheld PDA, to write prescriptions and then send them immediately and electronically to pharmacies. This will help to improve patient convenience. Additionally, physicians save time and money using PocketScript with the bi-directional renewal capability. With PocketScript, pharmacists initiate requests routes through an office staff member prior to review and approval by the physician. With electronic prescriptions, pharmacists will be able to initiate renewal requests. Both physicians and pharmacists are able to expedite the processing of prescription requests quicker than the traditional methods of writing scripts, calling in orders over the phone or sending a fax.
During the prescribing process, in real time, the application provides formulary information, a drug reference guide, drug-to-drug and drug-to-allergy checking, and patient-specific drug-dispensed lists. PocketScript(R) e-prescribing service reduces costs and improves patient care by automating the prescription process between payers, doctors, and pharmacies. Another company that shows good pros for electronic prescribing is iScribe which allows you to instantly access critical health information at the point of care, securely access patient medication histories, easily ascertain formulary information for all the patients in your practice, and reduce pharmacy phone calls with online refills and renewals. iScribe electronic prescribing allows you to write prescriptions, access formulary information and print or transmit legible prescriptions using your Palm OS-compatible PDA.
With iScribe Electronic Prescribing, you can:
· Generate prescriptions from approximately 6,000 drug formulations and medical supplies.
· Easily customize prescription-specific signatures to quickly generate prescriptions.
· Effortlessly check formulary status and alternatives at the point of care.
· Print prescriptions in office (Infrared or Bluetooth) or transmit directly to the pharmacy.
· Build your database of patient medication histories on the handheld for easy reference and simplified renewals.
· Automatically check for drug-to-drug interactions.
· Complementary Web-based tool provides formulary searching for you and your practice staff. (Hot Stocks Set For Gains, 2006)
But as always there is a down side to every story and for this one it’s the cons for electronic prescribing. And a con for this could be a wrong patient name may be selected from a list or patient ID information may not be displayed on each new screen. More things include: wrong diagnosis may occur for a patient causing some serious problems plus if not picked up on in time. Errors can be easily avoided with alerts, although sometimes these alerts are inactivated or ignored.
Solutions for Electronic Prescribing
Many issues hinder the proper and successful adoption of electronic prescribing. Some physicians complain that finding information about information technology is hard to find. This presents a problem. All kinds of information is available, but there is no real and easy way to access it. Once a physician actually finds information about electronic prescribing and other information technology options, usually the tools are too costly. These high costs can be attributed to software, training, up keep, and initial programming. How can we make electronic prescribing more affordable? It is a fact that electronic prescribing limits the amount of prescribing errors. Even if a health care facility can afford electronic prescribing, there is still hesitation in the form of previous experiences or negative assumptions. In this section you can see solutions to help fix or soften some of the issues prohibiting adoption of electronic prescribing.
In a relatively recent article titled, Medical Informatics in Neurology, Dr. Sami R. Hamid said that “Despite the tremendous growth of the Internet and the vast amount of information available to medical practitioners, busy physicians (especially those in clinical practice) have little time to spend exploring the Internet. In some cases, physicians simply do not know how to access required medical information in the best and fastest possible way. Many physicians do not know how beneficial the Internet can be for their medical careers, especially in such areas as patient care, academic work, or research”. (Hamid) This problem more or less is defined by information overload. In our society information is in great abundance. There is no real way to find exactly what you want. It is beginning to become harder and harder to find accurate information. Doing a simple search for electronic prescribing can take several hours. There is a need to refine the search several times before you get the information you are looking for. Physicians cannot make an opportunity cost to take time away from patients to complete research. This information should be presented to them. The information should come to them in the way of external entities like medical information technology agencies or even snail mail. All information that can make a healthcare facility run more efficiently by adding things such as electronic prescribing should be handed to these facilities. If this means there should be standardization similar to like the Internet protocols, than steps should be taken. Ideally there should be a single entity that overseas all electronic prescribing. This would limit the amount of integration problems between facilities and pharmacies. There is a clear importance, according to Dr. Randeree “Medical Errors kill between 44,000 and 98,000 people each year.” (Randeree, 2007)
Cost is the number one concern for virtually every aspect of medical information technology. Based on Dr. Burke’s information, money from healthcare is not focused on healthcare information technology. (Burke, 2006) In fact information technology spending in the financial sector is seven times higher than that of healthcare! Is the health of our people not important? To help this funding issue there happens to be electronic prescribing technology strides being made to make those services available to facilities for free. Termed the National E-Prescribing Patient Safety Initiative (NEPSI), the project will be led by clinical information technology provider Allscripts. The NEPSI program intends to provide physician’s free access to a web-based e-prescribing software program called eRx NOW. The Allscripts designed software requires no download and no new hardware. (Pizzi, 2007) This company is acquiring support from huge technology giants such as Microsoft, Cisco Systems, and Dell Computer. This is the kind of exposure that is needed to help convert non-electronic prescribing facilities to use prescribing technologies. Because no downloads or hardware is needed, this makes adopting this technology very easy and cheap. It will not stop here. More and more companies will start to follow the footsteps of NEPSI, and create their own free or other electronic prescribing technology. The solution is for all healthcare facilities to use the tools available. In the same article, Dr. Namcy Dickey said, “Medication errors and adverse drug events could be virtually eliminated with this technology, which could save the healthcare system $27 billion.” (Pizzi, 2007) If that is not an incentive to change, then I don’t see there ever being a significant change.