Thursday, December 01, 2011

Electronic Prescribing and Prescription Transmission Seems To Be Working In the US. A Bit Different Here I Suspect.

This interesting report appeared a little while ago.

eRx worthwhile, but still problematic for docs, pharmacies

November 22, 2011 | Mike Miliard, Managing Editor
ROCKVILLE, MD – A new study by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality finds that physician practices and pharmacies are both keen on e-prescribing's ability to improve safety and save time – but that both groups face barriers to realizing its full benefit.
The study, published online in the Journal of the American Medical Informatics Association, focuses on the electronic exchange of prescription data between physician practices and pharmacies, which can save time and money by streamlining the way in which new prescriptions and renewals are processed. It finds that e-prescribing helps reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions.
Physician practices and pharmacies generally were positive about the electronic transmission of new prescriptions, the study found. But prescription renewals, connectivity between physician offices and mail-order pharmacies, and manual entry of certain prescription information by pharmacists – particularly drug name, dosage form, quantity, and patient instructions – continue to pose problems.
"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 AHRQ Director Carolyn M. Clancy, MD. "This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients."
Researchers at the Center for Studying Health System Change in Washington, D.C., conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies using e-prescribing. Community pharmacies were divided between local and national companies.
Physician practices and pharmacies used e-prescribing features for electronic renewals much less often than for new prescriptions. More than 25 percent of the community pharmacies reported they did not send electronic renewal requests to physicians. Similarly, one-third of physician practices had e-prescribing systems that were not set up to receive electronic renewals or only received them infrequently.
Physician practices reported that some pharmacies that sent renewal requests electronically also sent requests via fax or phone, even after the physician had responded electronically. At the same time, pharmacies reported that physicians often approved electronic requests by phone or fax or mistakenly denied the request and sent a new prescription.
.....
The study, "Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies," is available at jamia.bmj.com.
Lots more here:
Here is the abstract:
J Am Med Inform Assoc doi:10.1136/amiajnl-2011-000515
  • Research and applications

Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies

  1. Joy M Grossman,
  2. Dori A Cross,
  3. Ellyn R Boukus,
  4. Genna R Cohen
  • Received 29 July 2011
  • Accepted 15 October 2011
  • Published Online First 18 November 2011

Abstract

Objective A core feature of e-prescribing is the electronic exchange of prescription data between physician practices and pharmacies, which can potentially improve the efficiency of the prescribing process and reduce medication errors. Barriers to implementing this feature exist, but they are not well understood. This study's objectives were to explore recent physician practice and pharmacy experiences with electronic transmission of new prescriptions and renewals, and identify facilitators of and barriers to effective electronic transmission and pharmacy e-prescription processing.
Design Qualitative analysis of 114 telephone interviews conducted with representatives from 97 organizations between February and September 2010, including 24 physician practices, 48 community pharmacies, and three mail-order pharmacies actively transmitting or receiving e-prescriptions via Surescripts.
Results Practices and pharmacies generally were satisfied with electronic transmission of new prescriptions but reported that the electronic renewal process was used inconsistently, resulting in inefficient workarounds for both parties. Practice communications with mail-order pharmacies were less likely to be electronic than with community pharmacies because of underlying transmission network and computer system limitations. While e-prescribing reduced manual prescription entry, pharmacy staff frequently had to complete or edit certain fields, particularly drug name and patient instructions.
Conclusions Electronic transmission of new prescriptions has matured. Changes in technical standards and system design and more targeted physician and pharmacy training may be needed to address barriers to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions.
The full paper is here (free).
It is interesting to note that as of a few weeks ago over 50% of use physicians were using electronic prescribing and prescription transmission.
See here:
It really seems the US has their act together in this area - while we still seem to be trying to sort out Standards and have a couple of presently non-interoperable prescription transmission providers.
This is an area where the leadership from DoHA has been just woeful to say the least.
This from DoHA in June 2008 says it all!

KPMG CONSULTANCY IN ELECTRONIC PRESCRIBING AND DISPENSING

JUNE 2008

DEPARTMENT OF HEALTH AND AGEING RESPONSE

The Department of Health and Ageing considers electronic prescribing (ePrescribing) to be an important element of the national eHealth strategy and one that has the support of a large range of stakeholders.
The development of technical and business process standards for ePrescribing and dispensing of medications will serve as building blocks for broader opportunities arising from developments in medication management systems and individual electronic health records.
A number of amendments to State and Federal legislation have already been enacted across jurisdictions to enable ePrescribing systems to be implemented.
It is in this context that the Department of Health and Ageing in December 2007 contracted KPMG to undertake a research and consultation process to develop a national ePrescribing framework.
The KPMG report titled “Consultancy in Electronic Prescribing and Dispensing of Medicines (ePrescribing)”, finalised in June 2008, identifies strategic, technical and operational perspectives for developing ePrescribing across the various prescribing settings, namely: general community, private and public hospitals and the aged care sector.
The report provides an overview of the emerging issues in Australia, considers past experiences, international developments and broad stakeholder views in formulating a guide to the development of standards and guidelines for nationally consistent ePrescribing systems.
The process undertaken by KPMG was robust and importantly included substantial stakeholder consultation and investigation of the key issues.
The report identifies a number of implementation steps to support a nationally consistent ePrescribing systems environment.
The four key recommendations made in the report (page 6) are accepted by the Department of Health and Ageing and will be progressed in conjunction with broader eHealth initiatives.
A full copy of the KPMG report can be found at  www.health.gov.au
----- End Release
Almost 3.5 years later just where are we? We have the Pharmacy Guild and Medisecure / RACGP competing for the market and the Commonwealth incentive funds.
The Australian Standards are still in draft and contentious and progress is less than optimal!
This really could have been done just so much better!
David.

3 comments:

Anonymous said...

Equally as important as the KPMG Report is the VIC DCPC Report May 2008 and the Victorian Government’s responses which leave me scratching my head in bewilderment.

On the one hand we see state and federal government’s throwing hundreds of millions of dollars around and achieving next to nothing in the development of an electronic prescription service whilst turning a blind eye and a deaf ear to the private sector’s attempts to deploy an EPS.

In the Government’s response to some recommendations made by the DCPC one reads:

1. “An electronic prescription service would be a necessary pre-requisite for the development of a national electronic ‘real time’ prescription recording service that would be available to medical practitioners and pharmacists, and as such is strongly supported by the Victorian Government.”

2. “In pursuing a national approach, Victoria would be prepared to take a leading role in implementing the service, as it did in the previous Commonwealth initiative in this field (Mediconnect) in which the Victorian Department of Human Services and the Commonwealth Department of Health and Ageing jointly undertook a trial in Ballarat”

3. “The Victorian Government does not support the development of an electronic prescription service on a state-wide basis, but rather, supports the development of a national system of electronic prescribing.”

As for”
Point 1 - Duuuhh – strongly supported!! Pull the other leg.

Point 2 – Duuhhh – MediConnect – we all know what a dismal failure that turned out to be.

Point 3 – excuse me – perhaps if a state-wide system had been developed as a first step we might now have a working system right across the nation. Perhaps is the operative word. The Victorian Ombudsman’s report last week into Government managed IT projects like MYKI and HealthSmart, etc, suggests ‘perhaps’ is too kind a word to use.

Anonymous said...

I think it fair to say the Victorian Government got something right when it said an electronic prescription service is a pre-requisite for the development of a national electronic ‘real time’ prescription recording service

…. well, we have 2 EPS’s in Victoria right now,

... so why doesn’t the Victorian Government support their extension to develop a state-wide “electronic ‘real time’ prescription recording service” that could then be extended nationally?

Anonymous said...

You ask why? Because they are waiting for NEHTA never ever happening - terrible attitude