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Wednesday, February 06, 2008

e-Prescribing – A Strong Case Put for Adoption.

The following article appeared a few days ago.

ePrescribing and its Impact on Care Management

Marybeth Regan, PhD, for HealthLeaders Media, January 28, 2008

New technology is being introduced every day in the healthcare industry, which impacts the manner in which providers deliver care. Impacts may be positive or negative, depending on the technology and the way in which it is implemented and supported. The goal is to implement the right technology at the right time, in the right way, so patients are receiving higher quality care, delivered in a safer environment and in a more efficient manner.

In the ideal scenario, prescriptions would be checked against a patient's current medications, allergies, diagnoses, body weight, and age for possible interactions, appropriateness, and dosage. Prescriptions would be legible and patient information about their medications, including indications, properties, side effects and instructions for administration, would be dispensed with the medication. A permanent record would be created that included all of the patient's medication history over time. Not only would prescription data be available on orders, but also that the prescription was refilled. Patient adherence to medication regimens can be improved through a closed-loop communication of refill data to both payers and physicians.

ePrescribing is an interactive data transaction that allows the prescriber to see a complete profile of the patient's medication with software inputs allowing the physician to check formulary status, any administrative limits (Rx limits per month, days supply limits, etc) and clinical edits (drug/drug interactions, disease drug interactions, dose checks, etc.)

ePrescribing is greater than just process improvement. ePrescribing has the possibility of impacting clinical outcomes for the positive. Prescribing medication is the physician's most frequently used, efficacious, and potentially dangerous therapeutic tool, outside of surgical interventions. The proper or improper use of prescription drugs has a profound effect on patient outcomes. And, because prescription drugs are expensive, the physician's selection of drugs has a major impact on the cost for payers and employers. The management of prescription medications directly or indirectly affects every stakeholder in healthcare.

The bulk of the over 3.27 billion prescriptions issued in United States last year were still written manually, generating the need for an estimated 150 million phone calls from pharmacists to physicians' offices for clarification of handwriting, dosing, and other issues. Up to 40 percent of prescriptions require reworking at the retail pharmacy before they are dispensed to the patient. Medication errors are currently responsible for an estimated 7,000 deaths per year, and approximately $77 billion is spent annually on treatment of adverse drug events.

ePrescribing can benefit patients, physicians and pharmacists by significantly decreasing medication errors, reducing the incidence of adverse drug reactions, saving physicians and pharmacists valuable time now spent on non-clinical administrative tasks, and enabling payers to improve formulary program compliance--collectively saving millions of dollars while potentially increasing patient and physician satisfaction.

Doctors' hieroglyphic handwriting and prescription pads could soon be a thing of the past. Electronic drug prescriptions can now be delivered to pharmacies in all 50 states.

It is no longer appropriate to manage pharmaceutical therapies and costs independent of overall medical care, as prescription drugs have become an indispensable part of modern treatment regimens. By 2010, prescription drugs will account for about 16 percent of overall healthcare costs, according to Hewitt Associates, but this underestimates their impact on costliness, because pharmaceutical care also influences the use of inpatient, outpatient and emergency room services.

ePrescribing takes a process laden with numerous workaround steps and streamlines it to offer significant clinical improvements. Experience teaches us that the greatest problems do not involve technology, but rather are due to organizational issues and human factors. At the end of the day, it is human will--political, professional, and personal--that must drive the technology if it is to serve the users.

Continue reading this excellent article here:


A very useful part of the analysis presented is the following assessment of benefits:

“All of the stakeholders benefit from ePrescribing; listed below are the stakeholder benefits;


  • Improved patient safety and accuracy
  • Better formulary adherence
  • Streamlined communication of prescriptions to pharmacies
  • Improved patient satisfaction, through rapid prescription fulfillment, less visits to the pharmacy and fewer errors


  • Increased safety and accuracy
  • Improved access to data--Rx History
  • Improved decision support
  • Increased patient satisfaction and peace of mind
  • Potential decreased premiums for malpractice insurance.
  • Enhanced efficiencies through decreased callbacks to pharmacies through illegible prescriptions, non-formulary medications, potential drug interactions, incorrect dosages, renewal requests and others


  • Reduced errors due to misinterpretations or data entry mistakes
  • Avoided unnecessary phone calls
  • Increased processing efficiencies
  • Improved customer relationships

Health Plan/Employers

  • Control increasing pharmacy cost
  • Improved formulary adherence and generic drug utilization
  • Future opportunities for disease management and patient compliance
  • Reduction in costs associated with adverse drug events
  • Improved access to data on physicians prescribing patterns and patient medication profiles
  • Improved patient adherence to therapeutic regimens
  • Reduced healthcare costs
  • Healthier, more satisfied workers
  • Potential reduced claim losses”

While some of the suggested benefits are a little US centric a lot of this list is on the money (sorry!).

It is really amazing that such useful and proven technology is taking so long to be deployed in Australia.

With NEHTA’s currently announced time frames (mid 2009 for the IHI etc.) it seems it will be a good while yet. The opportunity costs in all this are just enormous!

Dr Regan makes a very compelling case that Australian policy makers should be taking notice of.


1 comment:

Anonymous said...

Interesting, in 2006 I spoke with a PhD student at Syd Uni who was investigating e- prescribing. One of the things she mentioned was the error produced when doctor's don't pay attention to what is selected from the drop down menus or mistype the dosage and then in their rush remove it from the printer, sign it without carefully reading the script and then hand it to the unsuspecting patient. It happened to me too, as a patient!