Overcoming the challenges and realizing the benefits of e-prescribing

Electronic prescribing (e-prescribing, or eRx) is designed to bring advantages to doctors, insurance companies, pharmacies, and patients.

The benefits include:

• Patient safety
• Easy prescribing
• Improved efficiency
• Cost reduction

Still, when it comes to e-prescribing, some of the main hurdles that providers face include training, cost, the potential for errors, and concerns about privacy and sharing data.

To allay those fears, it is important to understand exactly what e-prescribing is, what its benefits are, and how practices can overcome those perceived challenges.

What is e-prescribing?

E-prescribing is defined by the US Centers for Medicare & Medicaid Services (CMS) as:

[…] the transmission using electronic media, of prescription or prescription-related information between a prescriber, dispenser, pharmacy benefit manager, or health plan, either directly or through an intermediary, including an e-prescribing network. E-prescribing includes, but is not limited to, two-way transmissions between the point of care and the dispenser. (CMS)

Through meaningful use guidelines, financial incentives, and penalties, CMS has helped increase the adoption of e-prescribing among prescribers and pharmacies alike. E-prescribing has a foothold in the American healthcare continuum, but for it to truly thrive, practices need to overcome the aforementioned challenges.

Challenges of e-prescribing

Patient safety

People make mistakes. Human error is unavoidable. But, when it comes to prescription mismanagement, mistakes are unacceptable. At worst, an error in prescribing could be deadly. If not, it can still lead to unwanted symptoms, side-effects, and non-deadly threats to patient health.

This is where sharing of patient data from EHRs comes into play. Doctors need to be aware of a patient’s complete medical history to avoid conflicting medications and treatment plans, particularly in an age where comorbidity is so heavily on the rise. The most common e-prescribing mistakes found in research include errors in quantity, directions, dosage, dosage form, days' supply, drug, and even patient name.

These errors can be caused by a few different things. Some studies have pointed out that drop-down menus and picklists in e-prescribing systems can make it easy to choose the wrong information. There can also be discrepancies within an electronic prescription. For example, the dose in a structured field might not match the dose typed into a free-text field. A doctor might pick a dose from a drop-down menu and then type a different one in an "additional instructions" field.

Manual errors and the consequences of a subpar EHR

Common causes of mistakes in e-prescribing include manual error and lack of training, but bad EHR software also plays a major part. If the software was not designed with intuitive prescribing in mind, it causes workflow inefficiencies and does nothing to help with error management.

When your practice considers its EHR, put a focus on easy e-prescribing and strong implementation.

Consider how unintuitive or poorly designed software impacts these common errors:

• Wrong drug, pharmacy, or patient: It can be easy to select incorrectly from drop-down menus.
• Incorrect directions or conflicting information: Be careful about auto-populated fields. It could be incorrect data carried over from prior prescriptions.
• Wrong quantities: Some software systems require a quantity of the prescription, even if the providers are unaware of this. This causes the wrong quantities to be dispensed.
• Refill errors: Watch out for wrong refill information. Using old refill prescriptions as templates can cause the wrong data to auto-populate.
• Incorrect physician or patient selected by pharmacist: Providers and patients appear differently in order entry and pharmacy databases, so pharmacists may guess—incorrectly—when multiple choices appear.
• Errors associated with modified prescriptions: Try not to send a revised prescriptions back-to-back. If a provider makes a mistake on a prescription and sends it again, it may be unclear to the pharmacist which one to use.
• Incomplete processing of all prescriptions for a single patient: Prescriptions for the same patient may not arrive at a single time or may be mixed with those of other prescriptions.

Training

E-prescribing is much more than a replacement for a paper script pad. Robust eRx systems include a wealth of information that can help patients, prescribers, and support staff both from the perspective of workflow (time) as well as adherence.

The adoption of an e-prescribing solution should be largely determined by the ease of use of the product and the training provided.

If doctors struggle to use their system, errors occur. This leads to frustrated patients or impacts to a patient’s health and wellbeing! If not properly trained, providers might find themselves resorting back to an older, more problematic process.

For example:

• More and more medications require prior authorization from insurance companies or pharmacy benefit managers (PBMs) due to costs and rules, but this incredibly burdensome process has seen many advancements in automation as result of e-prescribing.
• Still, despite the benefits, many prescribers continue to fall back on paper systems that cost their staff time and delay therapy. The time spent to help get patients their medications is uncompensated, so it is worth spending a few minutes learning the new processes. Even if there is still variability according to PBM processes, etc., it is still better than time-consuming faxing and phone calls.

Positive outcomes of e-prescribing

Fortunately, the benefits of e-prescribing definitely beat out the alternative. Paper prescribing is tedious, time consuming, and riddled with errors.

Improved prescribing accuracy and efficiency

Even at its onset, the intention of e-prescribing was to prevent medication errors that arise due to difficulties in reading or understanding handwritten prescriptions. Though earlier we talked about some common but avoidable errors in e-prescribing, this is nothing compared to the errors seen as result of the slow-paced, cumbersome process of paper prescribing.

According to the FDA, more than 95,000 prescription drug errors have occurred since 2000, mainly due to mistakes when reading a handwritten prescription and dispensing a similar sounding, different drug.

Overall, e-prescribing is quicker and patients appreciate not only the speed of the prescription delivered, but also the prescription reminders and information provided within their patient portals. 

Financial incentives

To speed up the adoption process for e-prescribing, CMS implemented a drug benefit program. Since 2009, e-prescribing systems have been required to comply with CMS standards on medication history, benefits information, and fill status notification. To participate in the benefit program, providers must use one of these qualified eRx systems and report on any use within in the system. Providers additionally have to meet eRx reporting criteria specified by CMS.

How your EHR vendor should help with e-prescribing

Your EHR vendor should be helping—and definitely not hindering—every aspect of your practice from charting to billing, patient satisfaction, provider happiness, and more.

Regarding eRx systems, your EHR should have:

• Auto refills: Can your EHR enable the automation of prescription renewal requests and refills? Instead of patients having to remember to call or visit the clinic for refills, the EHR system can send automated reminders when their medications are due for renewal. This feature reduces administrative burden, improves patient satisfaction, and ensures continuity of care.
• Real-time benefit information: eRx systems should show real-time benefit information that can potentially lower the cost of equally efficacious medications for the patient. Lower costs mean that the patient is more likely to fill and take the medication. Cost is a top barrier to adherence.
• Prescribing shortcuts: Rapid prescribing is a possibility. Shortcuts, saved and weighted preferences, the ability to see short lists of commonly prescribed medications for specific conditions, drug-allergy/drug-drug interaction/cross-sensitivity alerts, and formulary information all help save providers time! 
• RxChange: Taking away one of the common errors faced with e-prescribing, RxChange delivers the ability to receive and respond to change requests from pharmacies. For example, providers using RxChange can easily update a prescription to generic or alternative therapies if the initial medication was unavailable.
• Responsive EHR: By now, a mature EHR vendor should have refined its system and workflows to be responsive—no screen refresh delays—and appropriately information-dense to reduce screen transitions. They should have focused on provider efficiency, eliminating unnecessary clicks or the effort required to link diagnoses manually, etc.
• Best practices: Avoid confusion and follow best practices such as utilizing alerts that physicians can quickly review for new medications. For example, the EHR should support ‘tallman’ lettering when appropriate to avoid mistakes.
• EPCS and PDMP integration: Are EPCS and PDMP integrated as part of your natural prescribing workflow? There is no reason why an e-prescribing system shouldn’t have, for example, information about other controlled substances prescribed at other medical facilities directly in the workflow of prescribing new ones.
• Real-time cost: Real-time cost information at point of care is a must for quicker care and better prescription adherence. Your EHR should help you understand a patient’s out-of-pocket costs and suggest alternative therapy choices that may be more cost effective.
• Patient information tools: Patient information tools can reach patients in convenient ways such as a mobile application. Use these tools to give patients important information about their medication, link across to cost-saving offers, provide relative cost information by pharmacy with locations, and more.
• Electronic prior authorization: Electronic prior authorization represents a huge time and cost savings for practices. In the past, prior authorization was only available by telephone, but now that the feature can be automated within the EHR, electronic transmission is growing rapidly as an essential e-prescribing enhancement. 
• Fill information: Did patients actually pick up their medication? A worthwhile EHR can share this fill information electronically.
• Sorting: Look for tools and worklists that make it easy for practices to sort and review medication information and delegate work according to protocols such as counselling, re-routing, refilling, etc.

A beneficial e-prescribing platform and a well-designed EHR go hand in hand. If you’re looking for an EHR that makes e-prescribing easier, CGM APRIMA is the leading choice.

Contact us to learn more about a full-featured, integrated solution for e-prescribing and more. Contact us about CGM APRIMA.

Sources cited

Causes and consequences of e-prescribing errors in community pharmacies - PMC (nih.gov)

Electronic prescriptions: opportunities and challenges for the patient | AHCT (dovepress.com)

Evaluation of the effectiveness of electronic prescription in reducing medical and medical errors (systematic review study) - PMC (nih.gov)

E-prescribing and medication safety in community settings: A rapid scoping review - ScienceDirect