e-prescribing: e-fficient, but still e-lusive?

Electronic prescribing or e-prescribing, has multiple potential benefits, including helping to reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions.  However, according to a study funded by the U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ),  neither prescribers, pharmacists or indeed patients are getting the full benefit of the technology.

The study, published online in the December issue of the Journal of the American Medical Informatics Association focused on a key aspect of e-prescribing: the electronic exchange of prescription data between physician practices and pharmacies. This practice can save time and money by streamlining the way in which new prescriptions and renewals are processed. The study showed that while physician practices and pharmacies were generally positive about electronic transmission of new prescriptions and prescription renewals, connectivity between physician offices and mail-order pharmacies continue to pose problems. Additionally problematic is manual entry of certain prescription information by pharmacists, for example, the drug name, dosage form, quantity, and patient instructions.

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, M.D. “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, conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies using e-prescribing. Physician practices and pharmacies used e-prescribing features for electronic renewals much less often than for new prescriptions. More than a quarter of the community pharmacies reported that 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 noted that resolving e-prescribing challenges will become more pressing as increasing numbers of physicians adopt the technology in response to federal incentives. Physicians can qualify for Medicare and Medicaid electronic health record incentive payments by generating and transmitting more than 40% of all prescriptions electronically.

The study concludes that a broad group of public and private stakeholders, including the federal government, e-prescribing standard-setting organizations, vendors and others will need to work together to address these issues.

Do you have any experience, good or bad with e-prescribing?  Let us know.

Medicines Use(less) Reviews

SRxA’s Word on Health brings you news of a great idea gone bad!  Six years ago the UK National Health Service (NHS) introduced Medicine Use Reviews (MURs). Run by community pharmacists, MURs were designed to help patients understand how their medicines should be used and why they have to take them, identify any problems and, if required, provide feedback to the prescriber.

In addition, they were supposed to improve patient compliance and the clinical and cost effectiveness of medicines by reducing medicine wastage which is estimated to cost the NHS £100 million a year. However a damning new study by pharmacy researchers at the University of Nottingham found that they’d failed to achieve either clinical or cost effective improvements. And this failure didn’t come cheap.  1.7 million MURs were conducted between 2009 and 2010 at a cost of £28 ($44.63) per review.  In that period, the total cost to the NHS was £47.6m ($76 million).  Multiply that by the six years the scheme has been running and you’re talking close to $300 million. As part of the review, researchers carried out five weeks of observation in two retail pharmacies, during which 54 MURs were observed and 34 patients were interviewed about their experience of the MUR. Patients with any condition were invited for MURs rather than those with complex conditions and medicine regimes who may benefit most, the study found. They also found that pharmacists responded to pressures to complete the MURs quickly so that they could return to “routine” duties by adopting a scripted, formulaic approach. Complex medicine-related issues that did arise were circumvented by the pharmacist and so the opportunity to improve the clinical management of the patients’ medicines was lost. Moreover, most patients revealed that they already felt adequately informed about their medicines, and there was no evidence of a reduction in the wastage of unused medicines. Asam Latif, a researcher in pharmacy practice at the University of Nottingham, concluded: “There was little evidence that MURs in practice demonstrated improvements in the clinical or cost-effectiveness of patients’ medicine use or reduced waste.”  Ouch!