Good Medicine: E-Prescribing
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Electronic prescribing improves patient safety and increases efficiency by providing important drug information at the point of care.
Fam Pract Manag. 2002 Oct;9(9):63-64.
I suspect the first joke about physicians’ illegible handwriting was told shortly after the first prescription was written on a clay tablet. A few thousand years later, computer technology has finally given us the answer to poor penmanship. Prescribing software for personal digital assistants (PDAs) and desktop computers not only reduces the likelihood that prescription orders will be misinterpreted, it also promotes safe prescribing practices.
Our office of four physicians and one physician assistant began using electronic prescribing almost two years ago. To date, we’ve processed over 33,000 prescriptions and faxed approximately half of those directly to patients’ pharmacies. We use Allscripts prescribing software (www.allscripts.com), a database server, a desktop computer and Compaq iPaq pocket PC units that communicate with the server via a wireless local area network. [See "E-prescribing software" for more information.] The service costs approximately $50 per physician, which we feel is quite reasonable, considering prices of comparable systems today. Pricing depends on the number of physicians using the system and the sophistication of the software. Options and costs continue to change rapidly.
Our physicians use the pocket PCs to “write” or refill prescriptions at the point of care. The software gradually builds a database of patient- and physician-specific information that includes frequent diagnoses and frequently prescribed drugs. After four or five months, we could write or refill common prescriptions faster than we could handwrite them. Our nurses use the desktop computer to process refill requests.
Our primary motivation in undertaking electronic prescribing was to get a taste of office automation without having to buy a complete electronic medical record (EMR), but we’ve realized a number of other important benefits in the process.
Our software has built-in safety features: It automatically cross-checks newly prescribed medications with the patient’s allergy and medication history to guard against interactions. It also provides clinical decision-making support at the point of care. For example, the software automatically prompts us through a menu of accepted dosages and formulations for individual medications, eliminating guesswork and time-consuming searches.
Before we switched to electronic prescribing, I sent questionnaires to local pharmacists to get their input. I had a firm grasp of how electronic prescribing could increase patient safety in the office, but needed to understand whether it could reduce errors once patients’ prescriptions left the office. Many pharmacists and pharmacy technicians who responded agreed that electronic prescribing would cut down on the number of errors made trying to decipher physician handwriting. Recently, I spoke to several pharmacists who’ve filled our patients’ prescriptions over the past two years and they unanimously agreed that computer-generated prescriptions reduce errors not only because they are easier to read, but also because more information can be put on the prescription order.
It took a few months for us to fully implement electronic prescribing in our office. The company offered assistance for the first few days, but after that, users gradually brought on board other physicians, nurses and front office staff. Our entire office staff adapted well; some have developed an especially deep understanding of various aspects of the system. And although we’ve had to upgrade some hardware and software, downtime has been minimal. I’d estimate overall reliability of the system to be about 98 percent.
Patient acceptance has been quite uniform. We often demonstrate to patients how electronic prescribing enhances their safety, for instance by automatically checking dosages and crosschecking for interactions with other drugs they may be taking. Most intuitively grasp why computer-generated prescriptions are more desirable than handwritten ones (perhaps they’ve heard a joke about physician handwriting) and they appreciate the convenience of having prescriptions faxed to the pharmacy.
There is almost no question that electronic prescribing has led to increased office efficiency, especially when refilling multiple medications for a patient (which requires only a tap of the stylus on the name of a drug) and when processing patients’ refill requests (no more calling the pharmacy only to be put on hold). Another unexpected advantage of electronic prescribing is that implementing it has taught us to work as a team. I believe this will serve us well when we try to implement other, more complex systems, such as an EMR.
Allscripts (www.allscripts.com); Windows CE compatible.
Doc-U-Scrip (www.docuchart.com/products.htm); Windows CE compatible.
ePhysician (www.ephysician.com); Palm compatible.
iScribe (www.iscribe.com); Palm compatible.
Medemorphus (www.medemorphus.com); Windows CE compatible.
PocketScript (www.pocketscript.com) Windows CE compatible.
And some surprises
We’ve also realized that electronic prescribing isn’t error-proof and that automation can introduce its own set of problems. For example, we learned the hard way that some pharmacies ignore their fax machines, keep them in poor repair or forget to refill the paper. This has led to callbacks and questions from both patients and pharmacies. We have gradually learned which pharmacies we can fax to and which ones to avoid.
We also realized that if we’re not careful, it’s still possible to choose the wrong medications and wrong prescribing information. And, until we learned to customize the software, we found the warnings about drug interactions and side effects to be too broad to be of real use to us. And occasionally, printing patients’ prescriptions simultaneously has led to one patient receiving another patient’s prescription.
Nevertheless, I believe beyond a reasonable doubt that e-prescribing increases patient safety and that implementing it in our practice has been good medicine for us and for our patients. We’ve achieved a nice balance between improving patient safety and convenience, and improving our efficiency and our confidence in our prescribing practices.
Dr. Spikol is a family physician in Allentown, Pa.
Conflicts of interest: Dr. Spikol is a shareholder in Allscripts Healthcare Solutions.
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