Cutting costs and improving safety are two goals for health care in the United States, and electronic prescribing is one means of achieving both. But physicians and pharmacies face barriers to realizing the technology’s full benefit, according to a study funded by the U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ). The study was published online in the November 21 Journal of the American Medical Informatics Association.
Electronic prescribing, or e-prescribing, is expected to reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions. The study focused on the electronic exchange of prescription data between physician practices and pharmacies. While physician practices and pharmacies generally were positive about e-prescribing, prescription renewals, connectivity between physician offices and mail-order pharmacies, and manual entry of certain information by pharmacists — particularly drug name, dosage form, quantity and patient instructions — are problematic.
In the study, researchers at the Center for Studying Health System Change, 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.
The study results include the following:
- 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 not sending 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.
- About three-quarters of physician practices reported problems sending new prescriptions and renewals electronically to mail-order pharmacies. Many practices were unsure which mail-order pharmacies accepted e-prescriptions and believed that, even when a mail-order company did accept them, the process was unreliable.
- Pharmacies noted the need to manually edit certain prescription information, such as drug name, dosage and quantity. Both physicians and pharmacists reported that physicians must select medications with more specificity when e-prescribing and decide on options as packaging and drug form — decisions typically made by pharmacists for handwritten prescriptions.
- Nearly half of pharmacies reported having to rewrite patient instructions for patients to understand them.
The study noted that resolving these e-prescribing problems will become more urgent as more 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 to pharmacies electronically.
The study, “Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies,” concludes that a broad group of public and private stakeholders must work together to address these issues. Stakeholders include the federal government, e-prescribing standard-setting organizations, vendors and others. The study is available at http://jamia.bmj.com.
For more information, please contact AHRQ Public Affairs: (301) 427-1246 or (301) 427-1248.