E-prescribing: Using Technology to Prevent Errors

NOVEMBER 01, 2006
Sam Mahrous, PhD, MBA, CIS, and Muhannad Dalbik, PharmD Candidate

It is well-known that adverse drug events (ADEs) are among the leading causes of death in the United States. Several studies have reported that between 44,000 and 98,000 deaths each year are the result of some form of medical error.1 Medication-related errors are the number-1 contributor to these deaths.2

Former President Bill Clinton said in 1999, "Our health care system does wonders, but first must do no harm." 3 To minimize medical errors and the further loss of life due to them, Former President Bill Clinton called for the following changes in 1999:3

  • A $20-million Center for Quality Improvement to serve as a clearinghouse on medical errors
  • A 50% reduction in medical errors over the next 5 years
  • Patient safety programs to be installed and implemented in all hospitals
  • New packaging and labeling standards to be developed by the FDA

Yet, when the Institute of Medicine released its latest report on preventing medication errors in July 2006,4 the findings were alarming, as the number of ADEs had actually increased and become more costly. Although there has been no accurate study to calculate these costs, they are estimated to be about $3.5 billion a year, including lost time and lost productivity at work.

The IOM researchers examined many studies and found that ~400,000 ADEs occur in hospitals every year, all of which are preventable. In long-term care settings, >800,000 drug-related injuries have been reported each year, and among outpatient Medicare patients ~530,000 such injuries occur.

The IOM investigators recommended several steps to lower the number of medication errors and their related injuries. They advocated the use of available technologies and proposed that by 2010 all health care providers should use electronic prescribing systems.4

What Is E-prescribing?

Electronic prescribing (e-prescribing) refers to the practice of using a personal computer (PC), laptop, Tablet PC, personal digital assistant (PDA), or Smartphone to write and generate a prescription at the point of care.5 Handheld technology can offer a solution to the problems of illegible handwriting and overlooked drug interactions. This method of prescribing is growing in acceptance. It is increasingly replacing the "old-fashioned" method of doctors writing prescriptions on paper slips that are given to patients to be taken to the pharmacy for processing.5

E-prescribing is gaining popularity among health care providers because of its many benefits to all parties involved. Physicians, personnel with health care plans, third-party payers, pharmacies, and pharmaceutical companies, and especially patients can benefit from the ease, the efficiency, and, most importantly, the absence of errors from using this technology.

Figures 1, 2, and 3 show examples of a mobile e-prescribing system for physicians that uses a PDA. The technology is able to send prescriptions from the point of care to pharmacies via wireless transmission such as LAN, WiFi LAN, EVDO, and other wireless services, such as GPRS and EDGE technology.2,5,6

Characteristics of E-prescribing

Health care providers, by adopting and using e-prescription systems, will be able to generate legible copy of prescribed medications that can be sent to the pharmacy electronically, faxed, or printed with minimal error. They also can check for potential drug interactions, patient drug allergies, and possible drug duplications before the prescriptions are processed. E-prescribing is safer, faster, and more efficient than handwriting paper prescriptions because it eliminates the problem of illegible handwriting. It gives the prescriber the ability to perform formulary compliance by using decisionsupport systems, as well as an enhanced ability to transfer prescriptions.5

Other ways that e-prescribing can play a critical role in reducing medication errors are as follows:

  • Drug selection
  • Screening for interactions (drug-drug, drug-laboratory, drug-disease)
  • Links between laboratory and pharmacy
  • Dosing calculations and scheduling
  • Coordination between team members, particularly concerning patient education
  • Monitoring and documenting ADEs
  • Postmarketing surveillance of therapy outcomes7

Advantages of E-prescribing

As mentioned earlier, e-prescribing is efficient, fast, and reliable, and, most importantly, it is accurate. For physicians, e-prescribing will do the following:

  • Streamline the process of prescribing by providing important information about potential ADEs, drug interactions and allergies, duplicate medications, and formularies
  • Help reduce routine problem orders
  • Offer instant access to patient medication profiles in the doctor's office
  • Offer access to treatment guidelines
  • Enhance the refill-authorization process
  • Help lower medical malpractice insurance premiums
  • Allow the physician to retrieve information on specific medications prescribed to patients in the event of a legal matter2,5,7

Other benefits include dose checking, more legible orders, industry-wide standardization, and documentation of interventions in the event of ADEs.5

Drawbacks of E-prescribing

Although e-prescribing has great potential to reduce medication errors, some health care providers and prescribers have noted some concerns. Some of the questions that need to be addressed are as follows:

  • Will a procedure that usually takes 15 seconds to complete be exchanged for one that takes about 50 seconds?
  • Will providers select the pharmacies to which the prescriptions are sent?
  • What if a prescriber's office lacks Web access or high-speed wireless services?
  • What about variations among states' medical practice regulations?
  • Will patients accept leaving an office without an Rx?2,5

Technical Obstacles to E-prescribing

The idea of using technology to reduce medication errors is viable and feasible. Yet, health care providers need to be aware of some of the technical obstacles to e-prescribing so that they can be better equipped to overcome them. These obstacles include the following:

  • A lack of standards for systems to communicate among themselves
  • Lack of interfaces to current practice- management systems
  • Lack of electronic data interchange infrastructure between prescribers and pharmacies
  • Too many software vendors, with no regulations yet
  • Differing hardware setups
  • Physicians' lack of interest
  • Anticipated costs that involve new investments and training2,5,7

Key Components of an Ideal E-prescribing System

The key to success in reducing medication errors is to have all relevant databases pertaining to patients available to practitioners at the point of care. Such a system should interact with the following databases:

  • Patient-specific data: allergies, International Classification of Diseases codes, medication history, etc
  • Patient's laboratory work
  • Insurance companies and third-party payers
  • Current Procedural Terminology codes and diagnosis
  • Drug information and clinical guidelines
  • The patient's electronic medical records
  • Billing functions
  • Patient scheduling system2,5

Final Words

The development of standards for eprescribing is an important step forward to ensure that all health care providers will be at ease using such a system. The industry is moving toward a common system for physicians that will make it possible for all practitioners to communicate without the need for many differing systems on hand.8 The goal is to develop one system that can be universally used by doctors, insurance companies, and pharmacists. Also, health care providers are working toward the development of compatible interoffice technology, as well as interoperability across health care settings.

A greater emphasis should be placed on the importance of uniform standards that will make the system able to access all clinical databases and allow e-prescribing to take place within one effective system and not several subsystems. The future of e-prescribing is exceptionally promising in regard to helping reduce medication errors and allowing pharmacists to focus more on improving clinical outcomes for patients.7

Dr. Mahrous is an associate professor of pharmacy administration and preclinical education at Midwestern University's College of Pharmacy- Glendale and Arizona College of Osteopathic Medicine in Arizona. Mr. Dalbik is a PharmD candidate at Midwestern University's College of Pharmacy-Glendale.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Rybovic, Pharmacy Times, Ascend Media Healthcare, 103 College Road East, Princeton, NJ 08540; or send an e-mail request to: arybovic@ascendmedia.com.