Electronic prescribing

Electronic prescribing or e-prescribing (e-Rx) is the computer-based electronic generation, transmission and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, pharmacist, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.[1]

Functions

A "qualified" e-prescribing system must be capable of performing all of the following functions:[2][3][4]

Model

High-level dataflow diagram outlining the roles and processes involved in electronic prescribing

The basic components of an electronic prescribing system are the:[3]

  1. Prescriber - typically a physician
  2. Transaction hub
  3. Pharmacy with implemented electronic prescribing software
  4. Pharmacy Benefit Manager (PBM)

The PBM and transaction hub work closely together. The PBM works as an intermediate actor to ensure accuracy of information, although other models may not include this to streamline the communication process.

Prescriber

The prescriber, generally a clinician or health care staff, are defined as the electronic prescribing system user and sign into the system through a verification process to authenticate their identity.[3]

The prescriber searches through the database of patient records by using patient-specific information such as first and last name, date of birth, current address etc. Once the correct patient file has been accessed, the prescriber reviews the current medical information and uploads or updates new prescription information to the medical file.[3]

Transaction hub

The transaction hub provides the common link between all actors (prescriber, pharmacy benefit manager, and pharmacy). It stores and maintains a master patient index for quick access to their medical information as well as a list of pharmacies.[3]

When the prescriber uploads new prescription information to the patient file, this is sent to the transaction hub. The transaction hub will verify against the patient index. This will automatically send information about this transaction to the PBM, who will respond to the hub with information on patient eligibility, formulary, and medication history back to the transaction hub. The transaction hub then sends this information to the prescriber to improve patient management and care by completing and authorizing the prescription. Upon which, the prescription information is sent to the pharmacy that the patient primarily goes to.[3]

Pharmacy

When the pharmacy receives the prescription information from the transaction hub, it will send a confirmation message. The pharmacy also has the ability to communicate to the prescriber that the prescription order has been filled through the system. Further system development will soon allow different messages such as a patient not picking up their medication or is late to pick up medication to improve patient management.[3]

Imaging

When the imaging center receives the prescription, the imaging center will then contact the patient and schedule the patient for his/her scan. The advantage of ePrescribing radiology is that often times when a patient is handed a paper script, the patient will lose the prescription or wait to call and schedule. This can be disastrous for patients with severe underlying conditions. The imaging center will call and schedule the patient as soon as the referral arrives. There are mobile ePrescribing portals as well as web portals that handle this well, and there are advantages.[5]

Benefits

E-prescribing offers clinicians a powerful tool for safely and efficiently managing their patient's medications. Compared to paper-based prescribing, e-prescribing can enhance patient safety and medication compliance, improve prescribing accuracy and efficiency, and reduce health care costs through averted adverse drug events and substitution of less expensive drug alternatives.[2] This is of key importance because in 2000, the Institute of Medicine identified medication errors as the most common type of medical error in health care, estimating that this leads to several thousand deaths each year.[6] E-prescribing also has the potential to improve beneficiary health outcomes. For providers who choose to invest in e-prescribing technology, the adoption could improve quality and efficiency and could show promise in reducing costs by actively promoting appropriate drug usage; providing information to providers and dispensers about formulary-based drug coverage, including formulary alternatives and co-pay information; and speeding up the process of renewing medications. E-prescribing also may play a significant role in efforts to reduce the incidence of drug diversion by alerting providers and pharmacists of duplicative prescriptions for controlled substances.[7]

More specifically, the benefits of e-prescribing to both patients and clinicians include:[2]

Limitations

Although e-prescribing has the ability to streamline workflow process and increase the system's efficiency, the appropriate tools are required in the appropriate contextual setting. As with various sectors however, change can be difficult. Previous errors may be addressed, but the adoption and implementation of new technology does not come without drawbacks.

Challenges and limitations that may hinder the widespread adoption of e-prescribing practices are addressed below:[2]

Policy and Standards

United States

In the United States, the HITECH Act promotes adoption of this technology by defining e-prescribing as one meaningful use of an electronic medical record.[11] Standards for transmitting, recording, and describing prescriptions have been developed by the National Council for Prescription Drug Programs, in particular the SCRIPT standard, which describes data formats. Elsewhere in the world, health care systems have been slower to adopt e-prescribing standards.[12]

Adoption of e-prescribing technology has accelerated in the United States, in large part, due to the arrival of Stage 2 of meaningful use. One of the Stage 2 core measures is: "Generate and transmit permissible prescriptions electronically (e-Rx.)" In order to meet this measure, practices must prescribe and transmit at least 50 percent of permissible prescriptions electronically.[13]

According to data released in May 2012 by Surescripts, a company which operates the nation's largest health information (e-prescribing) network, roughly 317,000 office-based physicians now e-prescribe in the United States.[14] A more recent report released by the Office of the National Coordinator for Health IT in June 2012 finds that 48 percent of U.S. physicians use e-prescribing systems. National growth in e-prescribing over the period September 2008 through June 2012 increased over 40 percent, with individual states increasing adoption anywhere from 28 percent to 70 percent.[15]

Canada

Until recently in Canada, it was the position of Health Canada that, to allow for e-prescribing, amendments to Part C of the Food and Drugs Regulations made under the Food and Drugs Act, regulations made under the Controlled Drugs and Substances Act and possibly regulations made under Personal Information Protection and Electronic Documents Act would be required. After further review, Health Canada has concluded that there are currently no regulatory impediments to moving ahead with electronically generated and transmitted prescriptions and that these are permissible to the extent that they achieve the same objectives as written prescriptions. Provinces and territories wishing to proceed with e-prescribing are obligated to ensure that electronic prescriptions meet existing regulatory requirements and achieve the same objectives as written prescriptions. For example, there must be evidence of a genuine practitioner/patient relationship, and in the case of controlled substances, pharmacists filling prescriptions must verify prescriptions are signed by the practitioner before selling or providing drugs containing controlled substances to a patient. Health Canada has collaborated with Canada Health Infoway on the development of a technical document entitled Ensuring the Authenticity of Electronic Prescriptions, in order to provide advice about how to ensure the authenticity of electronic signatures. [16]

Electronic Prescribing Worldwide

Australia

Electronic prescription in Australia is currently provided by two service providers, MediSecure and eRx. Both services can be integrated into many of the existing clinical and pharmacy prescribing software systems. Since December 2012, they have become interoperable allowing bilateral transfer of information.[17][18][19]

Europe

The use of electronic prescription has been designated as an important strategic policy to improve health care in Europe. The aim of the European Union is to have a cross-border electronic healthcare system in Europe which will enable EU citizens to obtain e-Prescriptions anywhere in Europe. The Scandinavian countries are leading Europe in deploying e-Prescription. Electronic prescriptions were introduced in Estonia in January 2010[20] and by mid-2013, 95% of all prescriptions in the country were being issued electronically.[21] Other countries which use the prescription process routinely are Norway, Denmark, Finland, Sweden, the Netherlands, Iceland, Greece, England, Scotland, Wales and Northern Ireland. The European Union is pushing for more cross border health data exchange. Despite favourable attitudes towards cross border e-Prescriptions, multiple perceived barriers impede its incorporation in clinical practice. There are varying interpretations and implementations of data protection and confidentiality laws in the 27 member states. Infrastructures are not in place to support the system and stakeholders in some jurisdictions are reluctant to embrace e-health due to the high cost and the lack of security of the systems. Member states have varying degrees of health care policy, privacy enforcement and laws concerning data protection, telecommunication services and digital signature with regards to e-Prescription. Interoperability of different systems is only a partial solution. Security and enforcement of privacy must also be equally enforced.[22]

India

In India some private hospitals started using electronic prescription. But a major step was taken by government of West Bengal in August 2014 when they started the process of issuing e-prescriptions instead of hand-written instructions in top government hospitals. The biggest advantage of the system is that a patient has all his medical data stored in the server of state health department which can be referred to in future. In the private sector number companies have initiated to build software to support Electronic Prescription in India. ERXPAD.COM is one among the pioneer player offer cloud based electronic prescription software ( erx) in India.

Russia

With the development and implementation of electronic technologies in Russian healthcare system, electronic prescription became part of the project called EMIAS. EMIAS is the digital system designed to increase the quality and access of the medical aid in the public health facility. The project was designed and being implemented as part of «Digital city» program in execution of the Moscow Government's order from April 7, 2014 (as Moscow government amended on 21.05.2013 № 22-PP).
The system offers special portal Emias.Info, that provides appointment service to the patients and client area with different services including e-Prescription. Government social program allows getting pharmaceutical products for free or with the discount, depending on the category of the citizen.

See also

References

  1. MedRunner Inc. (2011). e-Prescribing. Retrieved November 22, 2011, from MedRunner Inc.: http://www.medrunner.ca/learn-more/eprescribing/
  2. 1 2 3 4 American Medical Association. (2011). A Clinician's Guide to Electronic Prescribing. Retrieved December 17, 2011, from: http://www.ama-assn.org/ama1/pub/upload/mm/472/electronic-e-prescribing.pdf
  3. 1 2 3 4 5 6 7 U.S. Department of Health and Human Services. (n.d.). How does e-prescribing work? Retrieved December 17, 2011, from Health Resources and Services Administration: http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/ElectronicPrescribing/epreswork.html
  4. American College Of Rheumatology. (2011). E-Prescribing. Retrieved December 17, 2011, from Practice Management: http://www.rheumatology.org/practice/office/hit/erx.asp
  5. http://www.rxportyl.com/advantages/
  6. Institute of Medicine (2000). To err is human: building a safer health system.
  7. 1 2 U.S. Department of Health and Human Services. "The Benefits of Electronic Prescribing".
  8. Medicare Program; E-Prescribing and the Prescription Drug Program; Proposed Rule. 70 FR 6256, February 4, 2005
  9. Grossman, J. M., Gerland, A., Reed, M. C., & Fahlman, C. (2007). Physicians’ experiences using commercial e-prescribing systems. Health affairs, 26(3), 393-404.
  10. Lasky, M. C., & Keen, S. (2007). An Electronic Subscription Prescription. Intellectual property & Technology Law Journal , 19 (10), 9-11.
  11. "Prepare to meet "meaningful use" EMR requirement". American Medical Association. Retrieved 2010-06-07.
  12. "E-PRESCRIPTION: IMPENDING ACCEPTANCE IN EUROPE". Frost & Sullivan. Retrieved 2010-06-07.
  13. "Meaningful Use Stage 2 Crib Sheet" Physicians Practice, September 2012.
  14. "Safe E-Prescribing: A Primer for Practices" Marisa Torrieri, Physicians Practice, October 2012.
  15. "State Variation in E-Prescribing Trends in the United States" Office of the National Coordinator for Health IT, Data Brief No. 4, November 2012.
  16. "Policy Statement on E-Prescribing". Health Canada. Retrieved 2011-11-27.
  17. "Electronic transfer ofprescriptions- ETP". NPS Medicinewise. Retrieved 2015-04-15.
  18. "Electronic transfer ofprescriptions- ETP (Frequently asked questions)" (PDF). NPS Medicinewise. Retrieved 2015-04-15.
  19. "ACCC to give green light to eRx/MediSecure deal" Pharmacy News, 14 February 2013.
  20. http://www.youtube.com/watch?v=m9rTZM2kj78
  21. http://e-estonia.com/components/e-prescription
  22. Kierkegaard, P. (2013), "E-Prescription across Europe". Health and Technology, 3 (1), pp. 1-15. doi:10.1007/s12553-012-0037-0

External links

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