Medical societies, quality improvement organizations, and federal and state health-related agencies all advocate that healthcare providers continue moving toward a patient-centered, integrated medication-use system. E-prescribing is a key component of such efforts. Studies show that paper-based prescribing is associated with higher error rates while e-prescribing is safer. Other benefits include eliminating handwriting, ensuring that vital information on drug identity, dose and frequency are disclosed, and enabling a broad range of clinical decision support, including recommended dosages and overdose information, drug-drug interactions, drug allergies, laboratory analysis issues, and clinical conditions.
Moving from paper prescribing to electronic prescribing can also dramatically improve the work flow in a busy practice setting, but the transition can be difficult. Technology-averse staff may resist new processes; productivity may temporarily dip as users become accustomed to the system; and frustrations may mount as a result of the impact on established roles and responsibilities. For a successful transition one needs:
- Commitment to the technology throughout the organization or practice.
- Alignment of patient care delivery processes and the new e-prescribing technology
- Effective communication whether intra-office, inter-office, or office-patient.
- Strong leadership and management in the practice.
- Proactive outreach to pharmacies, allied health professionals and patients.
When planning the switch to e-prescribing, it's important to set realistic, measurable goals; return on investment can, and should, be measured. The elements required to receive the 2% bonus from Medicare may be a good place to start. That bonus is based on the allowed charges for all Physician Fee Schedule covered services furnished by the physician or the eligible physician group during the reporting period. The e-prescribing incentive percent amount for reporting years 2009 - 2010 is 2.0 percent; for reporting years 2011 - 2012 is 1.0 percent; and for reporting year 2013 it is 0.5 percent. There is no bonus after 2013.
Realistic error rate reductions can also be set, perhaps starting with simply reducing the number of follow-up phone calls from pharmacists by 75%. Getting by with one less front desk person may be another useful measure of your return on investment. Whatever goals are set, all within the practice must stay focused on achieving them.
There are many e-prescribing systems available in the marketplace and more are coming on line. You must be prudent in their selection based on the specific needs and goals of your practice. Data entry and retrieval must be carefully examined, both from a user-friendly standpoint as well as the qualitative and quantitative benefits of input and output.
One of the first considerations when shopping for a system is deciding whether to purchase stand-alone software, which can be acquired for, on average, $2,000-$3,000 per physician, or a full-function EMR/EHR system with an e-prescribing component, which can cost up to $50,000.
Because full-blown EMR/EHRs will likely be a requirement down the line, if you're looking at a stand-alone system, think of it as one of the first modules to deploy in an electronic health record. For this reason, system interoperability should top the list of requisite features.
Other considerations include making sure the systems being considered meet the Medicare definition of e-prescribing and that they connect to the pharmacy industry's SureScripts Rx-Hub. Additionally, evaluate the user friendliness of the various systems, and try to visit other practices that have implemented the systems you're interested in to see the products in real-world action. Actual usability testing and evaluation with test scripts is a must; a sales rep demo is insufficient.
After selecting a system, negotiating pricing and contract terms with the vendor, establish a team within the practice to lead and manage the transition and to develop a reasonable "go-live" schedule that reflects the workflow and patterns of your practice. For large practices, pilot-testing at one facility or in one service line might be advisable. During this transition phase, it is important to include prescriptions for not only medications, but to the extent feasible in your locale, prescriptions for diagnostic testing, durable medical equipment, and physical/occupational/speech and related therapies as well.
Hands-on training is vital and should be scheduled close to the go-live date to increase acceptability, reduce errors and inefficiencies and to promote confidence in the e-prescribing system among physicians and staff. After implementation, the system should go through a continuous quality improvement process with frequent assessment to assure that it is functioning as intended and that new errors are identified and remedied. Remember, there will continue to be errors and problems with e-prescribing, however, the system should permit their detection more readily and at an earlier stage with, hopefully, far less serious consequences.
Finally, in anticipation of the transition, notify local pharmacies and your patients that you are switching to e-prescribing. One note of caution: as of the writing of this article, the Drug Enforcement Administration has not finalized final regulations implementing e-prescribing for controlled substances. Thus, at present, electronic signatures are not yet permitted on prescriptions for such medications. While the script itself can be produced electronically, it must be hand-signed by the prescribing physician and given to the patient to take to the pharmacy.
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