Post date: Nov 22, 2011 7:44:20 PM
E-prescribing is all about achieving efficiency to the practice and pharmacy to compensate for the cost of acquiring and implementing the technology. The just released Grossman et al (2011) study suggests there is some work to be done (excerpts follow):
New Prescriptions
"Pharmacies typically resolved transmission problems by calling physicians for verbal orders"
Refills
"Eight of these pharmacies lacked the functionality, and the rest chose not to use the feature, mainly to avoid Surescripts transaction fees"
"As one physician explained, ‘Sometimes the patient will call, the pharmacy will fax, and [send something via] Surescripts, all for the same patient, the same prescription, on the same day. That is cumbersome.’
'If they [don’t] respond, that’s where we run into problems. We fax the next day because we can’t send a duplicate request electronically.'
Mail order connectivity
"some practices first tried electronic routing for new prescriptions or renewal responses, followed by faxing or printing the prescription if unsuccessful."
These workarounds to intended system usage are just for the logistics of sending prescription information.
These so-called digital e-scripts still require manual intervention: "Three prescription fields commonly required manual manipulation: medication name, quantity, and patient instructions". Dosing and quantity seem to be problematic according to the study. The e-prescriber must know all the variations of drug packaging at a particular pharmacy in order to reduce the risk of digitally transmitted information containing an error that must be corrected at the pharmacy. This issue represents the role changes that occur with the introduction of technology. There are others in (a hope to see published) article I have under review.
An informative study that speaks volumes to practices and pharmacies putting up with all these system design problems because overall e-prescribing is better. Just imagine if some thought had been made in advance to system design so these unintended consequences would not be a problem.
Center for Studying Health Systems Change provides access to this article by Transmitting and processing electronic prescriptions. (pdf) For the interview protocols appendix click here. (pdf)
Article Citation:
Grossman, J.M., Cross, D.A., Boukus, E.R. & Cohen, G.R. (2011) 'Transmitting and Processing Electronic Prescriptions: Experiences of Physician Practices and Pharmacies', Journal of the American Medical Informatics Association.