Electronic prescribing
Electronic prescribing, commonly referred to as e-prescribing, is a technology-driven method that allows healthcare providers to send prescription orders directly to pharmacies through electronic systems. This practice has gained traction in medical settings, aiming to enhance the accuracy of prescriptions, minimize errors, and streamline the prescribing process. Historically, prescriptions began with handwritten notes and evolved through telephone communications, both of which presented challenges such as miscommunication and the potential for drug interactions.
The advent of electronic prescribing in the 1990s marked a significant shift in how prescriptions are managed, particularly after regulatory changes in 2010 allowed for electronic prescribing of controlled substances. E-prescribing systems enable prescribers to access patient records, receive real-time information about medication coverage, and verify past prescriptions, which increases the safety and efficiency of medication management.
Despite its benefits, including reduced chances of errors and improved communication between prescribers and pharmacists, electronic prescribing faces challenges like technical glitches, learning curves for medical staff, and the financial burden of necessary technology. As more states require electronic prescriptions, understanding the implications and functioning of this system becomes increasingly important for both healthcare providers and patients.
On this Page
Subject Terms
Electronic prescribing
Electronic prescribing refers to a method used by medical professionals to transmit requests for prescription drugs to a pharmacy electronically. This task can be accomplished using various forms of technology, including specialized computer programs and handheld devices. Electronic prescribing has been adopted by many medical practices as a way to improve accuracy, prevent prescribing errors, and save time and effort.
Background
Physicians have ordered medicinal compounds to treat illnesses for centuries. Ancient Sumerian cuneiform tablets have been found dating to as far back as 2000 BCE that include instructions for medications. Around 750 CE, specialized "stores" were opened in Baghdad, Iraq, that sold drugs, though most of the settled world was treated with compounds of medicinal plants and herbs made in monasteries. During the thirteenth century, pharmacies dispensing drugs began to appear in Europe.
In 1729, the first retail pharmacy in the United States was opened in Philadelphia, Pennsylvania. Prior to this, physicians often dispensed medications for their patients at the time of their visit. A few decades later in 1752, a pharmacy opened at a Philadelphia hospital. One of its earliest pharmacists, John Morgan, encouraged physicians to begin writing prescriptions.
For many years after the establishment of pharmacies, medical practitioners primarily ordered prescriptions in one of two ways. At first, they sent a written paper prescription to the pharmacy. Once the telephone was invented, physicians often called pharmacies to order prescriptions that were either picked up by patients or delivered to them. However, there were problems with both of these methods. It was very easy for the pharmacist to misunderstand what the physician said or wrote, especially as more drugs became available. Such miscommunication was problematic because some drugs had similar names but treated different conditions. It was also possible for the patient to be given two or more drugs that could interact with one another, particularly in cases where more than one physician was involved in the patient's care.
The wider use of computers beginning in the 1980s made it easier for pharmacies to keep records of what medications their customers were taking and for physicians to more readily share records. In the 1990s, some pharmacies began using electronic prescribing. This practice, which began in the United States, was relatively slow to catch on. At first, electronic prescribing was used mostly in hospital settings. By 2016, about 70 percent of physicians wrote at least some electronic prescriptions, according to the US Office of the National Coordinator for Health Information.
In addition to the increasing prevalence of electronics and technology, one of the things that helped promote the increase of electronic prescribing was a law change in 2010. In that year, the US Food and Drug Administration (FDA) approved electronic prescribing for controlled substances. These drugs—which are considered to have the potential to be abused—were originally excluded from electronic prescribing. The 2010 change allowed physicians to use electronic prescribing for controlled substances as long as all other rules pertaining to their use and distribution were followed. Many states still had laws forbidding electronic prescriptions for some or all controlled substances; Vermont was the last state to change its laws on this subject, finally permitting e-prescription of all drug schedules in 2016. Since 2010, a number of states have implemented further legislation requiring controlled substances to only be prescribed electronically. As of 2018, states that had approved such a requirement included Arizona, Connecticut, Illinois, Maine, Massachusetts, Minnesota, New York, Rhode Island, and Virginia.
Overview
The electronic prescribing process begins when the prescriber logs into the system being used to transmit the order. The system then authenticates the prescriber's identity. In large practices where multiple prescribers share the system, this technology allows prescribers to have different levels of authority, which helps prevent fraudulent use of the system.
Next, the prescriber chooses the patient record of the person for whom the medication is being prescribed. While there can be variations in how the systems function, most e-prescribing systems will allow the prescriber to review the drugs the office has prescribed in the past, provide information on the drugs that the office prefers to use, and submit the prescription to the patient's pharmacy of choice.
At that point, the prescription is transmitted to a central transaction hub that connects the prescriber, the pharmacy, and the pharmacy benefits manager (PBM) at the patient's health insurer, where applicable. The PBM will return information about whether the patient's health insurance covers the medication and will also indicate if the patient has had the same, a similar, or a conflicting medication filled in the recent past. This information can help the prescriber make a decision about whether to continue with the initial prescription or choose another drug.
Once the physician has given final approval for the prescription, it is transmitted to the pharmacy. The pharmacy can then fill the prescription. If there is a question, the pharmacist can send a message to the prescriber seeking clarification. Some systems also allow the pharmacist to notify the prescriber when the prescription is picked up or if it is not picked up, which can help improve patient compliance in taking medications.
Electronic prescribing provides a number of advantages. First, electronic prescribing—sometimes called e-prescribing—helps eliminate filling errors. There is less chance the prescription will be misunderstood by the pharmacist. Since electronic form requires all information on dosage to be completed, there are fewer delays caused by missing or incomplete information.
Electronic prescribing systems also check the prescription being filled against past prescriptions; many can do this even if the prescription was filled at another pharmacy. This prevents prescribing accidents such as duplicate dosing and lowers the risk of drug-to-drug interactions when a patient is taking more than one medication.
Through electronic prescribing, the physician also receives useful information while writing the prescription, such as reminders about a patient's allergies and medical history and dosage information about the drug being prescribed. This means the prescriber does not have to rely on memory or search patient records or drug reference material for important information while prescribing. This saves time and increases the accuracy of the prescription.
In addition, e-prescribing makes it easier for physicians and pharmacists to keep track of the controlled-substance prescriptions received by an individual patient and can help prevent over-prescribing. Two-way communication between the pharmacy and prescriber can also identify patients who are not taking their medications as prescribed. Furthermore, the controls built into electronic prescribing make prescription fraud more difficult.
However, there are some drawbacks to electronic prescribing. Computer system failures can interfere with prescriptions getting filled. Some physicians find the process cumbersome and difficult to learn. Also, the cost of the equipment needed for e-prescribing can be prohibitive for some medical practices.
Bibliography
"Be Ready for Your State's Mandate." RxNT, www.rxnt.com/mandate/. Accessed 28 Sept. 2018.
"Benefits of E-Prescribing." DrFirst, www.drfirst.com/benefits-of-e-prescribing/. Accessed 17 Dec. 2016.
Ducker, Megan. "Pros and Cons of E-Prescribing in Community Pharmacies." US Pharmacist, 20 Aug. 2013, www.uspharmacist.com/article/pros-and-cons-of-e-prescribing-in-community-pharmacies-42392#sthash.EsrsQCd1.dpuf. Accessed 17 Dec. 2016.
"Electronic Prescribing." Medicare.gov, www.medicare.gov/manage-your-health/electronic-prescribing/electronic-prescribing.html. Accessed 17 Dec. 2016.
"Electronic Prescriptions for Controlled Substances (EPCS)." US Food and Drug Administration, 31 Mar. 2010, www.deadiversion.usdoj.gov/ecomm/e‗rx/faq/faq.htm. Accessed 17 Dec. 2016.
Porterfield, Amber, et al. "Electronic Prescribing: Improving the Efficiency and Accuracy of Prescribing in the Ambulatory Care Setting." Perspectives in Healthcare Management, Apr. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3995494/. Accessed 17 Dec. 2016.
"Pros and Cons of Electronic Prescribing." CBS News, 26 Mar. 2016, www.cbsnews.com/news/pros-and-cons-of-electronic-prescriptions-for-patients-and-doctors/. Accessed 17 Dec. 2016.
Venosa, Ali. "History of The Pharmacy: How Prescription Drugs Began and Transformed into What We Know Today." Medical Daily, 16 Mar. 2016, www.medicaldaily.com/pharmacy-prescription-drugs-378078. Accessed 17 Dec. 2016.
"What Is Electronic Prescribing?" Centers for Medicare and Medicaid, 26 Feb. 2014, www.cms.gov/Medicare/E-Health/Eprescribing/index.html?redirect=/Eprescribing. Accessed 17 Dec. 2016.