EPrescribing: Eliminating Paperwork and Medication Errors
How many things can you count wrong with paper prescriptions? We can name at least four: illegible, ambiguous or incomplete prescriptions, no single comprehensive view of a patient’s drug record, no real-time decision support to guide and improve the appropriateness and accuracy of prescribing, and, finally, no real-time view of medicines administration. It is hardly surprising, therefore, that, like anything paper-based, conventional prescriptions are being substituted by their electronic counterparts with increasing frequency.
Electronic prescribing, or ePrescribing, is computer-based generation, transmission and filling of medical prescriptions. By reducing the risks associated with traditional prescription script writing, i.e. handwritten or faxed notes, ePrescribing goes in line with and is normally integrated into electronic health records (EHR) and fulfills the fundamental principles of eHealth: reliability and efficiency of healthcare.
In 2014 in the USA, according to the Office of the National Coordinator of Health IT, all states had physicians using ePrescriptions at a rate above 40% and 28 states had more than 70% of their healthcare professionals embarking on the program. This presents staggering contrast to the figures of 2008 when all but one state had participation rate of below 20%. The number of pharmacies that were able to accept ePrescriptions rose from 76% in 2008 to 96% in 2014. According to a study into adoption of ePrescribing in Europe, conducted in 2012, the rate of implementation varied greatly from country to country. Denmark was leading the way, with 97% of physicians ePrescribing medication to their patients, followed by Sweden with a rate of 81% and the Netherland (71%). Pilot programs were also found in Czech Republic, Finland, Italy and Poland. We can see that the US leads the way demonstrating the fastest increase in adoption, whereas Europe shows striking adoption rates.
The benefits of ePrescribing are numerous, but among the most crucial ones is the prevention of errors. In the USA more than 95,000 prescription error reports have been received since 2000, according to the Food and Drug Association. Since these reports are voluntary, it remains to be speculated just how many such mistakes actually happened. It is, however, certain that many of them could have been prevented. The main reason for such errors is the illegibility of handwriting and the resulting purchase by a patient of a wrong drug that might have a similar name, but a different effect. One example of such error occurred in 2015 when a series of errors in prescription and dispensing happened due the similarity in the names of an antidepressant called Brintellix and a drug used for treating acute coronary syndrome called Brilinta.
EPrescribing is capable of cross-checking medications and notifying doctors about potential issues with the drug chosen. It helps physicians make right decisions by operating a range of alerts on possible allergies, conflicts with other medications a patient has been prescribed and any possible negative reactions the drug may have. Such errors like the one described previously would be highly unlikely if ePrescribing was more uniformly adopted.
While with paper prescriptions there is always a risk of them being unfulfilled simply because a patient has forgotten, ePrescriptions allow doctors to track the fulfillment of a prescription and reach out to the patient to remind them or find out the reasons of their negligence, which, in turn, results in more effective healthcare.
The matter of treatment cost is often a diverting factor for patients, with some medications being rather pricey. This is an issue that ePrescribing also tackles by issuing notification about the availability of less expensive equivalents. In a conventional setting of paper prescriptions, a patient is usually reliant only on the pharmacist’s knowledge of available substitutes and has no choice but to either spend a hefty sum or to opt for the equivalent at their own risk.
With all the benefits of ePrescribing for healthcare professionals and patients alike, it seems merely a matter of time before it becomes the healthcare norm all across the globe.