Since the publication of that edition, the use of e-prescribing has risen considerably. Regulations have evolved, technology has advanced, and workflow challenges remain unsolved, all of which have the potential to compromise the health and safety of patients. While electronic prescription has been found to minimize drug mistakes and increase prescribing safety, it is prone to errors. We look at six interconnected areas where modifications to electronic prescription systems, especially in the outpatient context, might improve drug ordering quality and safety.
Researchers recommend that electronic prescribing incorporate medication indications, that a single published on the internet medication list be established, that electronic cancellation orders are transmitted to pharmacies (CancelRx) to help make sure that drugs are discontinued safely and reliably, that standardized structured, as well as codified prescription instructions, be implemented, that clinical decision support is reengineered, and that electronic prescribing be redesigned to facilitate the ordering of non-drug items.
What Is Electronic Prescribing?
E-prescribing is a phrase that refers to the secure bidirectional electronic transmission of information between prescribing clinicians, pharmacies, payers/PBMs, either directly or through an intermediate network. Drug allergies and sensitivities are checked, drug interactions are identified, and patients’ medication histories are accessed from other sources like claims databases. E-prescribing also aids in other critical care delivery procedures such as drug reconciliation, prescription monitoring, and prior authorization.
What Is the Significance of Electronic Prescribing?
In the United States, around 3.9 billion prescriptions are issued each year, including new and renewal prescriptions. Because it allows a practitioner to electronically deliver an accurate and intelligible prescription straight from the point of care to a pharmacy, e-prescribing may be a significant component in increasing the quality of patient care. In addition to prescription routing, the prescription benefit, and formulary, as well as the prescription drug history features, may all help to enhance patient safety.
A Single Medication List for Everyone
The lack of a standard “source of truth” ‘concerns patients’ current prescriptions leads to mistakes and inefficiencies, with reported discrepancy rates ranging from 25 to 70%. The immense effort needed in reconciling drugs in hospitals, clinics, healthcare facilities, and pharmacies, as well as during home health visits and by patients themselves, is essentially a work-around for the absence of a single standard prescription list. Outpatient medication lists that have been reconciled are out of the current as soon as the patient receives a new prescription from a specialist, is hospitalized, or ceases taking a medicine owing to a side effect.
The advantages of prescribing from a centralized medicine source go beyond the usefulness of a naturally reconciled list. Access to patients’ current prescription lists would be unrestricted by region, institution, practice type, pharmacy, or insurance plan if all prescribing software were linked to a single online database. Doctors would not have to care about which pharmacy a patient chooses, and pharmacists would have the ability to fill any current prescription (with checks to prevent duplicate filling). Primary care doctors would no longer have to evaluate drugs to reconcile various lists. Still, they could instead focus on making shared decisions with the patient about whether medications on the list must be continued or altered.
CancelRx: Ensuring Drugs Are Discontinued Safely and Reliably
For now, there has to be a reliable procedure to guarantee that the pharmacy does not dispense medicine that hate physician has discontinued. An order to stop taking a drug in an electronic prescribing system often does not result in the pharmacy receiving a notification of the order’s termination. As a result, the order stays in the pharmacy’s computer system, which increases the probability of an erroneous refill. The automated systems of many pharmacies may call patients to remind them to refill their prescriptions. Ideally, a patient would be aware not to take a stopped drug. However, the possibility of mistakes (and waste) is significant: Erroneous dispensing rates have been reported to be as high as 2–10%.
Clinical Decision Support Has Been Redesigned
Clinical decision support in the context of pharmaceuticals refers to health IT systems meant to assist physicians with suggestions, alerts, and reminders to alleviate the cognitive constraints of keeping track of information, including recommendations linked to patients, their meds, and lab results. When a prescription is submitted, one significant benefit of electronic ordering is the potential to give clinical decision assistance. According to a substantial body of data, medication-related clinical decision assistance may minimize mistakes and increase patient safety. Systematic studies suggest that using decision support systems reduces prescription errors, adverse events, and pharmaceutical harms.
Making Nondrug Alternatives Ordering Easier
Computerized prescription is often conceptualized and practiced as the electronic ordering of medications. This pharmacologic bias, which is firmly embedded in medical care systems across the globe, is perpetuated by the architecture of modern computerized prescription systems. The difficulty in obtaining non-drug options is exacerbated by many of these therapies being not as straightforward as taking a tablet once or twice daily. Many well-conducted studies have shown that non-pharmacological approaches like dietary modifications, physical activity, physical therapy, cognitive-behavioral therapy, and other forms of social support may be as practical as or even more successful than medication treatment.
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