Article

E-prescribing is becoming a standard of care

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  • Surescripts
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Abstract

Objectives: Electronic prescribing (e-prescribing) and electronic health record (EHR) adoption have risen in response to federal incentive programs, but little is known about provider utilization of these tools beyond self-reported measurements. Our objective was to measure e-prescribing utilization behavior and identify variability and characteristics associated with higher and lower levels of utilization. Study Design: Retrospective, longitudinal study. Methods: Using e-prescribing transaction data from a national health information network, we assessed 3 provider characteristics to describe utilization trends over time and by provider length of time on the network. Results: More than 450,000 office-based providers adopted and used e-prescribing systems over the length of the study. Transaction volume increased as provider use of e-prescribing grew over time. Average utilization rates increased from 93 e-prescriptions per provider to 156 e-prescriptions per provider over the course of the study. Length of time on the network was associated with increased average utilization levels. Providers on the network <1 year averaged 72 e-prescriptions per month, which increased to 178 e-prescriptions per provider per month among those who had been on the network >3 years. We observed similar trends across EHR systems, provider specialty, and geographic regions. Conclusions: E-prescribing utilization increased with length of time on the network, suggesting that once providers adopt and adjust their clinical work flow, e-prescribing becomes “sticky.” Results demonstrate encouraging signs of provider willingness to use EHRs, but questions remain as to whether these findings can be generalized to how other EHR functionality will be used and to what extent. © 2015, Managed Care and Healthcare Communications. All rights reserved.

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Recent studies have demonstrated that e-prescribing takes longer than handwriting. Additional studies documenting the perceived efficiencies realized from e-prescribing from those who have implemented electronic prescribing are warranted. We used a mixed method study design. We report on qualitative date from 64 focus groups with clinicians and office staff from six US states. Participants used one of six e-prescribing software packages. Qualitative data from the focus groups (276 participants) were coded and analyzed using NVivo software. Quantitative data regarding perceived efficiencies were extracted from a survey of 157 clinicians using e-prescribing. Perceptions of e-prescribing included 64% reporting e-prescribing as very efficient. The next closest method was computer generated fax and prescriptions in which ∼25% rated the method as very efficient. Improvements in workflow and record keeping were noted. Perceived efficiencies were realized by decreased errors, availability of formularies at the point of prescribing and refill processing. Perceived inefficiencies noted included the need for dual systems owing to regulations preventing e-prescribing of scheduled medications as well as those introduced with incorrect information on formularies, pharmacy used, and warnings. Overwhelmingly, clinicians and their staff confirmed the perceived efficiencies realized with the adoption of e-prescribing. Perceived efficiencies were realized in knowing formularies, processing refills, and decreasing errors. Opportunities to improve efficiencies could be realized by assuring correct information in the system.
Article
Background: Although electronic prescribing (e-prescribing) holds promise for preventing prescription errors in the ambulatory setting, research on its effectiveness is inconclusive. Objective: To assess the impact of a stand-alone e-prescribing system on the rates and types of ambulatory prescribing errors. Design, participants: Prospective, non-randomized study using pre-post design of 15 providers who adopted e-prescribing with concurrent controls of 15 paper-based providers from September 2005 through June 2007. Intervention: Use of a commercial, stand-alone e-prescribing system with clinical decision support including dosing recommendations and checks for drug-allergy interactions, drug-drug interactions, and duplicate therapies. Main measures: Prescribing errors were identified by a standardized prescription and chart review. Key results: We analyzed 3684 paper-based prescriptions at baseline and 3848 paper-based and electronic prescriptions at one year of follow-up. For e-prescribing adopters, error rates decreased nearly sevenfold, from 42.5 per 100 prescriptions (95% confidence interval (CI), 36.7-49.3) at baseline to 6.6 per 100 prescriptions (95% CI, 5.1-8.3) one year after adoption (p < 0.001). For non-adopters, error rates remained high at 37.3 per 100 prescriptions (95% CI, 27.6-50.2) at baseline and 38.4 per 100 prescriptions (95% CI, 27.4-53.9) at one year (p = 0.54). At one year, the error rate for e-prescribing adopters was significantly lower than for non-adopters (p < 0.001). Illegibility errors were very high at baseline and were completely eliminated by e-prescribing (87.6 per 100 prescriptions at baseline for e-prescribing adopters, 0 at one year). Conclusions: Prescribing errors may occur much more frequently in community-based practices than previously reported. Our preliminary findings suggest that stand-alone e-prescribing with clinical decision support may significantly improve ambulatory medication safety. Trial registration: ClinicalTrials.gov, Taconic Health Information Network and Community (THINC), NCT00225563, http://clinicaltrials.gov/ct2/show/NCT00225563?term=Kaushal&rank=6 .
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Public and private efforts are under way to promote electronic prescribing to improve health care safety, quality, and efficiency. Findings from this qualitative study of physician practices suggest that substantial gaps may exist between advocates' vision of e-prescribing and how physicians use commercial e-prescribing systems today. While physicians were positive about the most basic e-prescribing features, they reported major barriers to maintaining complete patient medication lists, using clinical decision support, obtaining formulary data, and electronically transmitting prescriptions to pharmacies. Three factors help explain the gaps: product limitations, external implementation challenges, and physicians' preferences about using specific product features.