Electronic Prescriptions are . . Legible, Reduce Errors!

February 25, 2010 in Health Care "Reform", Health Policy by RangelMD

From the desk of Dr. Obvious at the Institute for the Confirmation of the Blindingly Obvious:

So called “e-prescriptions” make use of a practitioner’s office electronic medical record system (ER) to send new prescriptions and prescription refills directly to a local pharmacy. It’s a system that’s analogous to email but it’s even better in that it’s more direct and is encrypted as a protection from unauthorized access. Security is important since a paper prescription containing the patient’s name, date of birth, home address, prescribing physician information, and medication information can easily be lost, stolen, copied, altered, and observed by unauthorized persons.

E-prescribing should also be much safer for at least three reasons. 1.) E-prescriptions eliminate bad handwriting that can lead to errors. 2.) E-prescriptions should eliminate reading and transcription errors at the pharmacy that can occur even if the handwriting on the prescription is pristine. 3.) Since it utilizes an EMR, e-prescribing can reduce errors a the point of origin by using¬† systems to automatically ensure that the dosage for a prescribed medication is correct and that there are no significant interactions with the patient’ other listed medications or medication allegies. I.e. the EMR will not allow me to send out a prescription for a medication with the incorrect dosage unless I over-ride the system (and even then it will fag the prescription for the pharmacist).

These improved safety assumptions have now been proven to be correct in a recent study from Weill Cornell Medical College:

To evaluate the effects of e-prescribing on medication safety, researchers looked at prescriptions written by health care providers at 12 community practices in the Hudson Valley region of New York. The authors compared the number and severity of prescription errors between 15 health care providers who adopted e-prescribing and 15 who continued to write prescriptions by hand. . . the authors reviewed 3,684 paper-based prescriptions at the start of the study and 3,848 paper-based and electronic prescriptions written one year later. After one year, the percentage of errors dropped from 42.5 percent to 6.6 percent for the providers using the electronic system. For those writing prescriptions by hand, the percentage of errors increased slightly from 37.3 percent to 38.4 percent. Illegibility problems were completely eliminated by e-prescribing.

These results are stunning. Even though the vast majority of prescription errors are either minor or caught and corrected by the pharmacist before the medication gets to the patient, there will still be a tiny though significant number of errors that will get through and potentially cause harm. By massively reducing the total number of errors, the potential for a harmful error that gets through to the patient is also massively reduced. And from a practical stand point, this reduction in errors significantly improves efficiency by eliminating most of the phone calls by the pharmacy back to the physician’s office for incorrect or problem prescriptions. This also improves convenience for the patient since it eliminates the extra step of having to drop off the paper prescription for processing at the pharmacy and may improve patient compliance (though this study did not look at the issue of patient compliance).

If a new medication reduced the potential for significant side effects from 42% to 6% it would make national news. And yet, only 43% of all US physicians utilize an electronic medical record system and fewer use the e-prescribing option. There are various reasons for this; tradition, ludditeism, but expense is one of the main hurdles for a system that often costs tens of thousands of dollars up front and does not directly generate any income (as opposed to, say, an ultrasound machine). And it doesn’t help that, thus far, the Federal government is more interested in giving Trillions to Wall Street schemers than they are in improving the health infrastructure of this country.

The 2009 Recovery Act did have a provision to give physicians $44,000 to purchase and convert to an EMR but as with everything else with the Federal government (not connected to muti-Billion dollar banks)¬† this money will only be made available after several years and only after going through a ton of bureaucratic hoops. This amount is paltry and laughable considering that the initial purchase price and start up costs of an EMR can be far more than $44,000 and ongoing licensing, use, and “maintenance” costs can easily be several hundred to several thousand per year per provider. It’s like winning the lottery but only having the option of collecting a few cents of it a day over several years. Yea, it sounds like a lot when considered in a lump sum but the way it is delivered makes it financially impractical.

Read more about my own experiences with e-prescribing.

Please share.