Group 3
LIS 4930
Health Informatics
Dontrail Brinson
William Davenport
Gina Iacuzio
Kevin Nanns
Bryan Valentine
Cheryl Werner
[ELECTRONIC
PRESCRIBING]
Electronic prescribing is an amazing technology that will almost erase all medical errors from happening.
There are some drawbacks to this tool. The technology costs a lot, doctors won’t adopt unless they have
tech support, and mainly there is no standardization. IT companies need to work with these healthcare
facilities to alleviate the problems. Medical errors should be a thing of the past.
Contents
Introduction ..................................................................................................................................... 3
What is Electronic Prescribing? ...................................................................................................... 3
Case Studies .................................................................................................................................... 4
Benefits and Problems of Electronic Prescribing ........................................................................... 6
Solutions for Electronic Prescribing ............................................................................................... 8
Future of Electronic Prescribing ................................................................................................... 11
Conclusion .................................................................................................................................... 14
References ..................................................................................................................................... 15
Group 3 | Electronic Prescribing 2
Introduction
Traditionally, healthcare professionals had to prescribe patient’s medication either by
writing a script, calling in a prescription to patient’s pharmacy, or faxing the prescription to the
pharmacy. The use of scripts is often prone to prescription errors that can have life threatening
consequences. Healthcare professionals have been known to have difficult to read handwriting
that pharmacists cannot decipher. This causes a pharmacist to either fill a prescription
incorrectly or not fill the prescription at all. If the physician is not readily available to confirm
the prescription, the patient may have to wait a day or longer for a critical prescription. Because
the healthcare workforce is very rich with diversity, a language barrier causes communication
with pharmacists difficult to understand. Different cultural vernacular and accents are a cause of
communication barriers. The advancements in technology have provided the health care
industry with electronic prescribing that can resolve many errors that are prone to outdated
methods such as faxing, handwriting scripts, and telecommunications.
What is Electronic Prescribing?
Electronic prescribing is in essence, the writing of prescriptions with the assistance of
computers. This could mean that the individual is using a hand held PDA and touch screen to
input/write the prescription, or alternatively it could be typed in using a laptop or even a full
sized computer. Electronic prescribing can also be referred to as a means of sending
prescriptions electronically from a doctor to a pharmacy. However, in either case, for it to be
truly electronic prescribing paper must not be used. (Spooner, 2005)
Currently, there is no standard to how electronic prescribing is setup technically. While
almost any computer can be successful in running the electronic prescribing system, touch screen
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hand held electronics have been the focus of many of the programs. Most companies have their
own version of a system that they believe is the superior way to handle it with many different
systems catering to a specific field of health. In most cases however, the system is setup with a
bunch of drop down menus and check boxes. With these, doctors input all of the required
information. With the variety of programs out there that offer electronic prescription solutions,
there are many different avenues that are able to be taken, however there are several components
that are required for that system to be successful if it is to technically be sufficient.
The system must first and foremost have all of the patient’s base records. This includes
name gender, age, and race. The system should also be able to display the complete medication
list from both the doctor's office, but also every other office that the patient is visiting. It should
also have a set of recommended medication for each medical diagnoses, protect against allergy
conflicts, provide assistance when calculating doses, and to make the system as intuitive for the
doctors as possible. (Bell, 2004)
After the information is inputted into the system, then the electronic prescription is
electronically sent to a pharmacy where the patient can then pick up their medication.
Medication that the patient knows is both correct and safe.
Case Studies
Since there are over three billion prescriptions written each year in the U.S., clinicians are
always searching for a way to make this process easier while ensuring patient safety. Electronic
prescribing seems to be a smart solution. With more and more physicians adopting Eprescribing, it is becoming much easier to actually see the results, findings, and their opinions of
what does and does not work. The publishing and distributing of Case Studies is very helpful in
aiding clinicians in choosing the best company or software to go with as well as providing them
Group 3 | Electronic Prescribing 4
with concrete evidence to back up the companies’ claims of increasing productivity and overall
patient care. Due to this increased access to statistics directly correlating to improvements made,
“40% [of physicians] express a future interest in electronic prescribing” (Marcinko, 2004)
One of the most important things healthcare professionals will look for before choosing
to adopt e-prescribing is its ability to benefit patients. Improving patient safety, well-being, and
satisfaction is a common goal among all clinicians and is very much desired when switching
from pen and paper to e-prescribing. The most common problem with written prescriptions is
the possibility for error, ranging from either the inability to read the handwriting to a severe drug
interaction. The health industry is constantly looking for ways to decrease these errors and using
an e-prescribing system that addresses these problems is the way to go. One example of a
system in use would be the use of the ViewSonic Wireless Tablet Client used at the Riverside
Medical Clinic in California. Physicians are provided with the hardware and software to write
“electronic prescriptions that can then be faxed, printed, or e-mailed to patients or directly to
pharmacies” as well as “[identifying] possible drug interactions and whether drugs are covered
by a patient’s insurance plan.” (ViewSonic V210 Helps Medical Clinic Write A Better
Prescription, 2006) It is important to provide these doctors with a way to write prescriptions
while in the room with the patient and have it immediately sent to the pharmacy, greatly
improving productivity.
Reducing prescription errors and increasing patient safety is another important aspect
health professionals will look for in an e-prescribing vendor. According to the Institute of
Medicine, “preventable medication errors result in more than 7,000 deaths each year in hospitals
alone and tens of thousands more in outpatient facilities.” (Make No Mistake: Medical Errors
Can Be Deadly Serious, 2000) This is a very serious problem and e-prescribing vendors are
Group 3 | Electronic Prescribing 5
searching for ways to address this issue, by providing software that will help to decrease the
possibility of errors. Studies have found that “overall prescribing errors have been reduced by
about 83% when using electronic prescription systems”, proving to be a good choice for
clinicians. (Bollen, 2001) One such vendor, Health Communication Network, an Australian
company providing e-health solutions to medical companies, was very effective in decreasing the
number of prescription errors and fall rates in one study done at a residential aged care facility.
Prescribing in such a facility was seen as more unsafe than in other facilities due to the
complexity and number of the medicines the patients were taking. (Bollen, 2001) This leads to
an increased chance for major and severe drug interaction as well as a slower recovery time.
Providing this facility with prescription management software not only helped reduce medical
errors but “improved awareness of safety and quality issues with regard to medication usage.”
(Sardinha, 1998)
Looking to change the way prescriptions are prepared and accessed, healthcare
professionals are seeking to implement electronic prescription software complete with the
capability to check for interactions with other drugs, diseases, or allergies as well as ensure the
correct dosage is given. Major patient based concerns lie with improving patient safety and
overall care as well as reducing the chance for error and drug interaction.
Benefits and Problems of Electronic Prescribing
A huge benefit to electronic prescribing is the PocketScript program. This will enable
physicians, through a wireless handheld PDA, to write prescriptions and then send them
immediately and electronically to pharmacies. This will help to improve patient convenience.
Additionally, physicians save time and money using PocketScript with the bi-directional renewal
capability. With PocketScript, pharmacists initiate requests routes through an office staff
Group 3 | Electronic Prescribing 6
member prior to review and approval by the physician. With electronic prescriptions,
pharmacists will be able to initiate renewal requests. Both physicians and pharmacists are able to
expedite the processing of prescription requests quicker than the traditional methods of writing
scripts, calling in orders over the phone or sending a fax.
During the prescribing process, in real time, the application provides formulary
information, a drug reference guide, drug-to-drug and drug-to-allergy checking, and patientspecific drug-dispensed lists. PocketScript(R) e-prescribing service reduces costs and improves
patient care by automating the prescription process between payers, doctors, and pharmacies.
Another company that shows good pros for electronic prescribing is iScribe which allows you to
instantly access critical health information at the point of care, securely access patient medication
histories, easily ascertain formulary information for all the patients in your practice, and reduce
pharmacy phone calls with online refills and renewals. iScribe electronic prescribing allows you
to write prescriptions, access formulary information and print or transmit legible prescriptions
using your Palm OS-compatible PDA.
With iScribe Electronic Prescribing, you can:

Generate prescriptions from approximately 6,000 drug formulations and medical
supplies.

Easily customize prescription-specific signatures to quickly generate prescriptions.

Effortlessly check formulary status and alternatives at the point of care.

Print prescriptions in office (Infrared or Bluetooth) or transmit directly to the pharmacy.

Build your database of patient medication histories on the handheld for easy reference
and simplified renewals.
Group 3 | Electronic Prescribing 7

Automatically check for drug-to-drug interactions.

Complementary Web-based tool provides formulary searching for you and your practice
staff. (Hot Stocks Set For Gains, 2006)
But as always there is a down side to every story and for this one it’s the cons for
electronic prescribing. And a con for this could be a wrong patient name may be selected from a
list or patient ID information may not be displayed on each new screen. More things include:
wrong diagnosis may occur for a patient causing some serious problems plus if not picked up on
in time. Errors can be easily avoided with alerts, although sometimes these alerts are inactivated
or ignored.
Solutions for Electronic Prescribing
Many issues hinder the proper and successful adoption of electronic prescribing. Some
physicians complain that finding information about information technology is hard to find. This
presents a problem. All kinds of information is available, but there is no real and easy way to
access it. Once a physician actually finds information about electronic prescribing and other
information technology options, usually the tools are too costly. These high costs can be
attributed to software, training, up keep, and initial programming. How can we make electronic
prescribing more affordable? It is a fact that electronic prescribing limits the amount of
prescribing errors. Even if a health care facility can afford electronic prescribing, there is still
hesitation in the form of previous experiences or negative assumptions. In this section you can
see solutions to help fix or soften some of the issues prohibiting adoption of electronic
prescribing.
Group 3 | Electronic Prescribing 8
In a relatively recent article titled, Medical Informatics in Neurology, Dr. Sami R. Hamid
said that “Despite the tremendous growth of the Internet and the vast amount of information
available to medical practitioners, busy physicians (especially those in clinical practice) have
little time to spend exploring the Internet. In some cases, physicians simply do not know how to
access required medical information in the best and fastest possible way. Many physicians do not
know how beneficial the Internet can be for their medical careers, especially in such areas as
patient care, academic work, or research”. (Hamid)
This problem more or less is defined by
information overload. In our society information is in great abundance. There is no real way to
find exactly what you want. It is beginning to become harder and harder to find accurate
information. Doing a simple search for electronic prescribing can take several hours. There is a
need to refine the search several times before you get the information you are looking for.
Physicians cannot make an opportunity cost to take time away from patients to complete
research. This information should be presented to them. The information should come to them
in the way of external entities like medical information technology agencies or even snail mail.
All information that can make a healthcare facility run more efficiently by adding things such as
electronic prescribing should be handed to these facilities. If this means there should be
standardization similar to like the Internet protocols, than steps should be taken. Ideally there
should be a single entity that overseas all electronic prescribing. This would limit the amount of
integration problems between facilities and pharmacies. There is a clear importance, according
to Dr. Randeree “Medical Errors kill between 44,000 and 98,000 people each year.” (Randeree,
2007)
Cost is the number one concern for virtually every aspect of medical information
technology. Based on Dr. Burke’s information, money from healthcare is not focused on
Group 3 | Electronic Prescribing 9
healthcare information technology. (Burke, 2006) In fact information technology spending in
the financial sector is seven times higher than that of healthcare! Is the health of our people not
important? To help this funding issue there happens to be electronic prescribing technology
strides being made to make those services available to facilities for free. Termed the National EPrescribing Patient Safety Initiative (NEPSI), the project will be led by clinical information
technology provider Allscripts. The NEPSI program intends to provide physician’s free access to
a web-based e-prescribing software program called eRx NOW. The Allscripts designed software
requires no download and no new hardware. (Pizzi, 2007) This company is acquiring support
from huge technology giants such as Microsoft, Cisco Systems, and Dell Computer. This is the
kind of exposure that is needed to help convert non-electronic prescribing facilities to use
prescribing technologies. Because no downloads or hardware is needed, this makes adopting this
technology very easy and cheap. It will not stop here. More and more companies will start to
follow the footsteps of NEPSI, and create their own free or other electronic prescribing
technology. The solution is for all healthcare facilities to use the tools available. In the same
article, Dr. Namcy Dickey said, “Medication errors and adverse drug events could be virtually
eliminated with this technology, which could save the healthcare system $27 billion.” (Pizzi,
2007) If that is not an incentive to change, then I don’t see there ever being a significant change.
According to Halamka, in the article Early Experience with E-prescribing “Most
physicians understand that e-prescribing will reduce medical errors and will be perceived by
patients as making the prescription process easier. However, they are skeptical about a number of
things. They worry whether their office processes will be improved or streamlined; e-prescribing
will interface seamlessly with their existing practice management software; training and support
will be available; e-prescribing data will be seamlessly transferable to an electronic health record
Group 3 | Electronic Prescribing 10
when they implement a more advanced clinical record system for their practice; and if they will
achieve a return on investment”. (Halamka, 2006) All of the concerns listed are important and
worthwhile be concerned about. This type of concern should not be the burden of the healthcare
facility. These concerns should be figured out by an external entity that provides technology for
the facility. Essentially an information technology company should be concerned with
integration, training and return on investment. The most important aspect of the concerns form
physicians is training. Without training how can a medical facility be comfortable and happy
with electronic prescribing services? Without training, facility users will not like the system and
not use it. This has a downhill affect. Return on investment will drop, and then eventually the
facility will drop the e-prescribing service. Healthcare will be back where it started.
Many solutions can be made to help alleviate some of the problems associated with
electronic prescribing. Information should be presented to healthcare providers; they should not
have to search for it. The creation of free online prescribing services should be in abundance.
Training a facility on how new electronic prescribing works will allow for the successful
adoption of healthcare information technology.
Future of Electronic Prescribing
To help make the push for electronic prescriptions, the government has begun to get
involved and lead healthcare into the future. In 2003, President Bush passed the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Although most of this
act was to help seniors and those in need of healthcare to be able to afford their necessary
prescriptions, part of this Act was dedicated to electronic prescriptions. This Act required that
there be standards for uniformity among systems of electronic prescribing and also allowing
companies to help with costs related to the implementation of these systems. This Act helps
Group 3 | Electronic Prescribing 11
show how the government thinks that the move to bond healthcare and technology is not only
important to do but is really a necessity for the healthcare industry to thrive into the future.
Although this Act will help continue the growth of electronic prescriptions, there will be many
more key factors that need to be dealt with to make this system run smoothly. (Meyer &
Cantwell, 2004)
The future of electronic prescriptions will be based on the implementation of the system.
As improvements in technology are made, more people will be willing to adapt to a system that
works efficiently. It is important that we not get up in bringing healthcare into the future. A
study found that the number of errors found when using computerized doctor order entry for
medications was reduced by 55%. (Bodenheimer & Grumbach, 2003)
Not only is it important to implement a new system to help the performance of
healthcare, there also has to be a stable support system to keep this system going. There has to
be a lot of time given for the adoption of the new system to take place. Most Physicians will not
jump on board to a new technology without seeing that this technology is well worth the effort
that it will take to get their whole team to put this system to use. It usually takes a couple of
physicians in an area to adapt to a new system and then spread the word and show people that
this new technique can help improve how the healthcare system can run by saving not only time
but also reducing the number of errors and problems that may arise from regular handwritten
prescriptions. There also needs to be technicians that are available to help solve any problems
that may arise. This will help solve any of the frustrations that some of the doctors and/or nurses
may have. It is easy to just give up when you arise at a problem that you cannot solve. The
healthcare staff will have to feel that they are being backed 100% by someone that can help them
figure out any complications that they have and also maybe show them some new techniques
Group 3 | Electronic Prescribing 12
with the system that they were unaware of. Support is one of the key aspects when
implementing a new system. People will rely on someone that can help them overcome the
challenges that they may face when trying to implement a system that will be better in the long
run for the company at hand.
There are some factors that will have to be worked out to help move into an age of
electronic prescriptions. One of the big issues is that pharmacies are not ready to handle this
move to technology. There are only about 40-60% of pharmacies available that currently have a
fax machine available for them to use. (Sardinha, 1998) Also, currently there are only a “few
pharmacies that are certified in SCRIPT standards for the electronic transmission of prescription
information, issued in 1996 by the National Council for Prescription Drug Programs.” (Sardinha,
1998) In order for a pharmacy to be certified, they have to prove that their current system can
handle a standard form of transferring and accepting data. The move towards electronic
prescriptions could really come into play when some of the major pharmacies move towards
becoming certified in the SCRIPT standards. There are also many services that are becoming
available to help link doctors and healthcare facilities with more than 700 HMOs, PPOs and
PBMs. (Sardinha, 1998) This would help allow the doctor to immediately check which drugs are
approved for this patient without having to go look it up. This could also really help the patient
to get the most affordable drug for them that is available.
The future of electronic prescriptions could be really important to healthcare. With
technology ever-changing, it is important that we try to grasp on to it now instead of when it
becomes too overwhelming. As time goes on, it is becoming cheaper to build forms of
technology. This will make it easier for people and businesses to be able to afford some of the
new things that technology has to offer to us in the future. As we move into the future,
Group 3 | Electronic Prescribing 13
companies are also developing new systems that are more user-friendly. This will make it easier
for the healthcare industry to understand and implement the new systems that are available into
their daily routines with ease. The future is not something that we can really control. It is
important that we take advantage of everything that is offered to us and get the full use out of the
resources.
Conclusion
If medical errors kill between 44,000 and 98,000 people each year, is that not a huge
incentive to improve healthcare? Needless loss of life is a huge waste that can be easily avoided
if new technology such as electronic prescribing is used. At a minimum electronic prescribing
will almost eliminate prescription errors. That feat in itself is worthwhile. Not only will most
errors be avoided all together, any error that does occur can be tracked to who made the error.
Because physicians will be held accountable for their actions, there is an incentive for physicians
to spend more time in entering data free of errors. It is easy to just label the benefits, and assume
that the usability and adoption of electronic prescribing is an easy objective. This is not the case.
There are lots of obstacles that healthcare providers will face while using or initiating the use the
electronic prescribing. Cost is the number one contributor to the lack of adoption. These services
should not only be free in some way but also standardized. Huge companies such as Dell have
made strides to place monies into this field. Once cost for these services is finalized there needs
to be a safety net of some sort that can aid healthcare providers with training and usage tips with
electronic prescribing technology. With improvements the shocking statistic of medical errors
contributing to death will decrease if not be completed eliminated. This is a goal that everyone
should have in common.
Group 3 | Electronic Prescribing 14
References
Bell, M. M. (2004). Recommendations For Comparing Electronic Prescribing Systems: Results
Of. Health Affairs , 305-317.
Bodenheimer, T. ,., & Grumbach, K. M. (2003). A Spark to Revitalize Primary Care? Electronic
Technology , 259-264.
Bollen, C. W. (2001). Introduction of Electronic Prescribing In An Aged Care Facility.
Australian Family Physician , 283-286.
Burke, D. D. (2006, January 30). Money in Health IT.
Electronic Prescribing. (2005). Australia Government Department of Heath and Ageing .
Halamka, J. (2006). Early Experiece with E-prescribing. Medline , 1.
Hamid, D. S. (n.d.). Medical Informatics in Neurology. . eMedicine Clinical Knowledge Base ,
10.
Hot Stocks Set For Gains. (2006, July 6). Business Wire .
Make No Mistake: Medical Errors Can Be Deadly Serious. (2000, October). FDA Consumer .
Marcinko, D. E. (2004). The Business of Medical Practice : Advanced Profit Maximization
Techniques for Savvy Doctors. Springer Publishing.
Meyer, B. M., & Cantwell, K. M. (2004). The Medicare Prescription Drug, Improvement, and
Modernization Act of 2003: Implications for health-system pharmacy. American Journal of
Health-System Pharmacy , 1042-1051.
Pizzi, R. (2007). Tech Coalition to Provide Free E-prescribing. 1.
Randeree, D. E. (2007, January 23). Transcription Errors. (L. H. University, Interviewer)
Sardinha, C. (1998). Electronic Prescribing: The Next Revolution in Pharmacy? Journal of
Managed Care Pharmacy , 35-39.
Spooner, M. M. (2005, February). AAP News. American Academy of Pediatrics .
ViewSonic V210 Helps Medical Clinic Write A Better Prescription. (2006, May 5). CRN
Magazine .
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