ROCKVILLE, Md. — Doctor’s offices and pharmacies see electronic prescribing as a key tool for improving patient safety and saving time, but they face barriers to realizing the technology’s full benefit, according to a study commissioned by the U.S. Department of Health and Human Services (HHS).
HHS said Monday that the study, funded by its Agency for Healthcare Research and Quality (AHRQ) and published online in the Journal of the American Medical Informatics Association, found that physician practices and pharmacies generally are positive about the electronic prescriptions. But prescription renewals, connectivity between doctor’s offices and mail-order pharmacies, and manual entry of certain prescription information by pharmacists — notably drug name, dosage form, quantity and patient instructions — continue to present problems.
In the study, researchers at the Center for Studying Health System Change in Washington, D.C., conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies using e-scripts. Community pharmacies included local and national operators.
The research spotlighted multiple potential benefits of e-prescribing — such as reduced medication errors from illegible or incomplete handwritten prescriptions — and focused on a key aspect of the technology: the electronic exchange of prescription data between doctors and pharmacies, which promises to save time and money by streamlining the processing of new prescriptions and renewals.
"Physicians and pharmacies have come a long way in their use of e-prescribing, and that’s a very positive trend for safer patient care and improved efficiency," AHRQ director Carolyn Clancy said in a statement. "This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies and patients."
According to the study, physician’s offices and pharmacies used e-prescribing features for electronic renewals much less often than for new prescriptions. Over a quarter of the community pharmacies said they did not send electronic renewal requests to doctors. Also, a third of physician practices had e-prescribing systems not set up to receive electronic renewals or only received them infrequently.
Doctor’s offices reported that some pharmacies that sent renewal requests electronically also sent requests via fax or phone, even after the physician had responded electronically. At the same time, pharmacies said doctors often approved electronic requests by phone or fax or mistakenly denied the request and sent a new prescription.
Other key findings included the following:
• Pharmacies noted the need to sometimes manually edit certain prescription information, such as drug name, dosage and quantity. One common cause reported by physicians and pharmacists was that doctors must select medications with more specificity when e-prescribing and make decisions about such factors as packaging and drug form. Such decisions had typically been made by pharmacists for handwritten prescriptions.
• Nearly half of pharmacies reported that patient instructions typically had to be rewritten for patients to understand them.
• About three-quarters of doctor’s offices reported problems sending new prescriptions and renewals electronically to mail-order pharmacies. Many practices were unsure which mail-order pharmacies accepted e-scripts and concluded that, even when a mail-order company did accept them, the process was unreliable.
The study noted that resolving e-prescribing challenges will become more pressing as rising numbers of doctors adopt the technology in response to federal incentives. As part of the HITECH Act of 2009, physicians can qualify for Medicare and Medicaid electronic health record (EHR) incentive payments by generating and transmitting more than 40% of all prescriptions to pharmacies electronically, excluding prescriptions for controlled substances.
