E-prescriptions becoming the norm

The days of blaming a doctor’s scrawl for medical errors are coming to an end. Computerized electronic prescriptions are replacing handwritten paper prescriptions.

Electronic prescribing, or e-prescribing, is one of the better, more functional components of electronic health records systems, said Dr. Joe Bachtold at the St. Charles Family Care clinic in Sisters. Electronic health records are integral to a national movement toward improved health care coordination.

Most providers in the area have already adapted to electronic records and e-prescriptions, and St. Charles Bend said as it upgrades its technology this year, providers in the hospital also will be able to use e-prescriptions by sometime in 2014.

E-prescribing is computer-to-computer communication (not faxes) between prescribers, pharmacies and payers about new or changed prescriptions.

Patient safety

“We certainly know there’s a harm rate around handwriting errors,” said Dr. Mary Dallas, medical director of clinical informatics with St. Charles Health System. In haste, physicians might write something no one else can read, or prescribe the wrong medication or wrong dose.

In combination with a patient’s electronic records, e-prescriptions offer many safeguards, said Bend Memorial Clinic Medical Director Sean Rogers. E-prescribing is meant to prevent errors and reduce dangerous drug reactions.

In an electronic system, the extra work from a physician is on the front end — entering data about the patient and what medications he or she needs. But then, to prescribe a medicine or renew or change a prescription, it just takes one click on a computer. A pharmacist can send a request for a refill to a doctor’s electronic record system just as easily.

“When I prescribe an antibiotic for a patient with bronchitis, it’s automatically added to their medications list with all the appropriate information — how many pills I gave them, all the directions. It’s part of their permanent chart. There’s no such thing as someone giving my patient a medication and me not knowing about it,” Rogers said. “It does automatic drug-drug interactions. It will check other medications on the patient’s list and warn me if there are possible interactions. It will also automatically check my prescriptions with the patient’s listed allergies. A warning box will come up and say, ‘This patient has an allergy.'”

The system is set up to catch an extra zero on a prescribed dose, for example, said Dallas.

“The greatest benefit is the improvement in medicine safety for the patient,” said Dallas. E-prescriptions have decreased the rate of medical errors, Dallas said, although she said she doesn’t have numbers to quantify improvements.

Incentive to e-prescribe

The e-prescription movement gained momentum with a July 2006 Institute of Medicine report that said at least 1.5 million preventable adverse drug events — injuries and problems from medication errors — occurred each year in the United States.

These errors are not only potentially deadly, they are also expensive. Each preventable adverse drug event that took place in a hospital added about $8,750 to the cost of the hospital stay, according to the report.

The IOM report recommended that all prescribers and pharmacies use e-prescriptions by 2010.

Under the Health Information Technology for Economic and Clinical Health Act of 2009, a set of “meaningful use” standards from the Centers for Medicare & Medicaid Services govern electronic health records and allow providers and hospitals to earn incentive payments. To promote e-prescriptions, CMS has been providing extra financial bonuses at the end of the year for eligible providers or clinics that meet certain targets for e-prescriptions for Medicare patients. And, starting in 2012, eligible physicians who hadn’t adopted the practice could get penalized through a payment reduction program that runs through 2014.

Bachtold said he was aware of Medicare incentives but that’s not why he uses electronic prescriptions. The e-prescription function is embedded in the electronic health records system that he has used for many years, he said.

The communication system “as a rule, works pretty good,” Bachtold said. However, some pharmacies, for reasons unknown to him, seem to have difficulty processing them, meaning the prescription doesn’t reach its destination and there’s no record of the transaction. Dallas said about 10 percent of pharmacies are not yet set up for e-prescriptions.

And, Rogers added, at this point, electronic systems don’t always communicate seamlessly between different clinics, but CMS is looking for ways to improve that.

Widespread use

“I think by now, today, most providers are on some sort of electronic record,” Rogers said. “It’s possible to do stand-alone prescribing programs that are not part of an electronic medical record, but the more sophisticated programs will be integrated ones.”

It’s challenging to manage both paper and electronic files and prescriptions if providers are keeping paper records.

Bend Memorial Clinic care providers have been using e-prescriptions, which are integrated into BMC’s electronic health records system, since 2007, said Rogers.

In St. Charles’ regional clinics, which encompass about 125 providers employed by St. Charles Medical Group, about 90 percent of the prescriptions are written electronically, said Dallas.

In the St. Charles Bend hospital, however, emergency room physicians and hospitalists are not yet using them. The hospital’s technological systems have not caught up with the clinics, Dallas said. By sometime next year, however, upgrades to the hospital’s electronic records system will enable hospital providers to e-prescribe, she said.

E-prescriptions can be used for all medications except controlled substances — which include drugs such as vicodin, morphine and percocet as well as some anti-anxiety medications and other things such as testosterone. While CMS strongly encourages the use of e-prescriptions, the Drug Enforcement Administration won’t allow it for controlled substances, Rogers said. So, for those, Rogers said, a physician must hand write a prescription or write it in the electronic file, print it, sign it manually and hand it to the patient, who fulfills it in person.

The discrepancy with controlled substances is rooted in the DEA’s desire to prevent fraud and what’s called diversion — the use of a drug for other than its intended use, Rogers said. But the law is counterintuitive and has been a point of contention for years, he said.

Dr. Janey Purvis, a family physician at Bend Memorial Clinic, said she e-prescribes 100 percent of the time, except for controlled substances and for equipment such as wheelchairs or walkers, which are acquired differently than medications. She said the transition from paper prescriptions to electronic ones was fairly easy.

“The electronic medical record made it quite simple, … providing commonly used dosages, and information regarding the patient’s insurance coverage,” she said. “I really didn’t have much hesitation, knew it was coming, and wasn’t inconvenienced in any way.”

Patients like it too, she said. “Prescriptions don’t get lost,” for starters. The information goes straight to the pharmacy.

“(It) also provides a record for the patient in case they forgot a previous medication or times to refill,” she said.

Many patients are still unaware of the process, she said. “They … were often surprised to know that a prescription had already been sent over to the pharmacy as we were discussing it in the office.”