The AHRQ’s report on its monitored eRx pilots is out. Here are the findings that I’ve extracted from their slightly longer list in the exec sum.
In addition to testing the functionality of e-prescribing standards, pilot sites tracked various outcomes of e-prescribing in their pilots. The following observations were made by the evaluation team:§ Prescriber uptake and satisfaction. Adoption and retention of e-prescribing among providers was generally good. In order to facilitate prescriber adoption, the evaluation team recommends institutions implementing e-prescribing take into account the role of their organizational culture and prepare for possible “surrogate prescribing” (see below).§ Prescriber and pharmacy workflow changes. One finding that was consistent across all sites was that prescribers’ staff played a much more important role in the e-prescribing process than most pilot sites had anticipated. The evaluation team recommends that future e-prescribing efforts take the role of these staff, or “surrogate prescribers” into account in their planning. Another finding was that e-prescribing almost never replaced the need for paper-based prescribing, leading to highly variable use of e-prescribing features. In addition, implementation of e-prescribing can create dramatic “paradigm shifts” in pharmacy workflow. Pharmacies implementing e-prescribing, therefore, must allocate sufficient resources to deal with substantial change management. Finally, preliminary findings suggest that e-prescribing tools may decrease reliance on verbal orders and generate certain efficiencies for small physician offices. Proof of such efficiencies is still relatively preliminary, however.§ Changes in number of callbacks from pharmacy to prescribers. Findings reported by some pilots suggest that e-prescribing reduces the number of phone time for physician practices while potentially decreasing efficiency on (Sic—I assume they mean “in”) the pharmacy through an increase in the number of callbacks required to complete a prescription. Yet other pilots found a decrease in callbacks related specifically to drug coverage issues. Given these inconsistencies, the evaluation team recommends that further study is required to acquire a more complete understanding of this potentially “cost-shifting” phenomenon. § Use of Medication History functions. Overall, the pilots’ findings demonstrated poor adoption of this functionality. We recommend further research to determine better ways for displaying and maintaining up-to-date medication histories to providers.§ Changes in prescription renewal and new prescription rates. The long term care site reported a reduction in new prescription rates, indicating the possibility that e-prescribing may reduce the tendency for such patients to accumulate unnecessary active medications.§ Use of on-formulary medications and generics. Clinicians surveyed by the pilots were concerned about the accuracy of formulary information provided by e-prescribing systems. Further studies will need to assess the perceived and actual quality of this information. In addition, generic prescribing that automatically allow for generic substitution may increase the rate of generic prescribing.§ Change in fill status rates. Fill status use was extremely limited due to the difficult implementation of this standard.
More comment later, but the issue of pharmacy workflow is clearly a major problem—especially if call backs from the pharmacy increased after eRx was implemented.