Why no e-Prescribing in the ED?


As previously reported,
we have a wonderful system that permits doctors to order prescriptions
online, allowing patients to pick them up directly from their preferred
pharmacy. Recently a friend of mine went to our BID~Needham Emergency
Department, and came home with a script to get her prescription from
our pharmacy. So I inquired. Our ever helpful CIO, John Halamka,
At present, e-Prescribing in the US is generally
limited to primary care practices and specialists who act as primary
care givers, i.e. cardiologists, ob/gyns, pulmonary docs, etc.
Massachusetts is the number one e-Prescriber in the country, yet only
13% of the routable prescriptions in the state go electronically. BIDMC
ambulatory clinics use it, and they are routing 35% electronically,
increasing every month.At BIDMC and BID~Needham Emergency
Departments, prescriptions are written electronically and printed to
tamperproof paper on laser printers in the department. To my knowledge,
there are no Emergency Departments in the state using e-Prescribing.
Here’s the challenge1. It is currently illegal to e-Prescribe
any controlled substance — pain killer, sedative, anti-anxiety drug
etc. Approximately 1/3 of all Emergency Department prescriptions are of
this type. Recently, the Massachusetts Department of Public Health was
able to get a DEA exemption to test one site (Berkshire Medical Center
using Meditech software) to e-prescribe controlled substances. The DEA
wants this to be a three year pilot , which illustrates how resistant
to change the DEA can be. I’ve just signed a letter along with many
health care standards and pharmacy leaders urging Congress to get
involved and accelerate the ability to e-Prescribe controlled
substances as a modification to Medicare Part D standards.

The real advantage of e-Prescribing occurs when a patient has an
ongoing relationship with the clinician and the renewal workflow can be
automated. Emergency Department Physicians do not have ongoing
relationships with patients (at least most of the time)

3. In my
anecdotal experience, many patients visiting EDs do not have a specific
pharmacy preference since their ED care is related to trauma, treatment
while traveling, or an acute event requiring a medication, but the
patients do not take meds chronically. Hence a tamperproof computer
generated paper prescription is most convenient for them.

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  1. The DEA should be abolished and started afresh. But that’s for a variety of non-health care related reasons.
    Getting in the way of eprescribing in EDs is just another reason…