The May 2012 edition of the Journal of the American Medical Informatics Association (JAMIA) offers the opportunity for a second look at an important recent study on e-prescribing. The study, “Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies,” examines practitioners’ experiences with this potentially game-changing technology.
The study, first available on the AMIA web site in November 2011, is now one of 12 articles included in the JAMIA issue on the “Focus on health information technology, electronic health records and their financial impact.” (It is available at no cost at http://jamia.bmj.com/content/current.) In the article, Joy M. Grossman, PhD, and colleagues from the Center for Studying Health System Change (HSC) conducted a qualitative analysis of 114 telephone interviews with representatives from 97 organizations including 24 physician practices, 48 community pharmacies, and three mail-order pharmacies actively transmitting or receiving e-prescriptions. This study is part of a larger qualitative project on e-prescribing. An earlier publication, released in May 2011, explored physician practice use of e-prescribing to access external information on patient medication histories, formularies and generic alternatives. It can be found at http://www.hschange.org/CONTENT/1202/.
The study found some progress has been made, but challenges to using e-prescribing remain. The study authors established that physician practices and pharmacies generally were satisfied with electronic transmission of new prescriptions, but reported that the electronic renewal process was used inconsistently, resulting in inefficient workarounds. Physician practices also reported problems communicating electronically with mail-order pharmacies. This was due in part to underlying transmission network and system limitations. And despite the labor-saving potential of e-prescribing, respondents said pharmacy staff often had to complete or edit certain fields, particularly drug name and patient instructions.
According to a 2011 survey conducted by Surescripts, e-prescribing is now used by 52 percent of office-based physicians compared with less than 10 percent use three years ago. The adoption rate is almost certain to keep rising, because the advantages of e-prescribing are impossible to ignore. Electronic transmission of both new prescriptions and renewals has the potential to streamline workflow and minimize interruptions from phone and fax communications. In the pharmacy, staff may save time processing prescriptions that do not have to be entered manually. For patients, reducing manual entry has the potential to lower the rate of prescription errors, which puts patients at risk every year.
But even as physicians and pharmacists adopt e-prescribing, they’re not embracing it yet. The barriers identified in the HSC study will grow even more important for practices and pharmacies as e-prescription volume accelerates in response to Federal incentives. These barriers are surmountable, particularly as physicians and pharmacies gain experience using systems, but the study asserts that structural and design issues underlying these challenges will need to be addressed directly.
I recently had the opportunity to hear directly from e-prescribing users. Dr. Grossman and I were invited to discuss the study with the State Health Information Exchange Community of Practice (CoP), supported by Office of the National Coordinator for Health Information Technology, who meet and share best practices and lessons learned in the use of e-prescribing. Some 35 health professionals joined us and readily confirmed they too have observed similar barriers, such as lack of connectivity with mail-order pharmacies or differences in medication names between e-prescribing and pharmacy systems. There was widespread agreement that addressing these barriers is essential for e-prescribing to achieve its full potential and CoP members are ready to identify solutions to these challenges.
In her introduction to the JAMIA special edition, the journal’s Editor in Chief Lucila Ohno-Machado, MD, PhD, cites the HSC study as one of several providing evidence that “it is clear that informatics and health information technology are in different stages of development in different settings.” This is a challenge for facilitating the impact of e-prescribing on quality. Large pharmacy chains, hospital systems, and group practices have the staff and resources to ease e-prescribing into their workflow settings with minimal disruption. The solo practitioner and independent pharmacy owner may find some of these barriers daunting, and are understandably wary of committing to health IT-enabled medication management.
What is the solution? We need to eliminate those barriers and foster widespread confidence that e-prescribing can help make our health care system safer and more efficient. This must be a shared endeavor. Policymakers must be clear in their policies, expectations, and guidance to e-prescribing system developers and users; developers must produce systems that are interoperable, designed to effectively support the medication management process, and cost effective; and providers and pharmacies must directly convey their needs and concerns for an effective e-prescribing system based on their experiences in clinical and pharmacy settings.
This AHRQ-funded study has given us a terrific start by compiling this information in one place. This body of knowledge, now in JAMIA, should be required reading for all with a vested interest in the delivery of prescription medicine to the patient and those who seek to have e-prescribing adoption reach its full potential.
Teresa Zayas-Cabán, PhD, is Senior Manager for Health IT at the Agency for Healthcare Research and Quality. She oversees projects in the portfolio that implement and demonstrate the value of Health IT, such as the Enabling Patient-Centered Care through Health IT grant initiative. Dr. Zayas-Cabán also manages several contracts focused on clinical decision support, workflow, and the design and implementation of Health IT and its impact on consumers.