Effective Use of e-Prescribing in Physician Practices and Pharmacies

Electronic prescribing (e-prescribing) is a central focus of efforts to promote health information technology due to its potential to improve patient safety by reducing medication errors. While many public and private sector initiatives to support e-prescribing have been implemented, physician adoption and use remains relatively limited. Research suggests that the availability of e-prescribing system capabilities that have the potential to improve patient safety and provider efficiency vary. In addition, physician practices face barriers to implementing these capabilities effectively and increasing physician use.

In this project, the Center for Studying Health System Change, a non-partisan health policy research organization, conducted research exploring the effective use of e-prescribing in physician practices and pharmacies. This research focused specifically on e-prescribing among users who electronically send or receive prescriptions directly from or to their e-prescribing system, rather than by stand-alone or computer-generated fax.

The main objective of the project was to explore two areas where challenges to successful e-prescribing implementation and use have been identified in previous research: (1) physician use of e-prescribing features that have the potential to yield health care quality benefits but that prior research has shown not to be available or used routinely by significant proportions of e-prescribers; and (2) electronic communication between physician practices and pharmacies.

The project team conducted 114 telephone interviews with 97 organizations, including 24 medical practices, 48 community-based pharmacies, and three mail-order pharmacies. The study explored physician use of third-party information at the point of prescribing including medication histories, formularies, and generic medication alternatives. The researchers also examined how communication between physician practices and pharmacies is affected by e-prescribing.

Most clinicians interviewed had access to formulary information, while slightly more than half had access to medication histories. Despite the availability of this information, many physicians indicated that they did not routinely review it when making prescribing decisions. To increase the use of generic medications, practices typically allow pharmacists to substitute generic medications when brand medications are prescribed. Some of the interviewed practices utilized tools that present generic alternatives to clinicians at the point of prescribing.

In addition, the project team found that there was general satisfaction with the electronic transmission of new prescriptions. However, electronic prescription renewal was conducted less consistently than transmission of new prescriptions, which led to inefficient workarounds for both prescribers and pharmacies. Because of limitations of networks and computer systems, electronic communication between practices and pharmacies was more likely to occur with community pharmacies than with mail-order pharmacies. Pharmacy staff noted that although there was an overall reduction in manual prescription entry, staff frequently had to edit or complete fields, particularly fields for patient instructions and the drug name.

The project team concluded that while some of the challenges noted might be overcome as physicians and pharmacies become more experienced with e-prescribing, inherent software issues should also be addressed. The study team recommended that a broad group of public stakeholders, including the Federal government, the National Council for Prescription Drug Programs (NCPDP), standards-setting organization, vendors, and medical informatics researchers should work together to address these issues.