Long Term Care E-Prescribing Standards Pilot Study

This project, part of five grants awarded by the Agency for Healthcare Research and Quality to conduct electronic prescribing (e-Prescribing) pilots, piloted an e-Prescribing application in a Long Term Care (LTC) setting. This setting is one in which e-Prescribing is rarely used, and in which historically, standards development has not taken into account the unique requirements of prescribing in a LTC setting. Barriers to its use have included the cost of implementation, as well as the lack of evidence outlining the benefits of e-Prescribing in these unique settings. The main objectives of this project were to:

• Implement and test current National Council for Prescription Drug Programs (NCPDP) standards in the LTC setting.
• Where current standards did not meet the needs of the LTC market, develop, test, implement, and evaluate revisions to the NCPDP standards that enable successful e-Prescribing in the LTC setting.
• To determine the impact of the e-Prescribing system to both the facility and the pharmacy in the areas of workflow timing, quality of care, and financial benefit.

The project successfully implemented a standards based e-Prescribing application in the LTC setting using a Web based approach. The team created a computer-to-computer e-Prescribing process by connecting the facility's electronic health record to the pharmacy application. Alerts were developed to be generated by the system prior to the order being sent to the pharmacy. Some modifications were made to existing standards during the pilot, including providing additional resident information and using the CANRX SCRIPT for providing resident discharge status. The CANRX SCRIPT is needed to communicate orders that have been discontinued from the prescriber-facility system to the resident's LTC pharmacy.

The study found that facilities experienced improvements in terms of both time and efficiencies. The team was unable to evaluate the impact to resident safety due to the duration of the project. It was noted that there were resultant impacts to pharmacy workflow, which caused additional work effort in that setting.

Areas were identified in which the existing e-Prescribing standards did not meet the needs of the LTC setting. Revisions to these standards however, were not possible during the study timeframe. These areas include new, changed, and discontinued combination orders, such as medication with both routine and as-needed schedules, or tapered dose therapies. The team notes the critical need to develop new or revised standards in order to address these identified areas.

The study also looked at the issues involved in provider adoption of this technology, noting that the full benefits of e-Prescribing cannot be realized unless the technology is more widely used. One example of a pharmacy barrier given were the inefficiencies in processing combination orders, rather than having those combined orders come across as a single message. Improvements in the standards may help these issues and lead to improvements in adoption.