Study: Physicians, pharmacies need to address problems with e-prescribing

Despite viewing electronic prescribing as a safe and efficient tool, physician practices and pharmacies are not utilizing the technology to its full benefit, according to a study funded by the Agency for Healthcare Research and Quality (AHRQ). The study is published online in the Journal of the American Medical Informatics Association.

Electronic prescribing, or e-prescribing, can help reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions. The study found physician practices and pharmacies to share a positive attitude toward the electronic transmission of new prescriptions.

However, prescription renewals, connectivity between physician offices and mail-order pharmacies, and manual entry of certain prescription information by pharmacists—particularly drug name, dosage form, quantity and patient instructions—continue to pose problems.

Researchers at the Center for Studying Health System Change, Washington, D.C., conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies using e-prescribing. Community pharmacies were divided between local and national companies.

Physician practices and pharmacies used e-prescribing features for electronic renewals much less often than for new prescriptions. More than a quarter of the community pharmacies reported that they did not send electronic renewal requests to physicians. Similarly, one-third of physician practices had e-prescribing systems that were not set up to receive electronic renewals or only received them infrequently.

Physician practices reported that some pharmacies that sent renewal requests electronically also sent requests via fax or phone, even after the physician had responded electronically. At the same time, pharmacies reported that physicians often approved electronic requests by phone or fax or mistakenly denied the request and sent a new prescription.

The study noted that resolving e-prescribing challenges will become more pressing as increasing numbers of physicians adopt the technology.

Other key study findings include:

● About three-quarters of physician practices reported problems sending new prescriptions and renewals electronically to mail-order pharmacies. Many practices were unsure which mail-order pharmacies accepted e-prescriptions and believed that, even when a mail-order company did accept them, the process was unreliable.

● Pharmacies noted the need to sometimes manually edit certain prescription information, such as drug name, dosage and quantity. One common cause reported by both physicians and pharmacists was that physicians must select medications with more specificity when e-prescribing and make decisions about such factors as packaging and drug form. Such decisions had typically been made by pharmacists for handwritten prescriptions.

● Nearly half of pharmacies reported that patient instructions typically had to be rewritten for patients to understand them.