eRx worthwhile, but still problematic for docs, pharmacies

A study by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality finds that physician practices and pharmacies are both keen on e-prescribing's ability to improve safety and save time — but that both groups face barriers to realizing its full benefit.

The study, published online in the Journal of the American Medical Informatics Association, focuses on the electronic exchange of prescription data between physician practices and pharmacies, which can save time and money by streamlining the way in which new prescriptions and renewals are processed. It finds that e-prescribing helps reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions.

Physician practices and pharmacies generally were positive about the electronic transmission of new prescriptions, the study found. But 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.

"Physicians and pharmacies have come a long way in their use of e-prescribing, and that's a very positive trend for safer patient care and improved efficiency," said AHRQ Director Carolyn M. Clancy, MD. "This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients."

Researchers at the Center for Studying Health System Change in 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 25 percent of the community pharmacies reported 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 AHRQ study noted that resolving e-prescribing challenges will become more pressing as increasing numbers of physicians adopt the technology in response to federal incentives. Physicians can qualify for EHR incentive payments by generating and transmitting more than 40 percent of all prescriptions to pharmacies electronically, excluding prescriptions for controlled substances.

The study's 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.

The study, "Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies," is available at jamia.bmj.com.