E-prescribing is benefitting healthcare system, but barriers to adoption remain

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Implementation costs, alert fatigue cited as obstacles for practices

E-prescribing is bringing substantial benefits to the nation’s healthcare system, but significant barriers remain to its more widespread adoption, a new research study concludes.

The study, in the form of a systematic review, examined the findings of 47 articles looking at e-prescribing-which the authors define as “the computer-based electronic generation transmission, and filling of a prescription”-from a variety of clinical and financial perspectives. The results appear in an article titled “Electronic Prescribing: Improving the Efficiency and Accuracy of Prescribing in the Ambulatory Care Setting” in the Spring 2014 issue of Perspectives in Health Information Management.

The benefits found in the review include:

  • Improved patient safety: E-prescribing makes prescriptions more legible, decreases the time needed to prescribe and dispense medications, and reduces medication errors and adverse drug events (ADEs) due to the presence of medication decision support (MDS) systems. One study of 12 community-based practices found that error rates dropped from 42.5 to 6.6 per 100 prescriptions one year after the adoption of e-prescribing.

  • Greater efficiency: Though it takes about 20 seconds longer per patient to enter a prescription into a computer than to write it by hand, “this time is offset by the time saved because of the fact that less clarification is needed for electronic prescriptions,” the authors say. At the pharmacy, meanwhile, prescriptions received electronically produce less paperwork and fewer issues that need to be resolved compared with paper prescriptions.

  • Cost savings: The authors cite a study by the clinical network Surescripts showing an estimated $140 billion to $240 billion in savings and improved health outcomes over 10 years, mainly due to better medication adherence and reduced ADEs. The Surescripts study also found a 10% increase in the number of e-prescriptions filled compared with written prescriptions.

In addition, e-prescribing systems that use MDS can help doctors choose lower-cost alternatives to brand-name drugs can reduce prescription drug costs. The authors cite a 2005 study involving 19 physicians that found a 17.5% decrease in prescriptions for high-cost drugs compared with the control group, leading to a savings of nearly $110,000 over 12 months.

Barriers to the greater use of e-prescribing include:

  • Implementation costs: “New technology requires training and information technology support for installation and upkeep,” the authors note. “A practice must take these costs into account when deciding whether to implement an e-prescribing system and when choosing a stand-alone system or one that is integrated into an EHR system.”

  • Alert fatigue: Faced with numerous alerts each time they enter a prescription, many providers stop reading the alerts, with the result that they may ignore a potentially dangerous interaction.

  • Privacy/legal issues: without effective firewalls and other safeguards, prescription data transmitted electronically may be breached, leading to HIPAA violations and fines. In addition, “most information breaches actually occur as a result of employees’ actions, so continuous training on security is imperative and can incur additional costs,” the authors write.

Legal issues usually occur when providers need to prescribe controlled substances. Although it is legal to prescribe such substances electronically, the process is time-consuming and cumbersome, and requires expensive hardware and software to implement.