Study: E-prescribing works, but challenges remain

If your practice is like those surveyed recently by the Center for Studying Health System Change, you find electronic prescribing (e-prescribing) to be an important tool for improving patients’ safety and saving time, yet you acknowledge barriers to realizing the technology’s full benefits.

For the study, “Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies,” researchers conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies, and three mail-order pharmacies using e-prescribing. The results were published online in the Journal of the American Medical Informatics Association. The study was funded by the U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ).

The study focused on a key aspect of e-prescribing: 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.

Practices and pharmacies generally were positive about the electronic transmission of new prescriptions, the study found. Prescription renewals and connectivity between doctors’ offices and mail-order pharmacies, however, along with manual entry of certain prescription information by pharmacists-particularly drug name, dosage form, quantity, and patient instructions-continue to pose problems, they said.

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

Practices reported that some pharmacies that sent renewal requests electronically also sent requests via fax or phone, even after a doctor 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’s authors noted that resolving e-prescribing challenges will become more pressing as increasing numbers of doctors adopt the technology in response to federal incentives. Physicians can qualify for Medicare and Medicaid electronic health record incentive payments by generating and transmitting more than 40% of all prescriptions to pharmacies electronically, excluding prescriptions for controlled substances, as part of the Health Information Technology for Economic and Clinical Health Act of 2009.

Other key study findings:

• About 75% 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 sometimes to edit manually certain prescription information, such as the drug’s name, dosage, and quantity. One common complaint reported both by doctors 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 typically had been made by pharmacists for handwritten prescriptions.

• Nearly 50% of pharmacies reported that patient instructions typically had to be rewritten for patients to understand them.

“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,” says AHRQ Director Carolyn M. Clancy, MD. "This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients.”

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