Viewpoint: E-prescribing prone to errors

January 10, 2013

Medical Economics readers discuss the potential for errors through e-prescribing.

I am a family practice physician who has been e-prescribing for more than 6 years. I generally find the process to be helpful and convenient, but Michael McBride’s article (November 10 issue) begins with a faulty headline, “E-prescribing prevents errors,” and proceeds to try and justify that argument.

As someone who has now generated tens of thousands of prescriptions electronically, I can assure you that e-prescribing neither increases patient safety nor prevents prescribing errors. What it does do is change the nature of the errors. The errors that occur now are unique to e-prescribing; they could not happen with handwritten prescriptions. Here are a few examples:

  • I want to give a prescription to John Smith. I enter his name and get a list of the John Smiths in my practice. I accidentally click on the wrong one, so the prescription gets prepared for the right drug and sent to the right pharmacy but for the wrong patient.

  • I prepare a prescription and accidentally send it to the wrong pharmacy.

  • Using a drop-down menu with the available doses of a medication, I accidentally click on the wrong dosage or I select the wrong set of dosing instructions.

The article mentions the importance of the database that checks for potential interactions. It has been my experience that a high percentage of prescriptions result in some type of warning, especially when prescribing virtually anything for an older patient. A warning almost always pops up that prescribing a drug to a patient aged 65 years or older should be done with caution. Based on the database, a doctor might think few, if any, drugs are safe to give senior citizens. As a result, the warnings are routinely ignored, making them entirely worthless.

The article also mentions the value of creating “a communications bridge between the physician, pharmacist, and patient.” That might be true if that bridge was in better condition.

On a daily basis, I get electronic refill requests despite having already submitted the refill prescription, sometimes days earlier and sometimes multiple times, because the pharmacy claims it didn’t receive it. Many pharmacies also seem to be set up to send refill requests automatically whether or not the patient needs the drug. I often approve the refill, not knowing that the patient doesn’t need it. Then the patient and insurance company get billed for a medicine that wasn’t even needed. This happens regularly.

Each time we find a way to remove humans from a process, we also remove logic, common sense, and critical thinking. Sure, e-prescribing may save a little time or eliminate bad handwriting, but it most certainly does not eliminate errors.

Steven Gitler, DO

Camden, New Jersey

Michael McBride responds:

I want to be clear that Medical Economics is not stating that e-prescribing prevents “all” errors from occurring, only that it prevents errors, which it clearly does, and which you agreed with in your letter. The potential for handwritten errors to occur is drastically reduced, as is the potential for transcription errors as well. It might be splitting hairs, but it’s an important point to make.

E-prescribing does come with its own set of potential errors, which can be equally harmful to patients. The medical industry must learn methods to prevent these errors from occurring as well.

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