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Using e-prescribing systems can reduce errors

Accreditation Connection, March 29, 2004

Illegible handwriting on prescriptions can lead to patients receiving the wrong medication or the wrong dose of the right drug. And if physicians don't check all the medications patients take-including herbal supplements and over-the-counter drugs-new prescriptions could cause harmful interactions.

According to the Institute of Medicine's 2003 report Patient Safety: Achieving a new standard of care, increasing physician access to technology is one of the best ways to reduce medication errors. Large hospitals often have computer systems that link all their departments, making it easy for physicians, nurses, and pharmacists to access patient medical records and spot potential problems before they reach the patient. But such systems are rare in small private practices, Thomas Sullivan, MD, president of the Massachusetts Medical Society (MMS), said during a February 12 seminar on improving patient safety in ambulatory settings.

Physicians in these settings are often reluctant to spend the money to install electronic medical records (EMR) programs on their computers and don't want to take the time to learn how to use a new system, said Sullivan.

One solution is to use less-expensive technology. Many physicians use hand-held computers to organize their schedules. It is possible to use these digital organizers to create electronic prescriptions, Sullivan said.

Massachusetts is currently involved in a pilot venture with DrFirst, a company that offers software for medical professionals. Members of the MMS who wish to try DrFirst's electronic-prescription software, called RCopia, can order it at reduced costs, said Sullivan. Also, BlueCross BlueShield of Massachusetts and Tufts Health Plan agreed to provide the e-prescribing system for free to the plans' 3,400 highest-prescribing doctors.

Using DrFirst, physicians can use their hand-held devices to write prescriptions, or they can write prescriptions using RCopia on the Internet.

The physicians can e-mail patients' prescriptions directly to the pharmacy via the hand-held device, or they can e-mail the prescriptions to the office computer and print prescriptions for the patients.

When physicians start typing a drug name, the program pulls up several possible choices. Once they select the correct one, RCopia will ask them what form and dose is best for the patient.

The program then allows physicians to enter how often the patient must take the medicine, so they do not have to physically write any aspect of a prescription, said Sullivan.

If physicians choose to use the computer version of RCopia, they will have access to more information that can reduce medication errors than the hand-held program provides. If physicians are reluctant to change their prescribing process, they can start slowly by receiving electronic notifications of when patients need refills and can still handwrite new prescriptions, said Sullivan.

The Web program will pull up several possible patients once physicians start entering a name. This ensures that the physicians have the correct patient information, Sullivan said. The system will alert the physicians to other medications their patients are taking, and different types of warnings will pop up when they try to prescribe a new drug.

The system might also warn physicians that a patient's insurance won't pay for a certain drug so they can consider an alternative. The system also alerts physicians to any possible interactions with existing medications or any patient allergies to the medicine, said Sullivan.

However, physicians can bypass the warnings if they enter an explanation. Although the electronic system can reduce potential errors, physicians still know what is best for their patients, said Sullivan.

Facilities should try to find cost-effective ways to adopt new technology, such as seeing whether state-based physician organizations can arrange for reduced costs for members. This will help eliminate one of the biggest barriers for adopting e-prescribing technology, said Sullivan. But he cautions that even though electronic prescriptions can reduce errors, organizations still need to have plans in place in case of problems. For example, organizations that rely on e-prescribing need to have a backup plan in case of a power outage.

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