Errors and E-prescribing

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The use of electronic medical records and communications by medical practices is not an issue that tends to get a lot of patients excited. In a medical system that can seem impersonal at times, the idea of patient information being stored in actual folders and cabinets — and of doctors writing prescriptions by hand — may seem refreshingly personal, relics of a time when medicine wasn’t all about efficiency and cost savings. But it turns out that resistance to e-prescribing — sending prescriptions electronically to pharmacists — may be responsible for millions of preventable drug errors each year.

Drug errors can take several different forms, resulting from prescriptions that have an interaction with another drug the patient is currently taking, prescriptions that prescribe the wrong dose of a drug, or prescriptions that prescribe the wrong drug altogether. According to a study published last month on the Web site of the Journal of the American Medical Informatics Association, e-prescribing systems within hospitals alone most likely prevented more than 17 million of these errors in 2008. This estimate was based on national data showing that e-prescribing can reduce the risk of error by 48% per prescription, combined with other data on how many hospitals use e-prescribing systems and how often these systems are used within hospitals that have them. Surprisingly, use of e-prescribing systems is not consistent even in hospitals that offer them. According to an article on the study at HealthDay, only about 40% of hospitals with e-prescribing systems use them to process at least 90% of drug orders. And in 42% of hospitals with these systems, they are used to process fewer than 50% of drug orders.

In light of the benefits, why are doctors so hesitant to use these systems? The HealthDay article may offer some clues by describing how e-prescribing helps prevent errors. To issue a prescription in the most common e-prescribing systems, a doctor must go through a series of steps that confirm the drug and the reason it is being prescribed, as well as the dosage and instructions given to the patient. This process may strike some doctors as tedious and even insulting, assuming that they will make mistakes without being double-checked by a computer — which is, of course, true in some cases. And some doctors may simply not have the time to go through the process of e-prescribing or of learning how to do it, given how tightly scheduled many medical practices are.

A separate study, commissioned by the prescription advertising company MediScripts and released late last month, found that handwritten prescriptions outnumbered e-prescribing by more than 60% in 2012, according to an article at Drug Store News. The company noted that many doctors are not comfortable with existing e-prescribing systems, given that the systems are not always easy to use and don’t offer the ability to prescribe every drug that is on the market. Of course, given that it advertises on prescription pads, one could argue that MediScripts has an incentive to defend doctors who resist use of e-prescribing.

What do you think — should all hospitals or medical practices adopt e-prescribing? Have you ever experienced a drug error that might have been prevented if e-prescribing had been used? Should even doctors with a low record of errors have to go through steps to confirm the correctness of a prescription? Is it reasonable to expect all doctors to learn how to use new software and computer modules? Leave a comment below!

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