e-Prescribing: Have the Promises of Decreased Errors and Improved Patient Safety Been Fulfilled?
Written by: Cheryl Reifsnyder, PhD
Although electronic prescribing (e-prescribing) was just introduced in 2003, by 2019, the number of office-based providers using e-prescribing had climbed to 80%. E-prescribing became an important piece of the U.S. push to enhance safety in the prescribing process.
An estimated 200,000 deaths occur annually in the U.S. due to preventable medical mistakes; some of the most common medical mistakes are errors in prescribing and filling medications. The Institute of Medicine estimates that 1.5 million preventable Adverse Drug Events (ADEs) occur annually in the U.S. They also estimate that more than 7000 patient deaths can be linked to poor handwriting and prescription filling errors.
e-Prescribing was predicted to improve patient safety—but has it lived up to expectations? Absolutely, both by reducing medical errors due to illegible handwritten prescriptions and by helping to prevent medication errors. Keep reading to learn more about how e-prescribing is contributing to patient safety in medicine today.
e-Prescribing: a boost to patient safety
Improves prescription legibility
The errors associated with handwritten prescriptions are due to illegible handwriting. If these errors are identified before the prescription is processed by the pharmacy, they usually require additional communication to clarify the intended order. Unreadable orders alone account for 150 million calls from pharmacists to providers annually in the U.S. This typically delays patient care as well as demanding time from both pharmacists and providers. Even so, not all mistakes are detected, potentially resulting in patient harm or death.
e-Prescribing improves prescribing accuracy by resolving legibility issues related to handwritten prescriptions.
Reduces prescribing errors
Researchers also estimate that 21% of handwritten prescriptions contain at least one error.
e-Prescribing helps decrease these errors through the utilization of prepopulated data libraries. For instance, when physicians enter prescription data, they must select the drug name, quantity, and instructions from an established list of choices which improves standardization in the prescription writing process. It reduces errors in both drug selection and in dosing as well as helping to prevent the omission of information by prompting prescribers to complete any missing fields.
One study evaluated the impact of e-prescribing, as part of a computerized provider order entry (CPOE) system, on errors in the ambulatory care setting. It found that e-prescribing resulted in:
- 97% reduction in errors of illegibility
- 94% reduction in errors due to the use of inappropriate abbreviations
- 85% reduction in errors due to missing information
Another study found that prescription error rates decreased from 42.5 to 6.6 errors per 100 prescriptions—nearly 1/7 of the previous level—just one year after 12 community-based practices adopted e-prescribing.
Improves access to patients’ medical information
Another important way e-prescribing contributes to patient safety is by providing prescribers with access to patients’ medical histories, diagnoses, and medication information. This information can help providers to reduce prescribing errors and helps to prevent duplication of therapy.
e-Prescribing also enables electronic storage of prescription records. This can be invaluable in crisis situations such as natural disasters and drug recalls because it allows patients’ medication histories to be retrieved even if the local medical facility or pharmacy is inaccessible.
Performs automatic checks for drug-drug and drug-allergy interactions
e-Prescribing systems frequently scan for drug-drug and drug-allergy interactions, as well as for contraindications due to the patient’s medical condition.
Data from the Southeast Michigan e-Prescribing Initiative (SEMI) demonstrated that e-prescribing improved patient safety by alerting physicians of risks related to drug interactions. These alerts resulted in a considerable number of prescription changes, preventing possible ADEs. Among 3.3 million prescriptions reviewed:
- Alerts for severe or moderate drug-drug interactions were sent to physicians for more than one million prescriptions (33% of total)
- Alerts resulted in changes to or cancelations of nearly 423,000 prescriptions (41%)
- Alerts were sent for more than 100,000 medication-allergy interactions, of which more than 41,000 (41%) were acted on
Can have clinical benefits
e-Prescribing can even have clinical benefits. One retrospective study assessed the effect of e-prescribing on attaining cholesterol goals for 796 patients. Cholesterol-lowering agents were prescribed either traditionally or via e-prescriptions. After about 4.6 months, patients using e-prescriptions had a higher rate of achieving their cholesterol goals than those who received handwritten prescriptions (51% vs. 44%), suggesting that the use of e-prescribing software was a factor in improving cholesterol goal attainment.
Research reveals that about 50% of medications are not taken as prescribed which can lead to worsening of the patient’s disease, hospitalization, or death. A study by the U.S. Food and Drug Administration reports that 25% of new prescriptions are never filled or picked up by patients. The Centers for Disease Control and Prevention (CDC) estimates that medication non-adherence causes 30% to 50% of chronic disease treatment failures and 125,000 deaths every year in the U.S.
Influences medication adherence
E-prescribing can improve patients’ medication adherence. This is partly because e-prescribing enables providers to check patients’ insurance formularies to confirm that specific medications are covered prior to prescribing them. If a medication is not covered, the provider can consult a list of formulary alternatives and prescribe a covered medication. This makes the patient’s treatment compliance more likely.
e-Prescribing can also improve medication adherence simply by making the prescribing process more convenient for patients. e-Prescribing means that patients will not have hard copies of their prescriptions, eliminating the risk that they will lose or misplace them. e-Prescriptions are also sent directly from the provider’s office to the pharmacy. The pharmacy can begin filling the prescription immediately; the patient does not need to be present.
A study by Surescripts found a 10% increase in prescriptions that are picked up when those prescriptions are e-prescribed rather than handwritten.
Improves patient safety with Electronic Prescribing of Controlled Substances (EPCS)
In 2014, the CDC characterized prescription drug abuse and overdose as the second highest health threat in the U.S. and EPCS technology was introduced to help address this problem. EPCS transforms prescriptions for controlled substances into a secure, tamper-proof form which has made a significant impact on prescription drug abuse, helping to reduce prescription diversion, fraud, and forgery. EPCS also helps providers integrate prescription information for controlled substances into patients’ electronic health records (EHRs), making it easier to identify patients with a potential drug problem.
Improve patient safety and streamline with Veradigm ePrescribe™
You can bring this wide-ranging list of safety benefits to your patients—from increasing prescription accuracy to decreasing the risk of ADEs—using Veradigm’s comprehensive, easy-to-use solution for electronic prescribing: Veradigm ePrescribe™. Veradigm ePrescribe facilitates prescribing by:
- Automatically delivering patients’ medication histories and formulary information
- Automatically performing checks to prevent drug-drug and drug-allergy interactions
Veradigm ePrescribe supports patient medication adherence by:
- Consulting the patient’s formulary before submitting prescriptions
- Offering RxTruePrice™, which enables you to check a prescription’s price before finalizing your medication choice
- Providing electronic prior authorization with Veradigm eAuth, a fully integrated electronic process for managing prior authorizations for patient medications—dramatically shortening wait times and increasing the probability that patients will take their prescribed medications
For prescriptions of controlled substances, Veradigm ePrescribe provides an EPCS feature that can be enabled directly within the platform, as well as integrations with the Prescription Drug Monitoring Programs that are mandated by many states for use with controlled substance prescriptions.
Veradigm ePrescribe also offers a mobile application. ePrescribe Mobile delivers a single workflow across desktop and mobile devices. It improves patient safety by replacing telephone conversations with in-app prescribing, including EPCS, allowing you to deliver prescriptions to pharmacies whenever and wherever you are.
Contact us to learn more about how Veradigm ePrescribe can help you improve patient safety in your practice.