E-prescribing

Seriously, any problem reading this?

Unsurprisingly to me, a recent study published by the Journal of the American Medical Informatics Association (http://health.usnews.com/health-news/family-health/articles/2011/06/30/e-prescribing-doesnt-slash-errors--study-finds) determined that there were the same number of errors with electronic prescribing as with written prescription. Same number, but the errors were different. Unsurprising to me because now that I've been e-Prescribing for more than five years I actually make MORE errors on-line than I do when I write them out. Of course this is partly due to the very strict Catholic sisters who oversaw my writing development in the 60's, ensuring that my penmanship was legible. If you don't believe me, ask any of the east-end Louisville pharmacists who have to fill my prescriptions. They LOVE them because they can read them.

Having said that, the study did imply that most electronic prescription errors are correctable IF the software is properly designed. In my own practice, using  an Allscripts product, I make certain errors on a regular basis (sigh):

1. The script is sent to the wrong pharmacy. This is a software error I have bugged Allscripts about for a couple of years now, but it falls on deaf ears. The default setting is to send the prescription to the local pharmacy. There should not be a default, the physician should have to choose either a mail order pharmacy or the local one. This happens weekly and the patients are angry when their medication doesn't show up in the mail (they ignore the reminder call from the local pharmacy). Ultimately, when the medication never shows up in the mail, my office gets an irate call from the patient wanting to know why Dr. Nieder sent the script to the wrong place and now they won't get their meds on time and they will have to pay extra for a 30 day supply (or more likely--go without). But for some reason Allscripts doesn't think this is a problem...
2. It's the right medication but the wrong dose. I often look on the medication list in the chart to choose the dose and if it's not been properly updated the patient gets the wrong number of milligrams. This is usually an easy thing to fix by cutting the pill in half or doubling it, but annoying none-the-less. Hopefully this will improve with electronic medical record documentation...then again, GIGO.
3. The prescription is sent from my computer but never makes it to the pharmacy. This typically occurs with mail order pharmacies. I don't know why it doesn't go "through" and Allscripts hasn't yet provided the physician with an adequate way of knowing when it doesn't make it. Hopefully communication processes will improve and I'll see a little flag on my desktop someday as a notification. As it is, the patient calls and informs us, we go through a lengthy process in the system trying to see what went wrong and then resend it, crossing our fingers that THIS time it works. Yet another situation where the patient will go without or get a temporary supply at the local pharmacy until their medication is mailed.

Ultimately e-prescribing will be a safer alternative for prescribing medications but it isn't quite there yet. It irritates me that there is not a board of prescribing doctors that routinely report to the Allscripts software development group to help make the process more physician-friendly. Instead the company relies on a "Client Connect" on-line community. If you're at all tech-savvy you know that this process is only as good as the people "patrolling" it and since these are not physicians, clinical issues may not be obvious for the IT guys to "get" what the fix needs to be. I've already had this experience talking to the support people with Allscripts.

Soon, I won't just be electronically prescribing, I'll be documenting like many of my colleagues. Something I'm not looking forward to because so far, none of my peers have been happy with the process or the result, all of them have been frustrated and few see the light at the end of the tunnel as anything but a train...