E-prescribing tools raise reliability concerns

E-prescribing technologies are gaining ground in doctors’ offices and hospitals, but are hampered by gaps in the systems and worries about reliability, industry experts told a federal advisory group today.

E-prescribing is included as a component of electronic health record (EHR) systems in recent regulations from the Health and Human Services Department. HHS is distributing at least $17 billion in incentive payments to doctors and hospitals who buy and meaningfully use such systems.

Dr. Alex Krist, a physician with Fairfax Family Practice Centers in Virginia, said his practice has been successful in implementing EHRs that include e-prescribing. He told the HHS Information Exchange workgroup today that the benefits include more legible prescriptions, helpful reminder systems and better documentation of medications.

However, e-prescribing currently has many limitations, including gaps in reliability when hub networks are down that temporarily prohibit electronic transfer of the prescriptions, he said.

“Many practices report that e-prescribing is not always reliable,” Krist told the workgroup, which is part of the Health IT Policy Committee that  advises HHS.

When hub networks are down, there are interruptions in communication between the doctor’s office and the pharmacy systems’ interface. This can prevent prescriptions from reaching pharmacies, and the problems are not always noticed until hours later, resulting in duplications of work, inconvenience and delays in obtaining treatments, Krist added.

Another reliability problem is that active medication lists maintained by e-prescribing systems often are so full of numerous past prescriptions that it becomes difficult to determine what is current and relevant information, he added.

“While systems keep historical records of all medications prescribed, active medication lists easily become cluttered with acute, short-term medications and long outdated medications – potentially resulting in a new cause for medical errors,” Krist said.

Raymond Adkins, chief information officer of the Peninsula Regional Medical Center in Salisbury, Md., said reconciling electronic medication records is challenging and depends on patients to remember what drugs they are taking.

The medical center has spent more than $500,000 during five years to establish processes to reconcile medications, but there are still challenges and inconsistencies in practice, he said.

“While a patient’s medication history is available for review and update at the point of an encounter with the medical center, the completeness and accuracy of information in that record remains largely dependent upon the patient as the historian,” Adkins said.

“Despite efforts to educate and raise awareness within our community, limited progress has been made in helping our patients understand their inherent responsibility to play an active role in the maintenance of an accurate and complete history comprised of medication name, dose, route, frequency, duration and last dose,” he added.

Another gap in e-prescribing is the current inability to use electronic formats to prescribe controlled drugs, Krist and Adkins said. In some practices, those represent a substantial portion of the medications dispensed. The exclusion of controlled substances from the electronic applications means doctors and hospitals must have twin processes for drug prescribing: one electronic and another based on paperwork.

“The current exclusion of the use of e-prescribing for controlled substances remains problematic requiring providers to employ dual processes,” Adkins said. “Though the impact of the exclusion varies by specialty, in our experience as much as one-third of the prescriptions generated can be for controlled substances."