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Doctors, patients find ease in e-prescribing

 

10-Feb-2008: Looking over a prescription refill request, Dr. Jeff Gladd scans his options.

He can approve it or reject it. He can send a note with his decision to the pharmacist.

He can check it against the patient's medical record to make sure the drug is appropriate, based on past ailments and current medications. And now – like a small but growing number of doctors around the country – Gladd is managing that part of his business work online.

Last year, 35 million prescriptions were routed electronically between health care providers and pharmacies in the U.S. That number was more than the three previous years combined, according to SureScripts, which operates the Pharmacy Health Information Exchange. The exchange facilitates electronic transmission of prescription information between physicians such as Gladd, who practices at Parkview Medical Group-Branch Court in Columbia City, and pharmacists.

"E-prescribing" is, defined by SureScripts, when a physician uses a computer or hand-held computing device to electronically generate and send a prescription to a pharmacist's computer.

Proponents say e-prescribing improves efficiency, requiring fewer phone calls, transcribing and dictating, and reduces potential errors from illegible handwritten prescriptions.

Most pharmacies are equipped to receive electronic prescriptions, but most doctors don't have the software to send them. And most prescriptions are still written on paper, delivered to the pharmacy in person, over the phone or faxed. Federal regulations forbid e-prescribing of controlled substances such as Ritalin.

Just 6 percent of office-based physicians e-prescribe, according to SureScripts' first report on the practice. But many others electronically fax prescriptions.

With e-prescribing, physicians can enter a prescription into a computer, see the most common dosages and alerts for possible drug interactions, cross-check with electronic medical records and send prescriptions with the click of a button. But pharmacies still receive the prescription as a paper fax and must transcribe the information.

"We see this as an interim step," said Kevin Nicholson, vice president of generic pharmaci regulatory affairs for National Association of Chain Drug Stores which along with National Community Pharmacists Association founded SureScripts in 2001. Ultimately, Nicholson hopes doctors who e-fax prescriptions will take the next step toward computer-to-computer connectivity with e-prescribing.

The Parkview Medical Group office, where Dr. Gladd practices with Dr. Richard Dickmeyer, made the switch from e-faxing to e-prescribing a few months ago. Although the change was negligible for new prescriptions, Gladd said the refill process is more efficient. Having a direct link between doctor and pharmacist means staff can spend less time fielding phone calls for refill requests.

But stricter restrictions on e-prescribing than e-faxing prescriptions have others waiting to make the switch.

"You can fax a good number of things that we could not e-prescribe and that's a problem," said Dr. Jay Fawver, a psychiatrist and former pharmacist based in Fort Wayne.

Many of the medications he regularly prescribes to treat anxiety and panic and chronic fatigue are controlled substances that can be prescribed by fax or phone but not e-prescribed. The list is long and includes Xanax for anxiety and panic disorder and Ritalin, which is often prescribed to treat children with attention deficit disorder and attention deficit hyperactivity disorder.

Current regulations and typical resistance to change, e-prescribing advocates say, are the main deterrents to progress. Cost is also a potential issue.

About half of those who e-prescribe use stand-alone e-prescribing software, and half use electronic medical record systems equipped to handle e-prescribing. Many e-prescribing systems allow doctors to remotely access a patient's updated medication list and history from their pharmacy, rather than relying on information in medical records at the doctor's office.

The federal Certification Commissioner for Healthcare Information Technology requires that newly certified electronic health records are able to e-prescribe. By the end of 2008, SureScripts expects that about 60 percent of e-prescribers will use electronic medical record systems.

Gladd has been using electronic medical records since he started practicing in the Columbia City office more than three years ago. The electronic medical record/e-prescribing system he uses costs between $25,000 and $30,000.

Gladd is a strong proponent of electronic technology to improve organization and overall patient care. The 33-year-old doctor used paper-based records in his residency and says invariably some charts got lost or misplaced. Legibility was also an issue.

"You can't (always) read the physician's writing. Sometimes I can't read my own writing." While he can print legibly if he needs too, he finds typing much more efficient and reliable.

While Gladd is among the few doctors equipped to e-prescribe, almost all pharmacy chains and a growing number of independent drugstores accept e-prescriptions.

"Locally its growing," said Nick Sloffer, pharmacy coordinator for area Kroger and Scott's Food & Pharmacy stores.

Currently, the percentage of e-prescriptions received by Kroger stores in the market area that also includes Indianapolis is less than 3 percent of total prescriptions, tracking close to national averages. But Sloffer says it's early in the game and expects e-prescribing to become more prevalent.

"Anything that can help us have more time to spend with our patients and eliminate errors … I think is a great thing. … It's exciting for that reason."

He also believes e-prescribing is highly secure.

"It'd be very difficult to forge an e-prescription; much more difficult than to forge a written one."

Nicholson of the National Association of Chain Drug Stores agrees.

"No computer network is 100 percent hacker-proof," but since SureScripts' inception in 2001, the Pharmacy Health Information Exchange it operates hasn't suffered a single security breach, he said.

In addition to secure transmission, e-prescribing may also increase the number of prescriptions pharmacies fill and the likelihood patients will get the drugs their doctors prescribe.

Recent research conducted by SureScripts and Walgreens showed an 11 percent increase in new prescriptions filled when tracking the number of prescriptions received by pharmacies before and after physicians began using e-prescribing. The research used data on prescribing physicians' from IMS Health, which provides market intelligence to the pharmaceutical and health care industries.

For Sharon Channell, one of Gladd's patients, the benefits are in time saved.

She likes that she doesn't have to wait around at the pharmacy for her prescriptions to be filled because the pharmicists get the order directly from her doctor's office.

And she likes that Gladd gets automatic messages from the pharmacy when she needs a refill on her asthma medicines or other prescriptions she's taking.

Channell also likes that Gladd has all her information right at his fingertips and doesn't have to rifle through paper records or go searching for medication and medical history information.

"(He) knows exactly what I'm taking and how much I'm taking. It's all right there."

Source: Fort Wayne Journal Gazette