Summary of ePrescribing Challenges

Posted on October 8, 2009 I Written By

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ePrescribing seems like the in vogue thing to do these days. It’s part of the proposed meaningful use matrix and so no doubt we’re going to hear a lot more about it (and we should). However, ePrescribing isn’t without its challenges. A little while ago I put the question to you my readers about the challenges associated with ePrescribing. The following are a couple of the responses that I received from people about their experience with ePrescribing.

Doctor’s advocate that I am, I’ll start off with a doctor’s experience…
E-Rx has been one of the best additions to our EHR. We have reduced paper use significantly, and rarely have problems with transmission. The problems mainly relate to the extra work of entering which pharmacy the patient ants to use.

Oftentimes patients decide to change from what they had requested previously and then you have to search the database for the correct pharmacy. If you live in a large city that can be cumbersome. Our clinical coordinator has entered cross streets into the database to make this easier.

Our state does not permit transmission of controlled substances which in a pediatric practice is primarily psychostimulant medications. Another minor issue is that you have to have the correct units before it will transmit – e.g. if you want 30 of a capsule you have to put 30 caps in the amount field even though you ordered capsules in the medication field. This is not the way most docs are accustomed to writing prescriptions but certainly more accurate.

If there are pharmacies that do not use E-Rx it goes by fax which can be very slow. Some pharmacies are better than others about keeping up with their -rxs coming in and it won’t be ready when the patient arrives. We tell the patient to call the pharmacy when leaving the office to let them know they are coming.

Overall, e-rx has been a very positive experience – saving time, paper and money. Our e-rx with Dr. First integrates fully into the EHR making the documentation seamless.

From someone who use to work for an ePrescribing company…
(1) There was a saying “Free is not cheap enough” i.e. even if you give away the service, many, if not most doctors are not interested in it, because of the time and effort to implement e-prescribing (HW, networks, training etc). The MIPPA incentives definitely helped, but many doctors still felt that they were insubstantial compared to the cost (mostly their time) that they would have to invest in this.

(2) You still cannot prescribe Schedule drugs (primarily narcotics) via e-prescribing. This made it a tough sell to several specialties (pain, ortho, etc.). However, I have heard that is in the process of changing over time.

(3) Some of the clients that I dealt with did not want to implement eprescribing if it meant implementing another system to be integrated with whatever they had via HL7. They just wanted to wait until their existing vendor came out with a solid integrated solution.

I agree with you that e-prescribing is an area where there is almost universal agreement that this is a service that is much better than the traditional paper and pen method. All the doctors I have spoken to agree on this. Over time, it will become more and more popular, especially as EHRs penetrate the market. The last data I saw from SureScripts indicated that over 100,000 providers were now eprescribing, which is significantly higher than even just last year.

From the owner of an EMR company talking about integration with an ePrescribing solution and challenges associated with it…
One of the links I found on the AMA web site (several months ago) referred me to iScribe. This site is sponsored by Caremark. It has, in my opinion, a relatively simple to use interface.

We’ve been able to figure out how to feed data into it (we recommend using Firefox for a web browser and a third-party app called iMacros – which is something developers should know about) and extract data out so that we can keep our systems in sync.

The price for iScribe is $0. There are some aspects that take more time on the part of the doctor/nursing staff, but then there are other things where life is greatly simplified. There is a learning curve and there are some quirks. Their phone support is superb, their e-mail support non-existent.

The first hurdle to overcome was to figure out a way to map their list of pharmacies with ours. Is it “Wal-mart” or “Walmart” or “Wal Mart”? Or, “Savon”, “Sav-on”, “Sav on”, “Albertsons”? It almost became a hand to hand combat to map.

The second hurdle was figuring out to map their list of drugs to ours. Tougher, because we had mis-spellings on our side.

Then there are the issues of dealing with controlled substances. Can’t send them electronically, so then the staff wonders why are we bothering with these extra steps? (Drug-drug interaction checking is the answer.)

In the beginning, the nurses would call the pharmacy. “Did you get our e-request?” The little pharmacies would always say yes. Early on, the big chains seemed to be hit and miss – which was odd.

The nurses have become a little bolder and have learned how to poke around in iScribe and now find reports to help them do their job more easily.

One interesting side note, I did an “edit” function on a patient we had sent prescriptions. On the iScribe side, they had ALL the insurance information on the individual. Which, btw, we had never provided. So in some method, the pharmacies already have all detail and have shared it all over the Caremark network.

Any practice can use the service and there is no need to even interface to existing EMR or practice management systems.

Some interesting information for those looking at ePrescribing. I’d love to hear more experiences in the comments.