Provider Feedback — Electronic Prescribing

Many physicians report that e-prescribing tends to increase their workload by adding extra clicks and keystrokes to tasks that previously were either easier to perform or done by other staff members altogether. I remember when I was first practicing and would have to handwrite multiple prescriptions for almost every patient I saw and at almost every visit. That’s when my signature degenerated into a form that could be written in an instant, but never deciphered. Medication names were nearly as illegible. EHR medication lists and printed prescriptions dramatically reduced the time I spent generating prescriptions. A simple click on the proper check box was all that was needed to print a prescription with the same amount and refills that were previously prescribed, or with a few extra keystrokes those amounts could be changed. And in addition to the prescriptions being totally legible, warnings pop up automatically if there are any potential drug-drug interactions based on the medications on the list.

Granted, e-prescribing involves additional clicks and sometimes even having to choose the patient’s pharmacy, but there are counterbalancing advantages. My system has a traffic-light system of formulary indications, which is present within the medication list. A green dot indicates that a medication is on formulary and is preferred; a yellow dot indicates that a medication is on formulary but not preferred; and a red dot indicates that a medication is not on formulary. This system has helped me avoid the many pharmacy calls I used to receive to tell me that a medication I had chosen was not on formulary and that I had to prescribe a different medication. Also, the time I might spend performing extra clicks or keystrokes is more than made up by my not having to wait for a prescription to be printed, sign it, and hand it to the patient.

Another advantage is my being able to send prescriptions more easily when I am not in the office. In fact, my patients can request refills on our patient portal and I can fill them remotely —  even at night or on weekends when I periodically sign onto my EHR desktop from home or elsewhere.

As for no longer being able to have staff refill prescriptions, this is a practice that is unsafe and in many places illegal. Refilling prescriptions essentially constitutes prescribing a medication, which requires a license that many employees performing this task don’t have. The reason for this is that knowledge of a patient’s current clinical status and other medications is essential for the safe and proper issuing of prescriptions, new or old. The Meaningful Use requirement that providers must issue and sign electronic prescriptions is merely enforcing long-established legal and regulatory requirements in the interest of greater patient safety.

Overall, e-prescribing has improved the efficiency and safety of prescribing medications to the benefit of both providers and patients.


2 responses to "Provider Feedback — Electronic Prescribing"
  • August 12, 2012
    Joseph J Muscato, M.D.

    As an oncologist, I am disappointed that the DEA has not been quicker to design a system for electronic proscribing of controlled medications. This really is a problem in a practice such as ours. It seems that an electronic system is safer than a lot of paper prescriptions sitting out there waiting to be copied.

  • August 13, 2012
    Mitchell A. Adler, MD, JD, MPH, FACP

    I share your frustration about the delay in implementing electronic prescribing of controlled substances, and I agree that this would be more secure than the current practice of using paper prescriptions. You should be aware, however, that the DEA outlined its requirements for this type of e-prescribing several years ago. Since that time, it has been up to each state to develop regulatory requirements for e-prescribing of controlled substances that are compliant with the DEA’s as well as with their own laws and regulations. One midwest state implemented this early on, but many others have been slow to act. You should contact your state’s various medical societies, such as your state’s ACP section, to lobby the state’s department of health to expedite this implementation.

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