E-Prescribing Growing Pains

As more medical facilities attempt to digitilize their workflow in order to to receive Medicare and Medicaid electronic health record incentive payments, they are tripping up in common areas when it comes to e-prescribing, according to a recent study from the Agency for Healthcare Research and Quality, a federal agency that researches the quality and effectiveness of health care services.

While the study noted that practices generally welcomed e-prescribing, many of those interviewed said they faced problems while attempting to accomplish simple tasks. Researchers conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies. According to those interviewed, issues arose when sending prescription renewal requests, connecting with mail-order pharmacies and even when manually entering data.

The biggest barrier to using the e-prescribing method effectively occurs when these parties communicate. Practice representatives said some pharmacies that sent renewal requests electronically also sent them through fax or by phone. Sometimes the extra requests came even after physicians had responded electronically. In other cases, physicians would receive an electronic request from pharmacies and then respond by phone or fax.

The study explained that, “despite the complexity of prescription routing through multiple parties, respondents reported true transmission failures were rare.” Yet, inconveniences and unnecessary redundancy weren’t as rare.

About three quarters of practices said they had trouble communicating with mail-order pharmacies. Practices were unsure which mail-order pharmacies accepted e-prescriptions and said they felt that even those that did accept e-prescriptions were unreliable.

It’s expected that more practices will look to adopt e-prescribing methods in response to the The Health Information Technology for Economic and Clinical Health (HITECH) Act. The act provides incentives for the adoption of health information technology and also contains specific incentives for practices that adopt EHRs, of which e-prescribing is a key feature.

“Full integration of electronic transmission into pharmacy systems as well as addressing some of the barriers highlighted in the paper are critical to minimizing the potential for error and ensuring patient safety,” said Senior Manager for Health IT at AHRQ, Teresa Zayas-Caban.

Zayas-Caban said the results of the study have been shared with the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services, and both are looking at how they can use the findings to improve their programs. She said that, after reading the report, one of the ONC’s communities of practice responded that they faced similar barriers in the field, including lack of connectivity with mail-order pharmacies.

The study concluded by calling for greater collaboration and interoperability between stakeholders, including the federal government, e-prescribing standard-setting organizations and vendors.  The paper highlighted the growing importance of getting institutions to work together to address the challenges faced by physicians and pharmacists. While this particular research focused on the adoption of e-prescribing, it spoke to AHRQ, CMS and ONC’s larger commitment to improve all aspects of care quality.

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