Challenges To e-Prescribing Implementation In Primary Care

Preventable medical errors cause approximately 200,000 deaths around the United States each year. More than 1,000,000 Americans are negatively impacted by medication errors each year caused by inadvertent mistakes in the prescription filling process. With 4 out of 5 adults taking at least 1 medication daily and 1 out of 4 adults taking 5 or more medications daily nationwide, errors in prescriptions cost healthcare industry billions of dollars per year.

Health IT was developed to transform healthcare services and change the way they are provided and compensated. Electronic prescribing (e-prescribing) becomes an integral part of that transformation process. And Surescripts’ National Progress Report proves it with numbers. Nearly 80% of ambulatory physicians in U.S. are sending prescriptions electronically and nearly all pharmacies are wired to accept them.

In December 2008, a short time before the adoption of the HITECH Act, less than 7% of all U.S. medical doctors electronically prescribed patient medications through electronic health record (EHR) systems. As of April 2014, nearly 7 of 10 U.S. medical doctors e-prescribe through EHR.

E-prescribing brings many unconditional benefits to medical facilities, private practices and patients. Starting from obvious – reduced drive trips to doctor’s office and 7-time drop in accidental prescriptions misreading – e-prescription is also a real game-changer in the ever-growing opioid epidemic in the country. Authorities and biggest healthcare associations believe it could potentially diminish prescription fraud and abuse in the United States.

The same Report by Surescripts highlights that while 73% of pharmacies nationwide are well equipped for e-prescribing of controlled substance (EPCS), only 1.4% of prescribers are willing to send them.

E-prescription systems are designed to reduce “doctor shopping”; yet, they remain vulnerable to cyber threats. This can be used in IT security field as a potential to develop and deploy software solutions for EPCS. Cambridge Health Alliance Organization in Massachusetts takes leading position in this collaboration, ensures EPCS workflow efficiency and meeting the DEA (Drug Enforcement Administration) authentication requirements.

Having analyzed recent research studies and legal initiatives on e-prescribing implementation in U.S. primary care, we've outlined the following challenges:

Lack of technologies to meet DEA requirements

without inhibiting workflow and bothering providers or patients (for example, 20% – 30% of patients abandon their prescribed medications at the pharmacy due to time-consuming reasons prior to authorization). For starters, clinicians and pharmacists must have their e-prescribing software upgraded to meet standards set by the Federal Drug Enforcement Administration. This means contacting their software vendor. Many vendors will perform the upgrade at no cost although others charge for it. So far, only 4% of e-prescribers have had their software tweaked.

Cost of e-prescribing

Cost of implementation is often a barrier. For example, Tennessee Exit Disclaimer initiated a partnership with the Tennessee Pharmacists Association to provide up to $675,000 in grants to 124 independent, community pharmacies to offset e-prescribing expenses.

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Unsettled standards

Nationwide network is still lacking essential rules and standards for e-prescription messages and their validation, drug terminology and classification, application forms, medication lists and many other meeting points among physicians, pharmacies (both chain and independent) and providers.

Uneducated clinicians and low PMP integration

While 72% of primary care physicians are aware of their state’s prescription monitoring program (PMP), only 53% of them use it due to time-consuming nature of information retrieval and the lack of an intuitive format for data provided by the programs. State government should consider the implementation of legal mandates, as well as investing in prescriber education, and take measures to enhance ease of access to and use of e-prescribing software.

Despite the listed challenges and with e-prescribing being a nationwide process for more than a decade now, the upcoming years can be defined as an optimisation stage for e-prescribing (more than 1.2 billion e-prescriptions were routed by Surescripts in 2014). Yes, there are still situations that may warrant electronic prescription systems, including temporary technological failures and other emergencies. But in the end of the day, this eHealth technology is designed to improve operations and consequently save time that can be used to elaborate personal approaches and build better relationship between healthcare specialists and patients.

We've approached our LinkedIn and Twitter followers who are subject matter experts to reflect on this article and provide their feedback about what they believe is today's biggest impediment to the implementation of e-prescribing of controlled substances. Check out our eHealth blog next week to see their feedback!

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