Prescribing is an important event in treatments of disease where doctor directs the pharmacist to dispense the medicine for the patients. Conventionally the prescriptions are written on a paper, in a format containing superscription, patient details and disease the patient is suffering from and also the medicines with the doses, address of the prescriber with his signature and date and the additional instructions for the pharmacist for dispensing. After receiving the prescription the pharmacist fill the prescriptions as per the instructions in the prescription, and do the patient counselling regarding medicines and how to store and use them at home.
Due to advent of information technology, in developed countries the prescriptions are sent by electronic form from the doctor to pharmacist directly by email instantaneously. Electronic prescribing or e-prescribing (e-Rx) is the computer-based electronic generation, transmission and filling of a medical prescription, taking the place of paper and faxed prescriptions.
E-prescribing allows a physician, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy.
It allows greater prescriber mobility, improved prescriber convenience can be achieved when using mobile devices that work on a wireless network, to write and renew prescriptions. Such mobile devices may include laptops, PDA's, tablet computers, or mobile phones. This freedom of mobility allows prescribers to write/renew prescriptions anywhere, even when not in the office.
Enhancing safety, medication compliance
E-prescribing offers clinicians a powerful tool for safely and efficiently managing their patient's medications. Compared to paper-based prescribing, e-prescribing can enhance patient safety and medication compliance, improve prescribing accuracy and efficiency, and reduce health care costs through averted adverse drug events and substitution of less expensive drug alternatives.
In 2000, the Institute of Medicine identified medication errors as the most common type of medical error in health care, estimating that this leads to several thousand deaths each year. It has the potential to improve beneficiary health outcomes.Reducing time spent on phone calls and call-backs to pharmacies hence more time is available to the pharmacist for other important functions, such as educating consumers about their medications.
A lot of paper-based prescription orders go unfilled by the patient, partly due to the hassle of dropping off a paper prescription and waiting for it to be filled. By elimination or reducing this waiting period, e-prescribing may help reduce the number of unfilled prescriptions and hence, increasing medication compliance. Allowing the renewal of medications through this electronic system also helps improve the efficiency of this process, reducing obstacles that may result in less patient compliance. Availability of information on when patient's prescriptions are filled can also help clinicians assess patient compliance.By checking with healthcare formularies at point-of-care, generic substitutions and generic first-line therapy choices are encouraged thus reducing patient costs.
The costs associated with purchasing, implementing, supporting and maintaining such a system may be beyond the means of most small clinical practices, and noted to be one of the greatest implementation barriers. Health care workers who are responsible for medical prescription, especially those in small practices, inner city areas, or remote rural settings, may bear more than their fair share of the cost associated with e-prescribing. Privacy of patient information stored in electronic format may lead to the possibility of novel errors, such as inadvertently divulging protected health informationon the internet through inadequate security practices. Instances of negligence may also arise, where employees may forward prescriptions to organizations outside its intended use.
Another security issue that needs to be addressed upfront is the verification of electronic signatures, in ensuring the medical integrity of the prescriptions received by pharmacists. Therefore, Hospitals, clinics and pharmacies should be protected with firewalls, use strict computer permission settings, and remain vigilant toward signs of an intrusion.
In the United States, the Hitech Act promotes adoption of this technology by defining e-prescribing as one meaningful use of an electronic medical record.Standards for transmitting, recording, and describing prescriptions have been developed by the National Council for Prescription Drug Programmes, in particular the SCRIPT standard, which describes data formats.
Elsewhere in the world, health care systems have been slower to adopt e-prescribing standards. Health Canada has concluded that there are currently no regulatory impediments to moving ahead with electronically generated and transmitted prescriptions and that these are permissible to the extent that they achieve the same objectives as written prescriptions
New figures from superscripts reveal that at the end of 2011, 58 per cent (or 317,000) of office-based physicians were using e-prescribing tools to fill prescriptions, versus only 36 per cent (190,000) in 2010.
Among specialty groups, e-prescribing adoption rates were highest among internists (81 per cent), endocrinologists (78 per cent), cardiologists (76 per cent), and family practitioners (75 per cent).
The government has to run incentive programmes to encourage doctors to adopt e-prescribing and other computerized health records, offering payments to help defray the costs of adopting the systems. These steps will lead to improved health care outcomes as well as increase medication compliance which is vital for the betterment of the health of the patient.
Future trends
The e-prescriptions are the future trends as this would save the environment by saving on paper and the helps the pharmacist to keep ready the prescription being filled before the patient reaches the pharmacy. The pharmacist can focus on plans of patient counselling and pharmaceutical care, when patient visits the pharmacy to collect the medicines.
(The authors are with MCOPS, Manipal, Karnataka 576104)