When selecting an e-prescribing system, physician offices should consider a variety of unfortunate possibilities:
Doctors might pick the wrong patient on a selection menu. In many cases, such an error would cause additional work. However, if a prescription is mailed to the wrong patient, the consequences could be much more serious.
Doctors using computerized entry might also slip on menus for selecting a diagnosis or medication regimen, particularly if drug names are similar.
Forcing doctors through a series of menu choices can increase the time it takes to write the prescriptions, perhaps causing them to rush other tasks.
If a system uses the same codes for both diagnosis and billing, clinically important distinctions might not be recorded or, worse, doctors may be tempted to select diagnoses that will ensure a prescription is accepted more quickly.
Decision support systems and dose calculations could prevent doctors from prescribing a drug that might endanger a particular patient. However, systems that send out false alarms or rely on data that is available only intermittently will either be ignored by physicians or could even suggest prescriptions that could harm patients.
In addition, systems might limit the choice of drugs with formulary lists or, for physicians that dispense medications from their offices, with in-house inventory.
The study also suggests additional uses of e-prescribing systems. One way is to increase support of outpatient drug administration, perhaps by printing out personalized dosing schedules for patients. Another is monitoring patients compliance and reactions, perhaps by alerting pharmacies when a prescription has not been refilled, or automatically soliciting feedback on reactions to a drug.
Bell cautions that early versions of e-prescribing will mask their ultimate potential. "There could be a difficult period of transition as physicians struggle to cope with changes in their work and as technology vendors struggle for market share. Performance of the system might suffer during this transition," he said.
Bell and his colleagues recently published a list of recommended features for e-prescribing. At the top of the list? The ability to integrate data to show physicians all the medication their clients are taking.
That list was published in Health Affairs. For an abstract, click here.
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