A report by a nonprofit group promoting health-care technology says a switch to prescribing medicine electronically can reduce medical errors and trim costs through increased efficiency.
While the Medicare Modernization Act of 2003 explicitly calls for a transition from paper-based to electronic prescribing, the eHealth Initiative says its report, based on a yearlong study of the process, is the first to offer concrete advice on how to do so.
Electronic prescribing systems would reduce medical errors and possibly prevent more than 2.1 million adverse drug events and 190,000 hospitalizations per year, the reports authors say. And it could be cost-effective as well.
Though some health-care providers have said expenses associated with implementing such systems are prohibitive, the eHealth Initiative counters that employers might save as much as $74 per employee in terms of delivered medical care and that national savings could be as much as $27 billion annually.
The report came out just days after researchers writing in the Annals of Internal Medicine concluded that while electronic prescribing reduces some error rates, it has done little to improve patient care.
Despite the potential benefits, only 5 percent to 18 percent of physicians and clinicians use electronic prescribing systems. To speed adoption, the report recommends giving physicians and their practices financial incentives to use the systems.
Legislative changes also could encourage electronic prescribing. State regulations currently vary as to what information prescriptions must contain, and some even prohibit electronic communication.
While physicians will likely have to make the biggest changes, new systems also must account for the needs of other health-care workers, such as pharmacists, third-party payers and doctors administrative assistants. The report recommends that all prescribing behaviors be possible on an electronic system. But speed is just as important, and the most common tasks should be not just possible but also fast.
The report suggests emphasizing instances in which an electronic method is dramatically more efficient than the paper-based one—such as renewing several medications for a single patient at once—to persuade physicians to adopt the practice. Doctors offices also can adopt systems incrementally, gradually stepping up the amount of information and integration that the electronic systems provide.
Also, the systems must be designed to provide information that is useful rather than extraneous. For example, a system that alerts doctors of acceptable drug interactions would not be as useful as alerting them of potentially hazardous interactions.
Varying ways of communicating medical information stall claims processing and prescription filling as well. While the systems must be as intuitive as possible, clinicians should not enter running text, the report says. While a standardized "drug vocabulary" for pharmacies, it is not suitable for clinicians. The report recommends adoption and enhancement of the vocabulary standards RxNorm and the National Drug Formulary Reference Terminology (NDF-RT).
Authors of the report included experts from Glen Falls Hospital, RxHub LLC, the First Consulting Group, Allscripts Healthcare Solutions and Partners HealthCare Systems Inc., as well as practicing physicians and clinicians.