E-prescribing is a technology that is steadily being implemented by several healthcare providers. It offers several advantages to prescribers, patients, and pharmacists alike and is likely to continue to grow in the next several years. During my IPPE rotation, I observed a lot of e-prescribing. Several of the area doctors us e-prescribing for their patients, and the process seems much more streamlined that the customary “patient-brings-the-prescription” or “doctor-calls-in-the-prescription” processes. One major advantage to the e-prescribing process is that the prescriptions are completely readable and there is a lower risk for entering error. Ideally, e-prescribing can increase the efficiency of the medication filling process. If prescriptions arrive at the pharmacy and are clearly written, prescribers will not have to be called for verification, and time will be saved. Also, if prescriptions arrive before patients do, the patient’s wait will decrease and patient satisfaction will increase. The flow of patients through the pharmacy area may improve and there may be fewer negative interactions between patients and pharmacy staff. One negative impact that e-prescribing may have on pharmacy is the fact that the prescription has to be transmitted to a specific pharmacy. For a patient who is in a hurry, having a written prescription in hand might be better because s/he can choose the closest pharmacy with the shortest wait. This also means, if the patient does not know the specific name or location of a specific pharmacy, s/he might be more apt to choose a chain store or highly marketed store that s/he actually knows the information for. For the patient, one negative impact of the e-prescribing process is that it is not instantaneous. Patients often think the pharmacy gets the prescription information as soon as they leave the prescriber’s office. Patients seem to miss the point that the information still has to be inputted into the computer and transmitted to the pharmacy. If the prescription has not reached the pharmacy by the time the patient has s/he usually blames the pharmacy for the inconvenience. E-prescribing has the potential to enhance relationships between prescribers and pharmacists. A provider may prefer sending e-prescriptions because s/he knows the prescription will make it there unchanged and that the pharmacist will not have to call to verify due to illegible handwriting. Limitations to the maximal implementation of e-prescribing include the financial burden involved with setting up and maintaining the e-prescribing technology. The technology itself has to be learned by everyone who will need to use it. Also limiting is that e-prescribing is frustrating for patients who expect a prescription to have been sent at a particular time to a particular place who arrive at a pharmacy that has not received the prescription. The use of e-prescribing is enabled by several factors. Prescribers and pharmacists alike do not want to have legal issues associated with prescription misfills that occur due to bad handwriting. This also decreases the amount of time that prescribers and pharmacists spend verifying prescriptions. E-prescribing decreases the opportunity for patients to tamper with their prescriptions, and enhances security measures already taken to combat counterfeit prescriptions. Patients enjoy e-prescribing as well because there is no prescription to lose and time can be saved if the pharmacy receives the prescription while the patient is still on their way. They will also save time if the prescriber can e-prescribe and they do not have to go in-office to pick up a prescription. If I could, I would make the transmission of e-prescriptions happen at the time of patient interaction. This would ensure that a prescription would arrive at the pharmacy before the patient. If it were feasible, I would also have the e-prescriptions go to a general place where they could be accessed by any pharmacy. This way, the e-prescriptions would be more like written prescriptions in that the patient could choose where to fill the prescription after it had been created and transmitted by the doctor’s office. This might be possible through the use of login names and passwords, but would take time to develop into an efficient system. While e-prescribing is steadily increasing in use, there are still some factors that keep it from universal adoption. In the next several years, I expect that e-prescribing will continue to be improved and to be adopted by more healthcare facilities.
As the rate of the negative outcomes and deaths due to medication errors and similar mistakes has either increased or plateau over the years, the healthcare industry has found a great way to improve accuracy and lower costs by harnessing the power of modern technology. Here, we will overview some of the benefits and drawbacks to the technology of electronic prescribing systems, or ePrescribing.
1. Improved Patient Safety and Compliance
- The prescriptions that are submitted to the pharmacy are more legible, leading to a decreased rate of medication errors and decreased liability. This is a great improvement over frequently illegibly hand-written prescriptions that decrease safety and efficiency.
2. Improved Workflow
- Since the pharmacy staff has greater clarity and improved communication with physicians, fewer callback and return faxes are needed. The time and effort that would normally be wasted by these steps can be diverted into improving patient safety and increased attention to the more important aspects of community pharmacy practice, such as monitoring drug interactions and counseling patients. From a doctor’s perspective, an ePrescribing system has higher up-front costs, but they see improved efficiency due to a lesser demand on their time, increased mobility and access with wireless prescibring systems, and improved medical record-keeping due to the electronic and reciprocal nature of the system.
3. Lowered Costs
- Electronic prescribing systems make it impossible for patients to lose their prescriptions, so no more wasted doctor visits or calls to the office. Also, refill requests can be almost fully automated, leading to a decrease in labor costs and wasted effort by the pharmacy staff calling inhospitable and sometimes hostile physician’s offices.
4. Improved Patient Experiences
- Patients may experience significantly shorter wait times in the pharmacy, as the prescription has been transmitted before their arrival, giving the pharmacy staff a head start in preparing their medications.
1. Barrier Cost of Implementation
- The ePrescribing systems are not free and the cost of implementation (equipment, training, decreases in productivity during transition), etc. is a prohibitive cost to many physicians. The incentives currently offered by Medicaid are working to decrease these costs, but the response has been somewhat limited. Further steps must be taken by the government to increase competition between vendors so as to decrease the entry cost for less affluent doctors.
2. Security Concerns
- Critics of ePrescribing are concerned with the security of the systems, mainly the verification and access control aspects. Greater security measures must be implemented, such as biometric verification for controlled prescriptions, etc.
This is just a brief overview of the nature of ePrescribing, and it is important to note that the technology is still evolving as further development and implementation is seen all around the world. The systems we see today will only improve in their record of safety, cost savings, and ease of use. ePrescribing will almost surely become the industry standard over the next ten years—a change that will almost surely aid in the improvement of drug therapies worldwide. Will you do your part to ensure that the transition is a smooth and safe one?
E-prescribing is an emerging technology in the medical field that is already impacting pharmacists and will continue to impact the profession of pharmacy in the future. E-prescribing has both advantages and disadvantages for all parties involved in the process. It clearly makes things easier for the doctor because they don’t have to worry about keeping up with a prescription pad and it is also much quicker to type or click boxes into the computer than it is to actually write a prescription on paper. As a patient, one thing I really like about e-prescribing and see as an advantage is that I don’t have to worry about keeping up with an actual prescription on a piece of paper. It is also nice to have your prescription ready and waiting for you when you get to the pharmacy. One thing that some patients may see as a disadvantage is having to decide what pharmacy they want it filled at before leaving the doctor’s office.
From the pharmacist’s viewpoint I feel that E-prescribing has the potential to be very beneficial and to make a positive impact on the profession, but as of right now I feel that there are some flaws or things that need to be improved. There are also many advantages currently to e-prescribing. The most important advantage that I can think of is that you don’t have to decipher doctor’s handwriting, which we all know usually isn’t the greatest, therefore it creates a drastic reduction in the number of errors related to handwriting issues.
From my own personal viewpoint, based on my experiences working in an independent community pharmacy, there are some aspects of e-prescribing that I don’t necessarily like or areas that I feel have room for improvement. The pharmacy where I worked was located in the same building as many doctor’s offices, so people would leave their appointments after having their prescription sent to the pharmacy via e-prescription, and come directly to the pharmacy expecting that their prescription would be ready to pick up. Most of the time if this was the case, we wouldn’t have it ready when they got there because we hadn’t seen their prescription come through on the e-script system yet. There was no type of notification from the system saying there was a new prescription had come in, so it required constantly checking the console to see if there were new prescriptions or not. This is an area in which I feel needs to be improved; I believe that there needs to be some type of notification system put into place to notify you when a new prescription comes through, or maybe not for every individual prescription but at least every 10 or 15 minutes because it often gets hectic and it is easy to forget to check the e-script console. Another thing that I feel could be improved or would be helpful would be if there was a spot for the doctor to put on the prescription when the patient was coming so that you would be able to have their prescription ready when they get there. Also, I don’t really feel like it is fair that the pharmacy gets charged for each e-prescription that they fill.
I have had the opportunity to observe some of the benefits of computerized order entry in delivering health care. While I was at a hospital here in Alabama, I observed some of the most illegible handwriting that I have ever seen. This was really very unacceptable. However, I understand that the doctors are often pressed for time and don’t generally write in print when they make their orders. As a result the cursive handwriting is hard to understand. At this hospital many of the doctor’s still wrote their own admit orders but some accessed a screen in which they could select admit orders for their patient. It made it easier for the nurses and others taking care of the patient to see what direction of care the doctor wanted for their patient. Some of these care takers were pharmacists. For these pharmacists, I would like the impact of a medication ordering and clinical decision support process to lead to reduced errors in the medication use process. We were taught that up to 49% of errors occur when creating the order. This number is just too high. A medication ordering system with clinical decision support would offer prescribers accurate information, about the patient and about the drug, at the time of prescribing and these prescribers can use their clinical judgment to determine the next step in treatment. The effect of this system is to prevent errors at the time when they are most likely to occur. One drawback that I see in this impacting pharmacy is that pharmacists may not be as vigilant when checking prescription orders. Since computers are often correct, they might assume there are no errors and maybe just dispense a medication without paying complete attention. To me, it is still important to monitor medications prescribed to the patient. Whether it’s just to note that the therapy matches the diagnosis or that the correct dosage form is used, I think the pharmacist should still monitor the process. Overall, this change is beneficial for patients too. If the computerized prescriber order entry (CPOE) system is programmed with current guidelines and a list of possible drug interactions for the drug being used, then the only impact that I see for patients is a good one. I think health care providers, after the initial frustration that is sure to come from learning a new system, will grow to accept it as a tool to enhance medical care given to the patient. In doing so, they would also appreciate the contributions of pharmacists to patient care. Limitations to implementing CPOE include the cost of the system and dealing with the amount of time required to learn the system. These limitations are currently addressed by the American Recovery and Reinvestment Act of 2009 which facilitates usage of a medication ordering system by offering incentives to providers if they use one. Also increased proficiency with repeated use will reduce the amount of time providers spend on each order. To make CPOE better, I will extend the amount of time that incentives are offered to prescribers and create a computing system that does not produce alert fatigue.
I believe in this technology-driven world, more prescribers should be using E-Prescribing. After using E- Prescribing in the pharmacy, I never wanted to see another handwritten prescription. There are certain doctors in the town where I worked who have a reputation for terrible handwriting and we had to call their office multiple times a day to verify what they had written on the prescription. It is a waste of our time and the staff’s time to deal with this issue that could be easily solved by the doctor using E-Prescribing. Forged prescriptions was a major problem where I worked and I think this system would greatly decrease this issue.
I believe by prescribers using E-Prescribing it will be easier to identify forged prescriptions because if we know a certain doctor’s office usually uses E-Prescriptions and we receive a handwritten prescription, we will be more alerted to call and check on the authenticity of the prescription.
I believe by more prescribers using E-Prescribing it will greatly impact a pharmacist’s job by freeing up more time for the pharmacist to do other things such as counseling patients. Pharmacy technicians should be able to put prescription orders into the computer without having to ask the pharmacist a ton of questions like what the name of the medicine written is or what dose has the doctor written on the prescription because they cant read it due to illegible handwriting. E-Prescribing allows the pharmacy technician to read the prescription with ease which gives the pharmacist and pharmacy technician more time to do other things. This extra time will help everything else in the pharmacy run more smoothly. I would not like for E-Prescribing to be a difficult system to use because I think that would negatively impact the pharmacy. If the system is difficult to use, the pharmacist will have to spend too much time helping the technicians figure the system out and solving problems related to the system.
I think E-Prescribing will positively impact patients because they will be more likely to receive the correct medication and correct dose because the pharmacy staff doesn’t have to make any guesses as to what the doctor wanted the patient to receive. This will limit the number of deaths and injuries caused by patients receiving the wrong medication due to illegible handwriting which will also help to decrease healthcare costs. Also, the patient is more likely to receive their medication quicker because the system eliminates time spent on figuring out what is written on a prescription or calling the doctor’s office to double check what was written. A way it could negatively impact patients is if the doctors aren’t careful when entering the prescription into the system. If they enter the wrong medication or dose the pharmacy will fill what was written and the patient may receive the wrong medication or dose. We are trying to eliminate patients receiving the wrong medications so if this happened frequently it would only increase the problem. Many of these systems have alerts and references doctors can use to help them choose the correct medication which would help reduce the amount of times this problem occurs.
I think E-Prescribing makes the relationship between the pharmacy and doctor better because we are saving them time by not having to call them about prescriptions that we cannot read. Also, both the pharmacy and doctor having access to the patient’s medical history will allow them to better collaborate and make decisions regarding the best way to care for the patient.
One of the limitations is that prescribers must purchase software to be able to use E-Prescribing and some prescribers are not willing to spend money on this. Also, if the power goes out it will be impossible for the pharmacy to receive E-Prescriptions. One of the enablers is that prescribers can receive an incentive payment from Medicare Part B for using E-Prescribing (https://www.cms.gov/ERXIncentive/). Also, pharmacists benefit from this system by being able to view a patient’s complete medical history even if they have used other pharmacies so the pharmacist is better able to assist in helping the doctor make the best decisions for the patient.
I would make this system better by having more features built into the system to make it more interactive. I think any doctor a patient visits should be able to use their medication history no matter what state the doctor is in. Also, this would help the hospital figure out immediately what medications the patient is on since many times the patient doesn’t remember their medications or isn’t conscious. I think it is hard to make the system interactive if physicians use different E-Prescribing systems but if they could find a way to connect all the systems and make it more interactive it would benefit the pharmacist, doctor and most of all, the patient.
Technology has changed so much of what we do today. It has changed our personal life, social life, and work life. It has had great impact on the medical field, including how we practice pharmacy. One new technologic advance that is changing pharmacy is the ability for physicians to electronically send a prescription to the pharmacy of the patient’s choice. This is called e-prescribing. This feature has the possibility to greatly change how pharmacists, physicians, and patients interact.
I have experienced e-prescribing in both pharmacies I have worked in. Regularly, I work in a chain pharmacy and their computer system is able to receive and process the e-prescriptions doctors send in. We would get many e-prescriptions a day. Also I have worked in a independently owned community pharmacy for my two week rotation. I was surprised to learn that their computer system could also handle e-prescriptions. I then learned in Management class this semester that approximately 85% of pharmacies have the capability to receive e-prescriptions.
There are many ways that e-prescribing can improve the prescription filling process. The main way is eliminating illegible handwriting. Many medication errors can be made by misinterpreting what a physician has written for a prescription. With e-prescribing there will not be any guessing as to what a doctor’s intentions were. Another benefit is Drug Utilization Review (DUR) will notify the prescribing physician if there are any drug allergies, drug interactions, duplicate therapies, etc. for the specific patient when he or she is filling out the e-prescription. This feature will save the pharmacist so much time from being the sole one handling the DURs. Much of a pharmacist’s day can be saved from spending time on the phone with physicians’ offices trying to decode a prescription or change a particular prescription because of an alert from DUR.
One way that e-prescribing could be negative, is there are still potentials to make drug errors. When the physician is choosing the patient, drug, or dose there is possibility of making the wrong selection. If there is ever any question about a particular drug or dose a patient is receiving the pharmacist should double check with the physician to ensure the e-prescription was filled out correctly.
E-prescribing will not only change the way doctors and pharmacists practice, but will also affect patients as well. Instead of taking a prescription to the pharmacy and waiting for it or dropping it off and having to return later, the prescription will already be in the pharmacy’s computer. This will save the patient’s valuable time and can also make them more compliant because sometimes they will not drop off the paper prescription.
Another important feature of e-prescribing is incentives from insurance providers and Medicare. Right now Medicare is offering incentives for providers who are e-prescribing. Starting in 2012 Medicare will start deducting 1% of reimbursements for those who are not using e-prescribing.
Overall, I feel that e-prescribing is a smart technologic advance. It can help make physicians’ and pharmacists’ jobs more manageable and reduce medication errors. I hope when I begin working in a pharmacy in a few years e-prescribing is still available.
E-prescribing has already, and will continue to, make a big impact on pharmacy practice. E-prescribing eliminates the problem of misreading medications, strengths, doses, and quantities due to messy handwriting. E-prescribing is very convenient for the patient as well because the patient doesn’t have to keep up with a paper prescription, which is especially useful if the patient isn’t going directly to the pharmacy from the doctor’s office. There are many benefits to using e-prescribing, but there are still some issues that need to be worked out.
E-prescribing is convenient for the patient, physician, and pharmacist; however, judging from my experience with e-prescriptions, doctors and their staff are not receiving enough training before fully implementing e-prescribing systems in the office. Multiple times a day, the pharmacy I work at receives prescriptions that are for the wrong medication. Sometimes these errors are easy to spot and can be corrected, but I know there are some that do slip through the cracks and the patient ends up with a medication that isn’t the medication the doctor intended. Even if the mistake is caught, it takes time to contact the doctor’s office to confirm whether or not the medication on the prescription was in fact the one the doctor intended to prescribe. Calling the doctor to confirm the medication has been the most successful approach for the pharmacy I work at. It is possible for us to write a note on the e-prescription and send it back to the doctor (similar to requesting a refill through an e-prescribing system), but the same prescription is often resent back to us. Errors like this are due to either not enough training with the system or the staff or physician not paying attention to which drug is picked from the menu. There are many generic drugs that are spelled very similarly and are long, so if the entire name isn’t read it is easy to pick one drug and think that another drug was chosen. Taking the time to confirm the drug with the doctor doesn’t add much extra work for the pharmacist, but it takes time and the patient has to wait, usually for about a day, before getting the prescribed medication.
I have seen many prescriptions that have errors in the directions, and this can be attributed to not enough training on the e-prescribing system. Usually the problem is that physicians and their staff are either unfamiliar with or do not like to use the codes and abbreviations to write the directions. Sometimes it is easy to see what the directions are supposed to be because the directions will have words or phrases repeated multiple times, but are still understandable and appropriate. Unfortunately, there are times when the directions contain contradictory statements and the physician must be contacted to confirm the directions. Again, this takes time and the patient must wait until the pharmacy confirms the directions with the doctor before the patient is able to pick up the medication.
If I could add one feature to e-prescribing systems, at least the system we use, it would be to have an alert that notifies the pharmacist and pharmacy staff when a patient has had a prescription e-prescribed. I think if there could be an alert of some sort on the patient’s profile that notifies the pharmacist that the patient has a new e-prescription, it would make e-prescribing even more convenient for the pharmacist. In our system, I have to scroll through a list of received e-prescriptions to try to find an e-prescription for a particular patient. If the e-prescription could be linked to a patient’s profile even before the prescription is processed, it would save the pharmacy staff time and it would keep the patient from having to wait for someone to scroll through a long list to figure out if the doctor sent a prescription over. I’m not sure if there is a feature like this available, but it would be very beneficial to have a feature like this for the e-prescribing system I currently work with.
There are still some issues to work out with e-prescribing, but as health care professionals use e-prescribing systems more I think most of these issues will resolve themselves. I think that health care professionals should take the time to train and become familiar with e-prescribing software because e-prescribing is beneficial to pharmacists, physicians, and patients.
E-prescribing is a great alternative to written prescriptions and exhibits a functional example of how technology can work to better patient care and health care efficiency. E-prescribing increases accuracy and drastically decreases the amount of clarification calls made to prescribers when handwritten prescriptions are unclear. One negative aspect of E-prescribing is misspelling of a patient’s name or incorrectly entered patient birthday can result in the pharmacy making a duplicate profile for a patient. This is only a minor issue and only takes a couple minutes to correct when the patient comes to pick up their medication. I personally ran into this issue frequently because I worked in an area with a high tourist population thus, most patients were not being seen by their regular physicians.
I would like to see E-prescribing become well integrated into retail pharmacy. After speaking with different interns who have all worked for different retail pharmacies, we all came to the same conclusion. E-prescribing works but, the scripts are often pushed aside since they usually will not register in the computer system as “waiting”. So, frequently patients become frustrated and confused when their prescription is not ready when they head to the pharmacy directly after leaving the physician’s practice. I would not like E-prescribing to result in pharmacists having more trust in the prescriptions they receive. If a dosage does not seem right or if the medication seems inappropriate, the pharmacist should still call the prescriber and double check the prescription. E-prescribing should cut down on prescriber calls due to hand writing but, not change the number of calls due to suspected mistakes.
E-prescribing will not have a drastic effect on patients but, mainly will increase efficacy in the pharmacy. Since E-prescribing will result in less prescriber calls being made as a result of bad handwriting, this will allow pharmacists to spend more time doing other things such as counseling patients. Patients will have more opportunities to be informed about the medications they are taking. Patients also will not have to worry about keeping up with the written prescription. The only negative of E-prescribing may be a duplicate profile created for patients if their prescriber accidentally incorrectly enters their information into the system. A few patients may be initially confused when they come to pick up their prescription and see it did not go through their insurance like it normally does. However, if the patient leaflet shows that the prescription was received via E-prescribing then asking the patient if they have insurance or if they have ever used that particular chain before would be a quick fix. Also, patients may feel a little disconnected from their own health care if they do not know what medications they are being prescribed. Overall, E-prescribing will make the patient’s retail pharmacy experience more beneficial.
There are very few limitations for the use of E-prescribing. The main limitation is simply the cost. It charges the pharmacy twenty cents a prescription. This number may seem insignificant but, when compared to written prescriptions which are free, this number becomes more important.
In order to better E-prescribing, there are many things I would do. First and foremost, I would set up a system where prescribers could indicate if the patient is planning on coming to the pharmacy immediately or not. I feel this would decrease the number of upset patients arriving at the pharmacy only to find that their prescription is not ready. I would also make it possible for the pharmacy’s computer system to notify the physician if a patient with that name and birth date does not exist in our system or if there are duplicates so that the physician can double check this information with the patient and assure the prescription is going to the right pharmacy. Overall, my experiences with E-prescribing are very positive and I hope to see it integrated more efficiently into more pharmacies.
I work in a hospital as a respiratory therapist and see mistakes happen all the time due doctors not writing clearly and correctly, thank God that most (not all) are caught. Our health system is not prefect in no way shape or form but it can be perfected. Most mistakes take place when orders are being prescribed. One way to help eliminate this problem is by using a computerize prescribing order entry (CPOE) system. CPOE is defined as directly entering medical orders via a computer system by a licensed provider; the orders are then transmitted to the appropriate location. The advantage of using this system is being able to reduce medication/medical errors that lead to improving health care quality and efficiency. CPOE could be beneficial to pharmacists, patients and physicians for a positive outcome.
The pharmacists would have the greatest impact (my opinion). When pharmacists do what they are suppose to do then everything else falls into place with the physicians and patients. By using CPOE, it will reduce phone calls and verifications (free up time) and it will reduce prescription errors. Last summer when I did my two weeks IPPE rotation at CVS, I recall seeing a lot of handwritten prescriptions that I couldn’t read and maybe the pharmacist could read them because they were accustomed to it but they shouldn’t have to be familiar to something like that. They shouldn’t have to guess and speculate on something as serious as reading a prescription for patient care. It is time consuming and takes away from patient care when the pharmacist has to make a call to verify a prescription/order. By using this system it will free up their time for more important things like patient care. The disadvantage is when or if the system goes down. At the hospital, the computer system goes down every weekend at midnight and it’s a big problem because orders can’t be put in during that time, it causes a lot of confusion. The hospital does not stop operating because the system is down; however, they have a back up plan/policy in place. What I hate most about when the system goes down is when it comes back up; we have to put everything that happen throughout the night in the system and sometimes the system can be down for more than four hours. If things are not done accordingly, there’s a possibility of losing charges, then there’s a lost of revenue.
Patients benefit by having confidence in their care from the physician and pharmacist which leads to compliant with their care. People will continue to go to places were they receive good services. When using CPOE, as mention early it frees up the pharmacist’s time and they will have more time to spend with the patients/customer. What patient doesn’t want attention concerning their health? It shows that you care about them as a person and not just a paying customer.
CPOE needs to be in place at every healthcare system, the number one goal is to improve healthcare by reducing medical errors by being efficient in taking care of patients
ePrescribing is a fantastic new system that is going to revolutionize the practice of prescribing medications. Technically it has been around since 2001. So why isn’t this used for every prescription you get?
First let us discuss the cons of the system. In the United States there is a large amount of different types of pharmacies and practitioners. Each of these entities has their own computer software that they use. This then poses the challenge of interoperability, or the ability of the systems to communicate with one another. Another problem that might arise for patients is that their doctor may send their prescription to the wrong pharmacy, or the patient may tell the doctor the wrong pharmacy. I have witnessed this many times and can vouch that it leads to untold frustrations. Another challenge is the DEA. They don’t want controlled substance prescriptions to be transmitted from the doctor to the pharmacy. Their reasoning for this is that the pharmacy; can’t authenticate the prescriber, validate the source of the prescription, or be able to keep satisfactory records. For these points one might think, if my bank can do it securely, why can’t the doctor and pharmacy?
Now let us discuss the pros of using ePrescribing. A major pro for this system is that there have been standards set down for it. Since it is standardized, each prescription should have the same amount of information. This is a big plus for pharmacies, because it helps them to set up their systems to accept the transmission. Although this is a good thing, I have seen mixed results with how a pharmacy’s computer system receives the transmission. Some work fine but others place the information into the wrong places in their software and make it more of a hassle to use. But this problem is something that the pharmacy might be able to work with the software programmers in order to fix. A theoretical pro that the DEA should be concerned with, is that it should be harder for the common person to “forge” a prescription. In order to do this, the less than savory person would have to hack into the connection between the physician and the pharmacy in order to produce their made up prescription. This is a much harder to do than stealing a doctor’s prescription pad, or writing over the doctors handwriting in order to forge your own prescription. This would also make the pharmacist’s life easier, by making them feel more at ease.
A possible benefit for the patient is that their prescription may be done by the time they arrive at the pharmacy. This may not be true for all times or all pharmacies, but the chance is still there. Another pro for the patient is that this system works to decrease the chances of error while filling the prescription. It makes it exponentially easier to read what the drug is, instead of trying to decipher the physician’s handwriting. It also means that the prescription has gone through two check points, at the doctor’s system and the pharmacy’s system, in order to check for problems. Another pro for using ePrescribing as a physician is money. Medicare will be reimbursing the physician a set amount more than usual for the next few years just for using ePrescribing. This should help increase the amount of ePrescriptions the doctors write.
All in all, ePrescribing is a great idea that will eventually change pharmacy for the better.
As an intern this summer at CVS I was able to learn about e-prescribing and how it can be useful to patients as well as the pharmacist. It was interesting for me to learn more detail about this process in class and be able to connect it to my experiences.
E-prescribing is very beneficial to the pharmacy staff because the physician is able to send a prescription electronically which allows for a quick transmission to the pharmacy. The staff does not have to type up any of the information on the prescription nor do they have to worry about if the handwriting is legible. Quite often the pharmacist receives prescriptions that they cannot tell what the medication is or they cannot tell the physician signature. E-prescribing saves time because it decreases the amount of typing that needs to be done as well as saves the pharmacist a phone call if the handwriting is not legible. Although e-prescribing decreases the amount of typing I noticed that the system was not perfect. The ancillary instructions did not always convert into our computer system so it is important to read the final version before giving it to the patient.
Patients benefit because they do not have to worry about keeping up with the prescription until they have time to take it to the pharmacy. Ideally, once the patient arrives at the pharmacy their medication will be ready to pick up. Of course this is not always the case. It takes time for the prescription to be sent electronically and many patients do not realize this. For example this summer patients would come to the pharmacy, which is located five minutes away from the hospital, and expect to be able to pick their medication up immediately. Sometimes we did not receive the e-prescription until thirty minutes later. This upset patients because it was a wasted trip to the pharmacy and they felt like they could be doing other things. I definitely understood why they were mad because e-prescriptions are supposed to decrease the amount of time the patient has to spend in the pharmacy. To solve this problem I always tell patients to make sure to call the pharmacy before they come to pick up their medication.
Another reason that e-prescribing is good is because it can help decrease the amount of forged prescriptions. It is sometimes hard for the pharmacists to recognize forged prescriptions especially when looking at hundreds of them per day. Over time they are able to recognize the handwriting of local physicians but this would not prevent a fake prescription, from another area that the pharmacist is not familiar with, from being filled. One of the ways that people forge prescriptions is by using a pen and changing the prescription or by stealing the physician’s prescription pad. E-prescribing decreases the chance of people being able to forge prescriptions because they will not be able to access the prescription at all. If e-prescribing becomes widely used than physicians may stop using pads all together. Of course e-prescribing is not fool proof because there are ways for people to hack into computers to send prescriptions.
To enable maximal usage of e-prescribing it is up to the physician as well as the pharmacist to make this happen. Physicians have to make the decision that they are going to start e-prescribing instead of the traditional method of using a prescription pad. Pharmacists need to voice their opinion and notify physicians that they would prefer e-prescriptions as often as possible. Pharmacists know all of the benefits that e-prescribing provides and it is up to them to make sure this is known to physicians. One of the limitations of maximal usage is physicians’ willingness to participate in e-prescribing. They may not be willing to send prescriptions for controlled substances electronically which is understandable.
Applying electronic medication ordering with clinical decision support technology may prevent medication errors, and the resultant consequences. Why would investing in such technology be worth it? Approximately 7,000 lives are lost and roughly 2 billion dollars in hospital costs occur annually.
When we covered this particular topic in class my interest was piqued. It reminded me of the “Swiss Cheese” model in the Medication Use Process Overview and Workflow lecture from last semester. Wherein the slices of cheese were a wall of defense and the holes represented ways in which an error could get through. Using that analogy the use of computerized prescriber order entry (CPOE) is like a slice of Swiss cheese. Combining CPOE with clinical decision support software (CDSS) the holes are made smaller – or, if you like, acts like another piece of Swiss cheese. The goal is not only patient safety, but also, according to Schiff, to affect change in “how we prescribe and use drugs”1.
In the article Schiff describes that CPOE is more than just cleaning up how drugs are prescribed, e.g. illegible prescriptions. Several key pieces of information need to be linked together to make CPOE a valuable tool. These key pieces include information on the patient (age, weight, diagnosis, lab values), their drug history, and knowledge (pharmacology, guidelines, warnings and errors, patient education.
In the immediate future physicians would most benefit from the use of CPOE with concomitant CDSS since they are and will continue to be the primary prescriber for patients. However, as the landscape of health care changes and pharmacists begin to play a broader role through providing MTM services and the like, they may also benefit from the use of CPOE; particularly for pharmacists that have been given prescriptive authority or have entered into collaborative agreements with physicians for the care of their patients. Plus, pharmacists can play crucial roles in the development of CPOE systems considering that they are the medication experts.
For patients the primary benefits that they will receive through implementation of CPOE will be increased safety and maximized therapeutic outcomes. Physicians will be able to capture up-to-date changes in their patients coupled with the other key pieces of information, so that they are better able to make the right decision at the right time. CPOE should give physicians a more complete picture and, combining this with CDSS, help to guide their clinical decisions for their patients. This will also provide more efficient health care for the patient and in this way redundancies may be avoided thus lowering costs.
The primary limitation to “jumping in feet first” to CPOE and CDSS, and perhaps its greatest enabler, is money. Expenses associated with purchasing equipment, training, and maintenance are all barriers to implementation. However, even with initial costs the long-term savings in cost reductions, related to better clinical decisions, far outweigh the costs.
CPOE with CDSS is more than simply a way to get physicians to stop writing illegible prescriptions. It is a paradigm shift in the way that we as health care professionals deliver care to our patients. Couple this with advances toward having an electronic health record (EHR) our ability to improve safety and maximize therapeutic outcomes is greatly enhanced. In turn, it is ultimately about meeting the health care needs of our patients.
1. Schiff G. Computerized prescriber order entry: models and hurdles. Am J Health-Syst Pharm. 2002; 59:1456-60.
To ePrescribe, or not to ePrescribe, that is the question.
I have only witnessed the use of electronic prescriptions (eRx) in the independent pharmacy where I am currently employed and in my store, I am not a fan. I am sure that our problem is that we aren’t maximizing the potential of the service due to the limited capabilities of both our hardware and software. Initially, we bought the necessary equipment and peripherals to allow our store to receive eRx at the request of one of the local doctors. We told him that we would make ourselves ready if he would do the same. Now that we have it installed and up and running, the doctor decided that he didn’t want to utilize it.
When we receive an eRx it is added to the end of the list of refills that are captured by patients inputting their prescription number in the interactive voice response (IVR) system. You must complete all of the other prescription requests before you can access it. If a patient comes on a very busy day (like the 1st of the month) we might not be aware that they have an eRx in the system and they will have to wait until we finish everything else in the system before getting to them. We also have to retype the whole eRx when it appears in our system. I don’t know if this is normal or nor but it seems like a big waste of time to have to retype the entire prescription. The way our system works now, eRxs increase the workload of the pharmacist.
There are many benefits to everyone in the prescribing loop including the patient, the doctor, and the pharmacist when electronic prescribing is utilized. The pharmacist can see reduced errors, reduced time spent on the phone, and electronic refills. If everything was setup the right way it could really help free up the pharmacists to allow them to spend more time face to face with the patients, answering questions and counseling. It could also help to decrease the number of medication errors since the pharmacist would no longer have to decipher the handwriting of some doctors. It would also decrease the amount of time the pharmacist has to be on the phone each day. Anything that can be done to save time and reduce the number of errors should be done. A patient can save a lot of time if their doctor does send their prescription electronically because it can be ready for them when they get there. Other benefits that the patient can enjoy if their doctor electronically prescribes are convenience, safety, choice, confidentiality, and even better compliance. The doctors get increased revenues, access to the patient’s previous filling information, cost reductions, and increased patient satisfaction.
I think one of the big reasons that some pharmacies like the one I work in haven’t really jumped on the eRx band wagon is the cost of getting the pharmacy up to standards because they are resistant to change. On the other hand, getting up to speed could enable the store to do more prescriptions per day increasing revenue which is always a plus.
Even though I have only had bad experiences with eRx, it should definitely be done by all prescribers. It will allow for less errors, improved patient satisfaction, higher revenues, and improved job satisfaction for pharmacists.
Today, I’d like to discuss the implications of using Computerized Prescriber Order Entry (CPOE) and Clinical Decision Support System (CDSS) in today’s healthcare system. I foresee CPOE and CDSS being utilized in all hospital settings some day. I hope to see them used in private offices and clinics as well. They would tie in very nicely with the implementation of electronic prescribing. The shift towards electronic based prescribing and record keeping is an enabling factor towards this technology. Most obviously, CPOE would vastly reduce the medication errors simply due to illegible handwriting. This would decrease the guesswork and follow up calls for pharmacists, and it would increase patient safety by ensuring that the patient receives the drug intended by the physician. Plus, an interactive menu of all the strengths and dosage forms for every drug in the system would reduce errors due to physicians’ decimal point misplacement or lack of knowledge of other availabilities. The CDSS would guide physicians in choosing the best drug for the patient, and it would also inform the inputting doctor when a drug is not covered in a certain formulary. This would be extremely helpful to the pharmacist because it would eliminate many insurance rejections. Therefore, it would save the pharmacist time in making those calls to both the insurance company and the prescriber. All of the benefits that save the pharmacists’ time may also help the patient receive his or her prescription sooner. More importantly, the patient can be confident that the drug therapy is more likely than ever to be safe and effective. This added confidence and convenience may increase compliance. I think this system could increase the cooperation and teamwork between physicians and pharmacists by eliminating those tedious and perhaps annoying follow up calls due to uncertainties about the written drug or strength. This way, pharmacists would have more time to focus on the drug’s potential interactions and adverse effects rather than getting hung up on deciphering the name of the drug. This would reduce frustration for the pharmacist. At the same time, it may reduce the frustration of the physicians because they will only be receiving pharmacist calls directly related to efficacy and treatment instead of what may be perceived as a call that wastes time. The efficacy guidelines to help the physician determine the best drug for the patient may also decrease “turf boundary” issues between the pharmacist and physician. Despite the benefits, hospitals and clinics may hold off on using CPOE and CDSS. Major barriers to implementation are most likely the cost and technical difficulties associated with computerized systems. The purchase and installation of new technology is very expensive, and many healthcare groups do not have enough money in the budget to afford it. New technology requires training, support, and patience. Implementing something new may be daunting, overwhelming, and time consuming, which could create resistance. However, with time and practice, these barriers will be overcome, and in the long run hospitals and doctors will save both time and money. Pharmacists will also benefit from time saved scrutinizing written prescriptions and questioning the efficacy and formulary constraints of the chosen drug. In the community setting, using CPOE may help to decrease fraud and forging of written prescriptions. However, CPOE and CDSS should not be used in place of the pharmacist’s verification and expertise in drug therapy. It is not a substitute for the pharmacist and should not replace the pharmacist’s responsibility in verifying the prescription and drug therapy. It is a means to reduce some of the more tedious aspects of the pharmacist’s job. This way the pharmacist has more free time to counsel patients and answer concerns. In the community setting it may allow for more time to perform Medication Therapy Management to patients. Overall, CPOE and CDSS are a valuable tool to healthcare and will improve medicine for each the physician, pharmacist, and patient.
I have very little experiencing with e-prescribing and e-scripts, but what I have has been positive. I still use the same physician I did in undergrad which is four hours away from auburn. At times it can be difficult because my monthly prescription is mailed to me and sometimes it does not get here in time. If the physician’s office used e-scripts it would make the situation so much easier. During my two-week summer rotation I filled several e-scripts and they were much quicker than taking phone-in prescriptions and I think there is much less room for error.
With e-prescribing there is a documented record of what was put in. This is a different than a phoned-in prescription, where a mistake would be harder to track. There is also an extra step in a phoned in prescription which adds another chance for error. A phoned-in prescription is written down, called in, and then entered into the computer system at the pharmacy. With an e-script, the transfer from person to person is taken out.
The implementation of e-prescribing will affect pharmacy workflow significantly. An e-prescription can be filled and checked quickly once it is sent to the pharmacy, and will already be entered. A hard copy prescription has to be brought to the pharmacy where it can be entered, filled, and verified. A faxed in prescription is not already entered electronically and a phoned in prescription must be written down and entered into the system. Also, refill requests can be done quickly and efficiently with the help of e-prescribing and this will significantly help pharmacy workflow.
When a pharmacy workflow has less steps, it will always benefit the patient. Mistakes are less likely and prescriptions are filled in a timelier manner. A patient can leave their physician’s office without a hard copy of the prescription and the process of filling and verifying can be ongoing before they leave.
One of the main limitations to e-prescribing is the physician’s resistance to change. Paper prescriptions have been the mainstay for so many years that many physicians may not want to see e-scripts implemented. This is a barrier currently but once medicare starts penalizing physicians who do not use e-prescribing, there should be enough incentive for each physician.
All of the major chain pharmacies use e-prescribing and this has most likely helped hasten its implementation. As chains compete with each other they are trying to come up with more error-proof and user-friendly systems for e-prescribing. They all want to keep up with current trends and so they are going to maximize it use. Chains stores in particular are moving more and more towards automation and e-prescribing fits very well with their daily work flow. Chains can look at data on e-prescribing on a national level and see what works and what does not. With this data, they are able to see correlations between mistakes and different aspects of e-prescribing. With all of these benefits, I think e-prescribing will be a common part of retail pharmacy.
E-Prescribing still has some kinks that need to be worked out, but there is a great amount of potential for its use in the future. The pharmacy I work at uses it, and overall, it is very beneficial. One of the main advantages to E-Prescribing is the increased accuracy over handwritten prescriptions. Instead of spending significant time trying to read a sloppy prescription, or calling the physician back to verify what it says, the staff is able to interpret exactly what was ordered. Some people argue that it is still easy to pick the wrong drug, but this could be said for entering any prescription. Also, prescriptions must still be verified before they are completed, and at my store we have not had a big problem with this. We also have a lot of doctors who have started sending E-scripts instead of leaving voicemail messages, so that saves the pharmacy staff a lot of time. It is not uncommon to have twenty to thirty messages in a few hours, so this time saved on the phone adds up quickly. It also helps with accuracy in that aspect, because many of the messages are difficult to understand, or the nurse does not give enough patient information to figure out who the prescription is for, which causes the staff to have to call the doctor back to verify the prescription.
No system is without its faults though, and there have been some issues with E-Prescribing. There is about a half hour lag from when the physician hits send to the time the prescription shows up in the computer system, so we often have patients come directly from the doctor’s office to get their medications, but we have not received the prescription yet. It has been a problem getting to patients to understand that the system is not instant- and sometimes, it is not any faster than a paper prescription. In some cases, patients have even requested that their physicians write their prescriptions out instead of using E-Prescriptions. Hopefully this lag time will be decreased though, so that both the providers and the patients will be able to benefit from it more.
Another problem for patients is that many patients like to review their prescription before it is filled. We have had several patients whose doctor wrote them prescriptions for incorrect doses, or left off important maintenance medications when submitting their prescriptions. Many of these problems would have been caught by attentive patients before they left their physicians’ office. In the future, it would be nice if the physicians could print off a duplicate copy (that would state it was a copy- not a prescription to be filled) for the patient to review in the office. This was also save pharmacies time also, because we often have to fix the problems when the patient comes into the store.
Even though there are still some problems with the E-Prescribing system, I feel that its implementation is a positive thing for pharmacy. The improved accuracy is a benefit to physicians, pharmacy staff, and patients, and it also saves a significant amount of time for the pharmacy staff, which ultimately outweighs the issues with the system.
CPOE and CDSS are two really important systems that are slowly being incorporated more and more in U.S. today. Over a million medication errors occur in hospitals in the U.S. annually, and some of those errors are life threatening or have led to thousands of patient deaths. Examples of possible errors that may occur are: pharmacists may dispense too much of a drug due to decimal point errors, pharmacists could dispense the wrong drug completely to be administered to patients because they could not decipher the physician’s illegible handwriting, or pharmacists could unintentionally overlook severe drug interactions or allergies that the patient may have. In addition to the unnecessary harm the patient experiences, these errors are also costly, and add an extra $2000 expense to the patient’s overall cost of care on average; this creates a financial burden for most patients now more than ever because so many people are unemployed now due to the economy. About 49% of medication errors occur in the ordering stage of the patient medication use process. CPOE and CDSS were developed in order to improve the quality of healthcare the patient receives and decrease the percentage of medication errors that occur annually.
CPOE specifically addresses the issue of pharmacists not being able to read physicians illegible handwriting. CPOE stands for computerized prescriber order entry, and it is done completely online by physicians and transmitted electronically to the appropriate destination for medications, procedures, lab work, and radiology. Since the orders are made solely online by the prescriber, pharmacists do not have the option to misinterpret a patient’s prescription and can dispense the correct dose and correct medication to be administered to the patient 100% of the time. These orders have more information on them than normal electronic orders and they help to decrease the majority of medication errors.
CDSS is another system that cuts down the medication error rate. CDSS stands for clinical decision support system, and it provides additional patient specific information and knowledge to clinicians so they can make better more informed decisions that will improve patient outcomes. CDSS helps make sure that the right patient gets the right dose of the right medication at the right time by clinicians using the right intervention format and channel in their workflow throughout each day. Clinical decision support includes: structured forms and orders that have no free text, picklists that the prescriber makes when placing an order that also has no free text, order sets and order sentences, medication reference information that provides clinicians with factual knowledge that is known to be true, protective guideline support that tells a clinician what the drugs of choice are for treating a disease state and what line in therapy a drug is, alerts and reminders that periodically pop up and inform the clinician of a problem or variation in drug therapy so they can help clinicians make better decisions and stop making bad ones, and aggregation of clinical data at the point of care.
Pharmacists have a huge role in CPOE and CDSS, and they have a lot of opportunities where they can benefit and also decrease the amount of medication errors that annually occur. Pharmacists are the medication experts, and they can design, customize, and implement: drug information, dosing regimens, treatment protocols, dose ranges, and drug interactions. Pharmacists could also get to interpret CDSS during prescribing, so they could actually be on a committee that decides what alerts and warnings are seen during the prescribing process. Pharmacists can also train other users and monitor patients’ care over prolonged periods of time to make sure patients don’t encounter any severe drug interactions among other things.
All in all, everyone benefits from CPOE and CDSS. Patients benefit because they are receiving a better quality of care that is more coordinated between their physician and pharmacist and less errors are made, so patient safety is enhanced. Physicians benefit because they are receiving additional information that was not previously available to them to make better decisions so less errors are made, they can manage patients’ risks better. Pharmacists and physicians both save time, which is more convenient, because they spend less time on the phone or emailing each other in order to verify information with each other.
Even though everyone benefits in the long run, there are some barriers to adopting CPOE and CDSS. Both the prescriber and the pharmacist have to purchase a software which imposes a cost to both of them, a wireless internet connection is required in their place of practice in order to transmit information between them, they both have to be trained to use the software which takes time and some getting used to. Also prescribers and physicians may not agree about how to treat a patient and some dissonance can be created between them about the patient’s care. Prescribers don’t understand what they are looking at because they have never had to view alerts before, and they are not appreciative of what they are looking at. Another barrier is that false positives or errors in alert generation occur, and the biggest barrier is that the number of alerts that pop up could disrupt workflow and take too much time for clinicians to read and document.
***ePrescribing in the 21st Century: The Time is Now!***
Numerous patients across America continuously grip and groan when they arrive to their pharmacy and are notified by the Pharmacist that the pharmacy has not received their prescription from the doctor’s office. As an intern at one the country’s top retail pharmacies I have witnessed the wrath of several customers when it comes to this issue. I have pondered a copious amount of times how pharmacies and physicians can improve this aspect of the healthcare profession. It was not until this past spring semester at school that I discovered a method known as e-prescribing, also known as electronic prescribing.
The Center for Medicare and Medical Services defines e-prescribing as the act of electronically transmitting a patient’s prescription or information related to a patient’s prescription solely between the prescribing doctor, pharmacy, pharmacy benefit manager, or health plan/insurance company of the patient. E-Prescribing is currently available to assist pharmacists and physicians in avoiding the problem mentioned above. Why then are the vast majority of pharmacies and physicians failing to implement this “ground breaking” technology into their businesses? In order to appropriately answer the question proposed I feel that it is necessary to thoroughly assess the benefits and limitations e-prescribing.
E-prescribing provides prescribing doctors, pharmacist, and patients with several benefits. In 2003 Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act, also referred to as MMA. The MMA addressed several issues in the healthcare profession. One item in particular that this Law established are the standards for using electronic prescriptions. The standards that MMA set for e-Prescribing ensures patients’ privacy and a consistent method that is used to connect physicians, pharmacies, PBMs, and health plans/insurance companies. Due to the standards e prescribing is mandated to follow by the Federal Law, patients can be assured that their healthcare information is being transmitted in a confidential and orderly manner. Implementing electronic prescriptions will assist in providing patients with faster service, therefore improving convenience for customers. Patients will no longer have to wait an indefinite amount of time for their physician’s office to call their prescription into the pharmacy. In addition to this, e-prescribing also has a positive impact on both physicians and pharmacists. E-prescribing aids in decreasing the amount of preventable adverse drug events and potential adverse drug events because all electronic prescriptions are typed. This eliminates the issue of physicians’ illegible handwriting and decreases the risks of administering a patient the wrong drug.
Electronic prescriptions will help to advance the workflow of pharmacies. E-prescribing will decrease the amount of telephone calls that a pharmacist has to make. There in turn, this will allow the pharmacist to have an increase in time that they will be available to counsel patients. Ultimately, e-prescribing will enhance the overall productivity of the pharmacy and improve customer service that a pharmacy will offer its customers.
Unfortunately, e-prescribing’s capabilities are limited in its ability to provide electronic prescriptions for schedule II controlled substances. Due to federal laws schedule II controlled substance drugs will not be able to be electronically prescribed for patients. Federal law mandates that schedule II controlled substance prescriptions be handwritten and contain the actually signature of the prescribing doctor.
Overall, the benefits that e-prescribing provides outweighs its limitations. I am a firm believer that the healthcare system should continue to progressively evolve and use the top technology to provide patients with optimal care. Due to my philosophy I deem that all pharmacies and physicians should take advantage of the services that organizations such as Surecripts provides and implement e-Prescribing into their businesses.
e-Prescribing would be a great thing for the profession of pharmacy. I have actually seen this used in one of the pharmacy settings that I have worked in, and I think it is an amazing marker of how far technology and health care have come. This can have positive benefits for the pharmacist and the physician as well as the patient. However, there are some negative attributes to e-Prescribing as well.
e-Prescribing will help cut down on the errors made in prescription filling due to illegible writing. However, errors will still exist due to entering the wrong name, dosage, etc. on the computer e-Prescribing software, so pharmacists will still need to vigilant and use good judgment at all times. This is ultimately good for the pharmacist because they do not have to spend as much time on the phone with nurses and doctors trying to decipher the writing on a prescription. This is a huge benefit to the patient because there is less risk of receiving the wrong medication due to illegible writing.
There is another drawback specifically for the pharmacist, and that is the direct cost to them to receive e-Prescriptions. With each prescription received the pharmacy is charged twenty cents. This may not seem like a lot but over time will add up and will become even greater as this begins to become the main mode of prescribing. There are also some instances where the prescription is sent to the wrong pharmacy by the physician causing the pharmacy to lose money because they never actually fill a prescription for that patient because it is not one of their patients. There are also some instances where physicians send e-Prescriptions for controlled substances and the pharmacy is still charged the twenty cent fee. It is unfortunate that pharmacists are penalized for trying to further technology in healthcare and physicians are receiving tax breaks and incentives.
As for the patient, it was mentioned earlier that their overall safety is increased, but there are pros and cons. On one hand, it is easier for the patient in that they do not have to keep up with the physical piece of paper to take to the pharmacy, especially if they are not planning on taking it to be filled immediately. But, this also presents one of the cons, my patients like to look at and read over their prescriptions before taking them to be filled. They like to be fully informed of what they should be receiving and exactly what the doctor wrote. This could lead to patients feeling disconnected from the pharmacist and the physician. This also makes them feel like they are less a part of the decisions being made about their own health.
Another huge benefit to everyone is the possibility of using e-Prescribing for controlled substance. The pharmacist does not have to worry about a prescription being forged and have to call a doctor’s office for confirmation. Physicians do not have to worry about their prescription pads being taken or patients changing what they have written the prescription for. This could hopefully in the long run cut down on the number of patients abusing controlled substances.
E-prescribing has helped bring pharmacy into the 21st century by allowing physicians to transmit prescriptions electronically and securely to the pharmacy designated by a patient. I have had the privilege of experiencing this innovative service firsthand through my work, and I think that, despite its flaws, it has helped make the prescription writing and receiving process more efficient.
As an intern, I cannot count how many times I have been presented an illegible prescription by a patient. Though the pharmacist is sometimes able to clarify the prescription for me, I usually end up calling the physician’s office for a clarification because the patient does not have enough health literacy to understand the medication he or she has been prescribed. I like that e-prescribing has reduced the number of calls I have to make to the physician because of illegible prescriptions. This gives the pharmacy staff more time to fill prescriptions, counsel patients, and solve other problems such as insurance rejections. The only downside to e-prescribing is that the pharmacy is responsible for paying for each prescription received and for refill requests. If paper prescriptions are phased out, the overall cost for pharmacies will increase. Since the CMS is mandating e-prescribing, I think a federal stipend or tax break for implementing and continuing the technology would be both beneficial and appropriate to help overcome the cost limitation that many independent pharmacies face. Though this may seem like a minor improvement to e-prescribing, I think it would help tremendously.
E-prescribing is equally beneficial for physicians. It allows them to prescribe medications without having to worry about tampering or possible errors resulting from illegibility. It also frees more time for office staff to interact with patients instead of handling calls from confused pharmacy staff members. Though open lines of communication can only help relations between pharmacists and physicians, in my experience both parties become agitated when a phone call and wasted time could have been prevented by simple legible handwriting. Additionally, kickbacks for physicians and hospitals from Medicare will facilitate implementation of e-prescribing.
Ultimately, the primary party we are interested in helping by implementing e-prescribing is the patient. Actually, everything healthcare practitioners do in some way works toward optimizing healthcare for patients. Though there are a few negative aspect of e-prescribing with respect to the patient, the process is very beneficial overall. The only complaints I have heard from patients regarding e-prescribing usually involve confusion about the medication prescribed. The physician does not always communicate effectively with the patient, so there are some instances where a patient arrives at the pharmacy and has no idea what he or she has been prescribed. With paper prescriptions, they were at least usually able to read the name of the drug and research it if they so desired. For these patients who like to be proactive with their own healthcare, it becomes even more important that pharmacists take the initiative to adequately counsel patients about their medications. Despite these few misgivings, the feedback I have heard from patients regarding e-prescribing has been overwhelmingly positive. Patients like the convenience it provides, and especially like that they do not have to keep up with a hard copy of the prescription. The security of the process is excellent, and as a student pharmacist I appreciate that I can have confidence in the legitimacy of electronic prescriptions. I look forward to seeing the major role that e-prescribing plays in implementing Electronic Health Records.
I have noticed from working in community pharmacies that eprescribing cuts down the stress level for pharmacists. I work at a small community pharmacy so our building is limited on space. Eprescribing cuts down the noise level, decreases the crowd in the waiting area, and it cuts down the time the pharmacist spends getting the prescription from the patient. Eprescribing is the electronic transmission of a prescription between a prescriber, pharmacist, and pharmacy benefit manager. It is the exchange of health records in a meaningful manner. This is a big step for all health care providers. It doesn’t include a printed electronic prescription that the patient brings to the pharmacy nor does it include an electronic fax by the physician.
It will impact the way pharmacists manage their time. It will allow them to spend more time counseling their patients rather than spending the time on translating what the physician prescribed. The pharmacist would have to call the physician’s office if they were unsure of what was on the prescription. This will help the pharmacist stay caught up on prescriptions being put in the computer to be filled. Also, it reduces prescription errors by the pharmacist. It causes less error than when the pharmacist has to manually type in the information for every prescription. There wouldn’t be any errors of typing in the wrong medication, dose, or quantity unless the physician wrote for the wrong dose or medication. If the physician were to write a prescription with an error, it would still be checked by the pharmacist like a normal prescription. It is still verified by the pharmacist, but it isn’t entered into the computer by the pharmacist.
I wouldn’t want this to cause a pharmacist to be reliant and not be able to enter the information themselves if something were to happen to the eprescribing technology. They should still be trained to do the work manually. This system may make some pharmacists become lazy instead of using their extra time to benefit their patients by counseling or checking for more drug interactions.
Eprescriptions would have the most benefit for patients. It would decrease their responsibility of having to drop off the prescription. They would only have to come to the pharmacy once instead of twice. The patient would know that their medication and disease states would not be discussed among the pharmacies employees because the pharmacist would be the only one to see the eprescription. If the patient brought in a paper copy of a prescription, the techs and the pharmacist would see the prescription. It would increase compliance because it would not require the patient to bring the prescription by the pharmacy. Also, it is more convenient for the patient. They only have to make one stop to the pharmacy. One problem would be that the patient thinks that when they leave the doctor’s office their prescription is sitting at the pharmacy already ready. Eprescriptions could cause patients to become annoyed with the time it takes to fill the prescription since their understanding is that it would already be ready. Eprescriptions can also be used for control prescriptions. This would help decrease the amount of forgeries. The payers would appreciate eprescriptions because it would increase patient compliance and formulary compliance.
Some limitations for the pharmacists and the prescribers are cost, change, time, and some people wonder if there is any real benefit to having it over paper prescriptions. The patients may feel like it makes their visit less personal because they have less contact time with the pharmacist. They only talk to them once about their condition rather than talking to the pharmacist when they drop the prescription off and when they pick up their medication.
In all, I believe eprescriptions are a huge step in pharmacy. Once health care professionals get used to using this service, I think they will appreciate this service. It will allow the pharmacist to do other things beside just fill prescriptions all day. They will be able to use their knowledge to help patients improve their quality and quantity of life.
With more than one million serious medication errors occurring every year in United States hospitals, something needs to be done with the system. An idea to solve this major problem is computerized prescriber order entry (CPOE). This system uses multiple factors, including the patient’s disease state information, age, weight, and laboratory data to determine if drugs and dosages are correct for each individual patient. Many institutions follow guidelines to prescribe/dose patient’s medication, but this system treats each patient independently. Since a majority of medication errors occur during order entry, this system is a great way to stop a problem before it even starts. CPOE has great potential to excel in the medical field, but the system is very expensive and has caused a halt in the progress of implementation. Many hospitals do not have the resources to start such an expensive program.
This system puts the safety of patients first. As a health care provider, you strive to give your patients the best care possible. If there is a system or idea that could improve the health of a patient, you would want to take it. The health care system has begun using many different technologies to improve the care that physicians or pharmacist can give their patients. There is no possible way a physician has the ability to hold every piece of medical information inside of their head. After all, the knowledge of a person combined with technology is far greater than the knowledge of a person alone. Medications and their indications are ever changing, and CPOE will help physicians stay up to date on the current uses and dosages of medications. If CPOE is implemented in hospitals, it will save a great amount of time for the pharmacist. It will stop pharmacists from having to question prescription from physicians. It may even prevent pharmacists from challenging a physician’s autonomy. Many pharmacists struggle on a daily basis with having to correct a physician’s medication order. It can be hard to correct an order without sending physicians the wrong idea about how you feel about the medication selection. You do not want it to sound as though you thought that the medication they prescribed their patient was incorrect because they did not look at their patient’s last lab values or they did not review the chart for allergies. CPOE would help prevent any conflicts that might arise during this conversation. Not only does CPOE make life easier on the pharmacist and physician, but it has also been shown to decrease adverse drug events (ADEs), reduce time patients spend in the hospital, and decrease turn-around times in labs and pharmacies.
While CPOE is expensive, it offers many advantages that could reduce spending in hospitals, decrease hospital fees for patients and third-party payers. With the debt of our country and the economic difficulties people are facing these days, CPOE would help to relieve some of the burden they might face. CPOE also benefits hospitals by prevent errors that could cause legal issues with patients. By decreasing the millions of errors that are in our hospitals, we can improve our health care system that has been under so much scrutiny.
While working as a pharmacy intern at Rite Aid, I have seen the advantages and the disadvantages of the utilization of ePrescribing when filling new prescriptions for patients. I have chosen to discuss this particular topic of electronic data transmission, because it has greatly affected not only patients, but hospital and pharmacy staff as well.
Upon receiving my first ePrescription, I had no idea what to think of it. The order was simply already in our order screen, without being input by any technician or pharmacist. The lead technician did a great job of explaining how to fill these types of prescriptions. We simply had to keep hitting the continue button until we reached the print label screen. I was astonished by the simplicity of the process. I didn’t have to look up the correct drug, struggle with deciphering a physician’s handwriting, or worry about any of the prescriptions being lost among the other unfilled orders. I felt like I was in prescription-fill heaven. The workflow seemed to improve by taking out the extra steps that were typically necessary in prescription input.
My first few days of utilizing the ePrescription process proved to have many advantages for the pharmacist and patients alike. The pharmacist enjoyed being able to clearly read the prescription. She didn’t have to make any phone calls to physicians trying to figure out the usual problems associated with handwritten prescriptions, such as:
1) Name of the medication
2) Incorrect strength of medication
3) Correct quantity of medication
Besides helping the technicians and pharmacist handle the workflow more effectively, patients were able to walk in the door and have their prescriptions ready and waiting for them to pick up. Patients were pleased with the impact ePrescribing made, but drastically cutting down their wait time. Furthermore, when patients are happy, everyone in the pharmacy is happy as well. Nothing is worse than having a bunch of angry patients waiting to pick up their drugs. So far I have evaluated the advantages ePrescribing has provided for pharmacist and patients alike. Now, I will discuss the many disadvantages I have experienced while working as an intern.
During the second week of receiving ePrescriptions, we began to receive numerous patient complaints. Many prescriptions were ending up “lost” in cyberspace. Patients showed up to pick up their new prescriptions, stating that the nurse had transmitted the prescription several hours earlier. The pharmacist could only stand there helplessly explaining to the patient that we did not have their prescription in our order cue. At this point, everyone in the pharmacy felt limited by our inability to retrieve the patient’s prescription. Once again, the pharmacist had to make calls to the offices of physicians to see what happened to the patient’s prescription. In many instances, we would just take down the new prescription over the phone from the nurse. Upon taking down the new prescription, we had to input the information and follow the normal process used to fill non-electronic prescriptions. In the end the patient would leave the pharmacy, with the impression that we were in some ways incompetent. But the problem of the lost ePrescription never ends there, because nothing is ever really lost in cyberspace. The ePrescription would show up later in various ways, such as:
1) Being located at another pharmacy location
2) In the order cue, after we manually filled the prescription
3) Being filled at another chain pharmacy, and also billed to the patient’s insurance.
Once an ePrescription enters our cue, it is very difficult to remove or delete it from the system. Many times, we have to run the prescription through and put it on hold in the patient’s medication records. After doing this, must call back the prescriber to make sure the patient is allowed to have the available refill that we have just created. This correction process is very time consuming and takes up precious time from the pharmacist and technicians, by increasing the load of tasks in the workflow. Besides being an inconvenience to pharmacists, patients are also inconvenienced. Many patients have problems retrieving their next refill, due to the fact that another pharmacy may have their prescription ready, and billed to their insurance provider. Fortunately, later updates have been made to the ePrescribing process and such errors are not as frequent as they once were.
In terms of ePrescribing, pharmacists are only viewed as the “dispenser” of medications. Pharmacists are not currently the focus in the implementation of ePrescriptions. I feel that this is the biggest limitation that ePrescribing currently faces. The main people who are involved in the process are the ones who work in the pharmacy. By overlooking the pharmacist, many common problems that occur with the maximal usage/implementation are often not realized by physicians or the people who are trying to promote the usage of ePrescriptions. However, I feel that pharmacists can become enablers to the maximal usage of the process by actively making the problems known. I feel that this blog is definitely a good way to start making progress in the world of ePrescribing. By addressing our current problems, we will be able to help offer solutions. These solutions can potentially have positive impacts on the workload of pharmacists, as well as the satisfaction and levels of trust felt by our patients.
The topic I have chosen is Clinical Decision Support (CDSS). While working at CVS, I have encountered a clinical decision support system. CVS just implanted a new software system that makes checking for drug interactions easier and faster for the pharmacist. DUR or drug interaction rejects only happen when the interaction has fatal consequences. Once a DUR occurs, the pharmacist has to contact the patient and the physician to change one of the medications. CVS also has a CDSS for accuracy at filling. You must scan a barcode on the bottle and the label to make sure you are filling the right medication. I would like for CDSS to make our pharmacists’ lives easier, however, CDSS seems to make a pharmacists’ job harder. CDSS usually have many DUR rejects that can be annoying and unnecessary. I have witnessed my pharmacist skipping right through DURs every day because they are not serious DURs, but they still require the pharmacist’s attention. I would also like the CDSS accuracy scan reject sound to be a little softer because the whole pharmacy can hear when you get an accuracy scan wrong. CDSS accuracy scan makes medication errors less however, because of the accuracy scan at filling. I would not like for CDSS to make a pharmacists’ job more difficult. If a pharmacist is spending 90% of his or her time calling physicians for DURs then patients are not going to get the medications that they need. If pharmacists have to take each DUR as serious because the system will not let the pharmacist move on until he or she addresses it, it will make the work flow slower and less prescriptions will be filled.
I feel that a CDSS will have a good impact on patients. Accuracy scans diminish medication errors at filling, and DURs can help diminish medication errors at verification. CDSS keeps patients from medications with serious interactions with their other medications. Also CDSS has a place for medication allergies, so at drop off our techs can check the prescription and make sure the patient is not allergic to the medication. This will help diminish ADRs due to allergic reactions. I feel that CDSS will have a good impact on a pharmacist’s relationship with other providers. Physicians do not know that some medications have serious interaction with each other. DURs from the CDSS will help diminish medication errors that could have fatal consequences to their patients. Also physicians may not know what medications their patients are allergic to or that some medications that are in different classes have the same allergic reaction profile. With CDSS at CVS, we can help diminish fatal allergic reactions to medications.
I feel that the limitations that exist with CDSS at CVS are that DURs are not only the ones that have serious consequences. The CDSS at CVS have DURs for medications even if the reaction is minimal. This can cause pharmacists to just click through that screen and they could possibly miss a fatal DUR by not paying attention. Also the allergies profile is not an essential part of drop off. If the tech at drop off is really busy, they could not notice that a patient is allergic to a medication a physician prescribed. I feel that the enablers that exist with CDSS at CVS are that the accuracy scan is efficient at making sure the techs filling the medications match the medication on the label.
I feel that I can make the CDSS at CVS better by making sure the DURs that come up are only serious drug interactions, so that the pharmacists will pay attention to the DUR screen. I also would make sure that allergies would be processed on each prescription, so that a patient’s drug allergies are not missed and a medication that a patient is allergic to is filled for them.
I work in a retail pharmacy and I have had some experience with e-Prescribing. From what I have seen, it seems to help with interpreting prescriptions where the doctors have legibility problems. This however does not completely eliminate the errors doctors can make. Doctors can still select the wrong medication from the drop down box for the patient and it causes the pharmacists more time by having to call and verify their mistakes. Overall there are benefits and downfalls of e-Prescribing to both pharmacists and prescribers.
E-prescribing would help pharmacists reduce prescription errors since doctors will have the prescriptions typed out instead of hand written. It will also reduce calls that pharmacists would have to make to verify any errors the doctors make. E-messaging also impact pharmacists by alerting them when a drug is not covered, if other coverage limitations have been exceeded, or prior authorization is required. E-refills impact patients and pharmacists by being convenient for patients and helping the pharmacy become more productive. I believe e-Prescribing could also negatively impact pharmacists since it would cost twenty to forty cents per prescription. It would also be a challenge for a pharmacist to know when the prescription arrived.
A patient may decide to go to a pharmacy if the pharmacy has e-Prescribing and their prescription would be sent to the pharmacy faster. The patient may also spread the word to others and bring more clientele to the pharmacy. E-prescribing would be more convenient and safer for patients. The confidentiality aspect is appealing to patients and knowing that the prescriptions are more accurate than written prescriptions. A negative impact that patients may experience is that they would expect that their medication is available when it may not be.
A relationship could be built between prescribers and pharmacists in that the prescriber may refer patients to the pharmacy telling the patients that the pharmacy is safer. E-prescribing is beneficial to a prescriber in that it satisfies patients and can save the prescriber some time. It can also help prescribers be more informed because they have the patient’s information in front of them while they are prescribing. E-prescribing will reduce the cost for prescribers, help manage risks, and increase revenues. These benefits to the prescriber could help in the relationship with a pharmacist by referring their patients to the pharmacy like mentioned before. An error made by the prescriber would be a negative impact on their relationship with pharmacists in that the pharmacists would have to take the time to call the prescriber to verify the error.
The cost to purchase the software is a limitation to both prescribers and pharmacists that could prevent implementation of e-Prescribing. Some negative aspects to the prescriber would be that it would take more time to create a prescription and they would have to adjust to changing from paper to touch screen. The enablers that exist to facilitate usage of e-Prescribing are prescribers, a pharmacy, Surescripts, and payers. Surescripts is the organization that provides the connectivity between where the prescription is originated and when it goes to the pharmacy. I believe e-Prescribing could be better if doctors were more aware of their careless errors in creating prescriptions and if the costs were reduced for both pharmacists and prescribers. It will probably take time before we start seeing a change in the cost.
Computerized prescriber order entry (CPOE) is a rapidly growing area in medicine today that impacts physicians, pharmacists, other healthcare workers, and patients. CPOE has become increasingly common in the hospital and community settings. CPOE is entry of medical orders into software that is then sent to the correct personnel. CPOE will impact how pharmacists work in several ways with the most obvious being easier reading of prescriptions. Everyone knows physicians’ hand-writing is atrocious. By using computer systems to fill out prescriptions, pharmacists will no longer have to make dangerous decisions as to what the physician is really ordering. Another change the pharmacist will see is reduced abuse potential. Because the physician electronically makes the prescription, it will be much more difficult for patients to change the prescription. For instance, the patient will not be able to change the quantity by just adding a digit or add a whole new medicine order by adding it to the bottom of the prescription. Another way CPOE will impact pharmacists is that it allows physicians to easily add more information to the prescription. Some of the information that can be included is the patient’s height, weight, address, allergies, and diagnoses. When a physician hand writes a prescription, this information is almost always unavailable to the pharmacist. Without this information, the pharmacist is unable to use the proper clinical skills to assess whether or not the prescription is appropriate or not. By adding this information, the physician’s liability will also be reduced because in the event of a medication error on the part of the physician, the pharmacist may be able to spot the mistake and prevent a potentially harmful event from occurring. Avoiding these potentially harmful events may help change the pharmacist from an order filler to a member of the healthcare team involved in medication decisions.
CPOE will impact patients in that fewer medication errors will occur because the pharmacist will receive a clear copy of what the physician ordered. Every year many patients are adversely affected when they receive the wrong drug or dose due to inability of the prescription to be properly read by the pharmacist. As previously mentioned, patients will also benefit because physicians may put more patient information onto the prescription which will allow pharmacists to better make clinical decisions as to the appropriateness of the medication. CPOE may also help change pharmacists relationships with patients in that patients may see that pharmacists need their health information to make clinical decisions. This process may teach patients that pharmacists are not pill pushers but rather medication managers.
One limitation to CPOE is that physicians must purchase the software required to make the prescription whether the final product is a printed prescription or an electronic prescription. Physicians typically do not like to purchase new software; however, recent CMS rules and ARRA will enable prescribers to better afford the technology. Another circumstance that will enable prescribers to want CPOE is the clinical decision support software (CDSS) that frequently is associated with CPOE. CDSS will allow prescribers to make better decisions for each patient. Physicians will see combination CPOE and CDSS products as another way to reduce their risk of choosing inappropriate medications. Another problem is that CPOE may make on more type of error possible. Prescribers may accidentally choose the wrong option from a drop down list or other software features. For example, the prescriber may mean to choose Amoxicillin 500mg but instead choose Amoxicillin 800 mg.
Overall, CPOE will continue to increase in usage and will improve patient care. However, vigilance with this technology is required by physicians and pharmacists to ensure proper usage of this technology to get the best outcomes possible.
ePrescribing is probably the most useful tool in retail pharmacy. As a current intern in a retail pharmacy, I find that eprescriptions make workflow fast and efficient. As a pharmacist I believe that eprescribing is convenient. For example, as a pharmacist, I believe that if a script came in that was missing information, it would be very easy to locate the physicians’ information and phone number because all information is on the eprescription. I would not like for physicians’ to become solely depended on eprescripting because of problems that occur with internet connections and networks. I believe that physicians should be able to adapt to both methods of prescribing and that if using eprescribing functions there should be a hard copy print off method in place. I would also be concerned with internet security, for example what are the protection mechanisms in place to guard against hackers to prevent the ‘stealing’ of prescriptions. I believe that most patients (at least the younger generation) will be positively impacted. I think that work generally flows faster and if there are questions the information is right there on the prescription. On the other hand many of the elderly patients may not be so open minded about online prescription (this could be due to lack of understanding or concerns about individual identity security).
It is my belief that many providers will be resistant to eprescribing initially. To be honest there is not much benefit unless physician is aware that he or she is not writing a complete script every time and the physician is tired of receiving phone calls from the pharmacy to verify the prescription or to change it. Of course the largest limit to eprescribing is cohesive software and user knowledge. There are I sure plenty of different eprescribing software on the market but it needs to be regulated by a common group and needs to be compatible with other types of software as well. Another limitation would be user training for both physicians and pharmacists. This could be costly and time consuming for both parties involved. There are some organizations (even at the national level) in place to oversee eprescribing. However, since the majority of the country is still in the beginning phase of installing eprescribing, I imagine in a few years that these organizations will be overwhelmed with compatibility problems unless they are preparing for it now.
I believe that the government is requiring eprescribing as part of the Medicare legislation and will give tax credit until 2015 and start penalizing after that. I think that is a great idea, but I think that it’s not enough. I think that in order to make it better the government should provide classes. These classes should not be mandatory but should be in place for providers, third parties, and patients. These classes could be on a variety of different topics, ranging from how to use eprescribing to the latest protection mechanisms in place to guard patient identify against hacker theft. Another consideration is the difference of state law. There will need to something in place in order to make eprescribing consistent across state lines.
I believe that E-prescribing is a good alternative to what we have right now with written prescriptions being handed into the pharmacy. Not only is it an innovational way to prescribe but it is going to be the only way to transmit medical prescriptions in the future. I have only worked in the hospital and all the orders we fill or that the pharmacists verify are already typed into the computer. Having them already typed into the computer allows the pharmacist complete understanding of what the doctor ordered; the medication, dose, dosage regimen and if possible a termination date. I feel that this is much safer to the patient because there does not seem to be as much confusion as to what the order is. During my brief time at Walgreens we had to type up prescriptions into the computer system and sometimes it took a lot of time due to the fact that we had to call and verify what the prescription even said. Switching to e-Rx would not only save time but also minimize the amount of errors that could potentially occur during transcribing.
I would like to see e-Rx to be fully incorporated into all pharmacies because I feel that the impact on not only the patient but also the pharmacy itself would be great.
For the patient, knowing that their prescription was getting to the pharmacy quicker would save them time waiting around for it to be filled, they would have the security in knowing that they would be getting exactly what the doctor ordered since he/she did it through a computer system and not through someone trying to read his writing and also it is more convenient to the patient because they don’t have to make two trips to the pharmacy; one to drop the prescription off and another to pick it up. These are great advantages to patients as we live in a world where time is money and saving both the patient and pharmacist time is crucial.
For the pharmacy it would be of great benefit to them as it would save time from having to type up prescriptions into the computer system, by not typing prescriptions into the system they are reducing the amount of errors that could occur from multiple people having contact with the prescription; from this time saved they could fill more prescriptions, spend more time on counseling or even implement a small MTMS within the pharmacy.
Of course there are problems with any new type of technology, for example the doctor picking the wrong medication on the drop down menu or picking the wrong dosage for that individual patient. Also on the pharmacists end of things they may not even receive the prescription because there are glitches in how technology works. Lastly technology cannot always be dependable due to the fact that it is not human and can miss what humans would normally pick up on. These are problems that would occur with any new implementation of a new program but over time, hopefully, will get fixed.
I believe that the relationship we have with providers would be good because their patients would be more drawn to safer precautions that their doctor is taking to make sure they get the right medication. With the providers having more patients and getting those patients referred to our pharmacy I believe the relationship can only be a positive one.
E-Prescribing is an amazing and great aspect that is being implemented into pharmacies. At first, while I was working in my pharmacy, I did not realize that we actually used e-Prescribing. It was not until I had been working for a little over a month that my pharmacist mentioned it. E-Prescribing is revolutionizing pharmacy and how we, as pharmacists will do business in the future. I have observed that e-Prescribing is extremely beneficial in the pharmacy. Not only does it save time, but, as long as it is inputted correctly, it can decrease the amount of errors. When this is used, there is no need to have to interpret what the physician wrote. I would not like for e-Prescribing to completely eliminate the interaction between pharmacists and physicians. I feel like the physical and vocal interactions between pharmacists and physicians is imperative for continued collaboration to increase patient care. I would want e-Prescribing to help decrease the amount of time that pharmacist has to spend on the phone checking voicemails from physician offices. In this way the pharmacist could interact with patients even more. I would also want this to impact the work that the pharmacist does by increasing the speed at which a pharmacist can receive prescriptions. The impact on the patients should be a good one. The patients will now be able to receive more personal care from the pharmacist since the pharmacist will have more time to interact and talk with the patient. The patient will also have less to worry about since they do not have to carry around a written prescription as often. There can be some problems that can arise with the use of e-Prescribing. These problems can be as simple as the system getting backed up. If this happens, then the patients may become irritated which can be unfortunate. However, the benefits that are accomplished from the use of e-Prescribing greatly outweigh the problems that exist with it at the moment. The impact of e-Prescribing could have a detrimental effect on the relationship with physicians if this leads to less interactions where you can discuss the patients and the outcomes that both of you want your patient to achieve. One major barrier to e-Prescribing that could limit its maximal use, is that many pharmacists that have been around longer may be less likely to want to adopt the new technology. Also, it can be hard to figure out if you are not experienced with computers and this could limit the use of e-Prescribing to a great extent. The thing that would help enable people to want to use this technology is the fact that it increases productivity, speed, and accuracy of the work that pharmacist would do. This would excite many pharmacist and lead to the acceptance and implementation of it. The way that I would make this technology better would be by making it quicker, more user friendly, and free for any independent pharmacies. This would eliminate most of the barriers to its implementation and would help the health care system get even more connected electronically.
Health care IT news gives health care related information and this particular page talks about the importance of implementing CPOE in hospitals and talks about some of the primary obstacles that a hospital might come across while implementing this technology. Leah Binder- CEO of Washington states that major challenge that they experienced was having the physicians getting used to the new system. Physicians liked the way things were done earlier. With the new technology it took longer for the physicians to place orders but one-on-one training regarding the new medication order process helped them come across the hesitance of getting adapted to the new system and they never wanted to go back to the old system.
Reorienting the other IT system was another concern, because once CPOE is implemented fresh into a hospital, new problems arise and for the system to work efficiently, providers need a reliable system in place o diagnose and correct the newly generated issues.
This site has serves moderate value upon the significance of COPE system implementation into any hospital network and reflects on some of the main concerns that the users (physicians) may have.
This website can be of great importance for sending e-prescriptions safely, fast, error free. It talks about all the various features that e-prescribing can provide that hold lot of value for physicians and pharmacies. It eliminates the use of illegible handwriting, faxing, and calling for prescriptions that counts for a number of errors in prescription filling. It briefly explains how e-prescribing can check for patient allergies, drug-drug interactions, dosage forms, and formulary compliance. Physicians can send orders using their web-browser or mobile device. It utilizes quick, one clink access to frequently prescribed medications in common dosage forms.
This site lists the advantage of using e-prescribing over the handwritten prescriptions to eliminate a number of different types of prescription errors but it doesn’t explain anything on the usage and the reviews of physicians and pharmacies who are using such applications on daily basis.
The website discusses various current health care issues that can be an important recourse of information for healthcare providers. This page talks about using software, Medmarx, designed by Quantros, Inc. to research errors that are associated with the CPOE. This program is an internet accessible database that is used to report and track the trends of adverse drug reaction and medication errors in U.S. hospitals. This program is a huge instinctive to learn and manage the use to CPOE to improve medication safely and evaluate the errors. CPOE has greatly reduced the errors in order entry and filling but this program can refine the use and improve the system to reach to a higher level of assurance.
I believe that this page is of great importance because even CPOE minimizes errors but it does not eliminate them. Advanced research can further quantify errors and improve medication safety.
Patient Safety (CPOE Leads to Drop in Patient Mortality, California Hospital Finds)
This website holds important health related topics. Patient safety page talks about the decrease in number of death in California Lucile Packard Children’s Hospital since they implemented CPOE into their system. This particular hospital had 20% decline in mortality rate, which are 36 fewer deaths in 1.5 year period. It talks about the significance of this system and suggests that other hospitals must participate in research to find their mortality rates and compare with the past experiences and see if implementing CPOE increase or decrease the number of death that occur in hospital per year.
This page comments that some hospitals have had increase in mortality rate but it does not describe in detail.
E-Prescribing May Significantly Improve Ambulatory Medication Safety
This wed page shows the results of a research comparing e-prescribing with the standard handwritten prescribing. The research was conducted to evaluate rate and types of prescribing errors in ambulatory care community practices in the Hudson Valley region of New York. Dosing recommendations, drug-allergy, drug-drug interactions, and duplicate treatments were some of the things that were considered. It was found that two in five handwritten prescriptions in community practices has errors. Error rates decreased 7-fold for physicians who used e-prescribing tools to write prescriptions. Most of the errors were not serious harm to patients but they could results in call back from pharmacies, that leads to loss of time for physicians, pharmacists, and pharmacy. In e-prescribing there errors were dramatically reduced, which results into better usage of time. These errors may have been much higher than reported.
This page hold great value for prescribers in opting for using a proper means of prescribing manner, it can help them make wise decision regarding their practice and a way to eliminate errors in medication use process to improve quality.
This website contains an article from The Journal of the American Medical Informatics Association. This website explains the use of CPOE systems and why they are advantageous. The website finishes by giving this organization’s views and recommendations for health care providers, policy makers, and so on. This website is useful for health care providers to use if they want to know why a CPOE system might be beneficial to their practice.
This website is run by a newsletter called patient safety and quality health care. This article is about the use of CPOE machines. This article takes somewhat of a view that the reader already knows what a CPOE system does. The website then talks about the proper ways to implement a CPOE system into the reader’s work place. This website is of value to hospitals wanting to implement the system. The website talks about preparing the staff for the system, incorporating the system into the current way of doing things, and getting the most benefit out of the system for the reader’s hospital.
This website is about errors that can be caused by the CPOE systems. It is the website of ASHP, which is a national organization of pharmacists in hospitals and other health systems. The website is useful to anyone who uses CPOE systems because they can find out where some errors could occur. One example on the website is that the CPOE system data sometimes is not integrated with the hospital data correctly. This could lead to dosage problems among others.
This website highlights the improvements in patient outcomes that have already been seen with CPOE and clinical decision support systems. This website is a the American journal of managed care’s website. This website is useful because highlights real life situations in which theses systems improved safety in a hospital setting.
Site purpose: The purpose of this site is to supply suggestions and information to be considered before one purchases a computerized prescriber order entry. This site is to serve as a guide for those interested in purchasing a computerized prescriber order entry system. The site makes it clear to the reader that it does not include everything but that the site was created to serve as a useful tool. The site provides bulleted points on what a perspective buyer needs to consider and what needs to be done in the beginning. After offering helpful information on “how to get started,” the site also supplies questions that future buyers need to reflect on when trying to decide which computerized prescriber order entry system to purchase.
Explanation of value: Overall this site seems to be a valuable resource to an individual or company that is interested in buying a CPOE system because it gives a starting point. This is helpful because it often be hard to decide what needs to be done first when dealing in an area in which there is no prior experience. Also, it gives questions that need to be considered and this can be accommodating due to allowing the prospective buyer different things to mull over that they might not have even thought to think about.
Site purpose: The basis for this site is presentation of recommendations that fall in one of four categories all of which are dealing with computerized prescriber order entry. These recommendations were put together by the POET (physician order entry team). The areas that these suggestions cover are as follows: ideas for executing a successful computerized prescriber order entry system, areas of CPOE systems that are still under debate, principles that others have found key in making their CPOE systems a success, and consequences that can occur unintentional dealing with a CPOE system.
Explanation of value: This site is of value because it offers suggestions which can be of benefit to those implementing or those who plan on soon implementing a computerized prescriber order entry system. Each recommendation that is made can be further looked into by the viewer by just a click of the mouse. All of the information offered on the site can also be viewed from a PDF file. Also, there is a person to contact with any questions, comments, or concerns. The site is a valuable resource not only because of the information it has to offer dealing with CPOE, but also because of the user friendliness of the site and the direct contact person who can answer other questions that may arise.
Site purpose: The purpose of this site is to recommend the use of computerized prescriber order entry. This site is based on facts and data being presented to the viewer in hopes of the importance of CPOE usage being seen. This site shows not only the benefit to the patient but also the advantages seen by payers and providers. The voluntary group over this website wants to express the positive outcomes that have been experienced with CPOE usage and because of this they advocate strongly the adaption of CPOE systems into places that currently function without them. A fact sheet is also available to be viewed on this website and it goes into more detail for the viewers.
Explanation of value: Overall, this site is valuable because it stresses the importance of CPOE usage. Viewers seeing this information may be persuaded to further consider implementing a CPOE program. This in return could save patient lives and also provide benefits for payers and providers.
Site purpose: The purpose of this site is to provide information about the computerized prescriber order entry service offered by Cerner. This site is for Cerner to provide information to potential buyers of a CPOE system. Cerner uses this site to show what their program includes and also the benefits that will be seen with implementation of their program.
Explanation of value: This site is beneficial because prospective buyers need to be able to compare the different services offered by different companies. Without sites like this one, buyers may not be able to properly decide on the right CPOE system for their location because of lack of information. The site also has a place that Cerner can be contacted if a viewer has any questions or would like any other information.
Site purpose: The purpose of this site is to promote the use of the computerized prescriber order entry service available through CureMD by emphasizing the features and benefits. Through this site potential buyers are able to read about what CureCPOE entails. The site provides detailed information on each amenity offered with CureCPOE. Along with detailed descriptions, the site provides a list of benefits that can be experienced through using CureCPOE.
Explanation of value: The value of this site is for a potential buyer of a CPOE system to be able to evaluate the type of system offered by CureMD. Another aspect that makes this site valuable is that it allows viewers to preview different portions of the CureCPOE system. This lets viewers gauge how user friendly the system would be for their specific location. Lastly this site is valuable to potential buyers of a CPOE program because it provides a DEMO version that can be viewed, success stories of current users of CureCPOE, a method of speaking an expert, and a brochure of CureCPOE that can be viewed through a PDF file.
It is a website that provides a compilation of articles and resources highlight various issues in health care that explicitly relate to patient safety. The organization has print and digital versions of its publications. They focus on a specific topic in regards to patient safety in the healthcare setting. It’s interesting to see how patient safety is so tightly tied to advancing healthcare technology. Overall, it’s a resource geared toward the general topic of patient safety. However, they have dealt with the issues of CPOE and other technology issues, which can be easily searched for, using their helpful search function. Although, this is not a site specifically, tailored towards the issues of technology and patient management, it does provide a wealth of information on patient safety, which is a key concern when developing health care technologies such as CPOE.
As the name implies: this is an organization which was built upon the hallmark of patient safety. A novel concept, ensuring that the name of an organization also directly corresponds to the purpose! Thus, with such straight forth naming and purpose, the site was equally pleasant to navigate. The sole endeavor of this non-profit organization is to make sure that the healthcare system works as a cohesive unit that strives to achieve safety for patients everywhere. For instance, this organization provides literature alerts on various topics such as: COPE. They help spearhead patient safety initiatives, as well as provide education and resource materials/literature on topics that surround the important issue of patient safety. This site would be a great resource for someone who is looking into healthcare technology in regards to patient safety.
CPOE.org was from by a research team at Oregon State University. The group is funded by a grant provided by the National Library of Medicine. Specifically they study the factors that contribute to the successful implementation of CPOE. This is a very thorough site that specifically focuses on CPOE…rather than multiple aspects of patient safety. The site is formatted to be easy to use, as I had no trouble searching for information. I think this should be the first site one looks thru when researching CPOE. That’s not to negate the importance of patient safety, but if one is short on time, CPOE.org can provide a plethora of information on the topic.
Certification Commission for Health Information Technology
I’m not going to lie here, the name of the website makes me giggle. The word “certification” in the title of the organization led me to think that it was some governing or official body regarding the topic of information technology in the healthcare setting. I’m not saying that their certification isn’t noteworthy, but I’d expect a “certification commission” to be a government body, not a non-profit organization. This volunteer organization strives to accelerate the assimilation of information technology in the healthcare setting, but cares to do so in a responsible manner. In the recent year, they seem to certify mostly EHR’s and e-prescribing programs. It’s a resource that can be used by healthcare environments that would like to read up on various programs, rather than just relying on data from the programming company.
The agency for Healthcare Research and Quality is part of the U.S. department of Health and Human Services. Here they explain the importance of CPOE, in layman’s terms. Basically, physicians are notorious for illegible handwriting, and pharmacists do not have the ability to decipher the penmanship of the 500 physicians in their community. Since this is a government organization they are quick to highlight how CPOE will reduce the cost of healthcare! Always a plus, and a great plug for the thrifty conscious individual. In all seriousness, this page will give a good summary of the issues surrounding CPOE. Additionally, it provides quick and helpful summaries on some articles on the topic. It’s a good website to bookmark if you have a keen interest on the topic of CPOE!
Site Purpose: The Agency for Healthcare and Quality (AHCQ) is a branch of the US Department of Health and Human Services. The AHCQ is committed to helping the nation improve our healthcare system. To do this, the agency conducts and supports a wide range of health services research. This website provides many links for consumers/patients, we well as links to data and surveys, and their own research data. It is updated regularly to provide users with up-to-date information.
Value: This website would be of value to someone interested in the knowing the fundamentals of the CPOE process. It provides the basic definition of CPOE, the training, staffing, and workflow needed, as well as other basic information someone might want to know before implementing CPOE.
Site Purpose: This is a website a PDF file of a 10 page article published in the Journal of Healthcare Information Management. The goal of the article is to highlight those parts of the medication use process in which CPOE improves and those parts where it does not. Overall, the website article intends to show that while CPOE is expensive, it will reduce medication errors. However, the article concludes by also emphasizing that CPOE will not solve all the medication error problems.
Value: This would be of interest to those seeking the factors that make CPOE a success and the factors that cause issues for its implementation. A person looking into CPOE would want to know these advantages and disadvantages prior to implementation such a system.
Site Purpose: This website is promotes the TheraDoc company which has pioneered the development of safety surveillance and clinical decision support. Its main purpose is to provide CDSS and educational information for various HCPs such as pharmacist and physicians. It provides a link to a Newsroom which provides users with the latest news regarding new software, updates, products, etc . On the website, there is also a link to show who they are partnered with and links to their websites. In addition, research links are provided that relevant to the use of computerized systems that enhance decision-making and improve quality and safety of care.
Value: This website would be useful to someone who has done their research on clinical support software and is ready to make a purchase. This website allows for users to purchase and download the software straight to their computer as well as provides additional information regarding CDSS.
Site Purpose: The PKC website is another website that can be used for the purchase of decision-support tools. The PKC Corporation is dedicated to transforming the way healthcare is delivered, believing that software can help healthcare consumers providers make better decisions. This company provides products for not only healthcare providers, but also for employers and healthcare consumers that want to take charge of their own healthcare. The website provides links to press releases mentioning the PKC Corporation, success stories, a reference library containing demonstration videos, articles, and the latest software manuals.
Value: Again, this website would be useful to someone wanting to review and purchase clinical decision software. There are different options for healthcare consumers, employers, and healthcare providers to purchase.
Site purpose: This website provides a link a 29 page PDF file published by the Federal Register on November 7, 2005. This document was published to put into law those changes pertaining to electronic prescriptions. The Modernization Act of 2003 established standards for an electronic prescribing program to be used by all physicians and pharmacists that serve Medicare beneficiaries with Part D benefits. This file serves the purpose to outline those laws of standards.
Value: This file would be useful to someone wanting to know the laws regarding e-prescribing within the scope of Medicare and Medicaid. The Modernization Act of 2003 provided changes to the law regarding e-prescribing. Those laws can be found in this document.
This website offers the definition, research, recommendations, and implementation of computerized prescription order entry (CPOE). These parameters are written in a simple to read, list format for the readers. The information does not contain medical jargon so that the “average joe” can easily learn more about CPOE. One thing I did notice; however, is that some of the information has not been updated since 2007 so some ideas may now be obsolete since technology is always changing. At the same time, other parts of the website have been updated as recently as 2009 so I feel that the website is legit (keep in mind that I am not an expert though). This website is valuable to those people who generally want to learn more information about CPOE.
There are all kinds of websites that offer information on electronic prescribing, but it seems like most of the websites are targeted at marketing the software. I felt that knowing a little about the e-prescribing incentive program would be useful knowledge for pharmacy students. This website offered an up to date overview and background information about the policies. It also provides pdf files of frequently asked questions about the program. The American Medical Association is the group that is providing this information so I feel that it is a credible, knowledgeable source. This website is useful for people wanting to learn more about electronic prescribing provided by an organization dedicated to medical professionals.
The information on this website was prepared by authors for the U.S. Department of Health and Human Services. The authors have provided a multitude of information about clinical decision support services (CDSS). The twenty-six page pdf file seems to answer all kinds of questions. It provides information about: the definition, scenarios, types of technology, recommendations, target users, effectiveness/impact, implementation/integration, evaluations and incentives for the use of CDSS. It seems that since this information was compiled for the U.S. DHHS that it has been well-researched and stated. I think that anyone who will take the time to read the entire document will come away with a better understanding of CDSS as a whole.
This website offers information about the nation’s E-prescription network, surescripts. There are links for all types of providers (physicians, pharmacists, hospitals) to click on to receive more information relating to his or her healthcare role and how it relates to E-prescribing. On the pharmacist link the website tells about the benefits of E-prescribing, provides peer reviews, has a frequently asked questions section, gives information about the software, and tells how pharmacies can get started with the program. For a pharmacist who is looking into E-prescribing this would be a good website to learn more details. However, he or she should keep in mind that the website is there to try to market the idea and may be biased.
Upon researching different websites (i.e. surescripts) for information about e-prescribing, I ran across payer information being included in the data. I had not previously thought about payers having much to do with e-prescribing ; therefore, I deicided that it would be a good idea to look up payers’ roles in the process. Since I had the question, I figured that other students might as well. The website as a whole gives lots of information about e-prescribing which is good for anyone wanting to know more about it. Surprisingly, they have devoted a section completely to payers’ roles in e-prescribing. The section gives information and tips on how payers can improve medication management. This would be good information to have in case someone is interested in working for an insurance company in the future or even for those people who are generally interested in the topic.
This website offers an extensive database on numerous healthcare topics regarding research and quality. The purpose of this web page is to offer information on CPOE with CDSS systems, mainly focusing on their ability to reduce adverse drug events but also gives a general overview on CPOE with CDSSs (including effectiveness, potential for harm, costs and implementation, etc). It offers results from a number of studies, four conducted on CPOE in conjunction with CDSS, and four studies on isolated CDSSs. The studies are evaluated in terms of adverse drug events and medication errors and the site clearly defines both of those parameters as well as offers examples.
The website this page comes from is a fairly large one, and without a direct link, it may be difficult for a person to discover this particular page. There is, however, a search engine that may help narrow down page selections. There was also a “Browse” tab for anybody curious in exploring the site and a “What’s new” section to offer updates on the most recent healthcare news. Another option I noticed was a FAQ page that not only offered answers to more commonly asked questions, but also allowed for the posting of new questions (this would be accessible for registered users of the site).
The page itself could be valuable for any person mildly familiar with CPOE and CDSSs and looking to find information on whether or not they are beneficial, and perhaps wanting some concrete evidence based off of studies and analyzed by a reputable source (.gov site under the DHHS).
The purpose of this website is “to offer healthcare IT executives timely, pertinent news every month”- it basically offers the latest information on new technologies, IT strategies and statistics, regulatory issues, etc. This specific page offers an article about CPOE related errors and a project centered on investigating these errors. The article explains the purpose of the project, and the reasoning for taking on such a large undertaking.
The page is useful for providing an interesting outlook on CPOE- instead of just writing about either advantages or disadvantages, it lets readers know that the system may have some flaws and research is being done to evaluate these flaws and hopefully improve the system. The information on the website is up to date, fairly easy to follow, and could be of value to anyone in the healthcare field using or thinking about using CPOE. This site is fairly easy to navigate and offers a search engine, a way to subscribe to the articles, and a Twitter page users can follow and post on.
This website is a blog dedicated to e-prescribing successes, failures, and updates; website authors can post a particular topic and article, or write in their own words about an issue and readers can leave comments if they chose to. Some topics on the blog include “Charting the next steps for e-prescribing policy” and “e-prescribe controlled substances in 2010?”.
The site is useful to anybody that uses e-prescribing or interested in learning more about it. It offers monthly posts and not only can you see the author’s opinion, but, because it is a blog, you can see other viewpoints as well as offer your own. There are also useful links to previous topics, popular stories, and categories to narrow your search.
The purpose of the AMA website is to help doctors improve patient care by providing a nationwide network for physicians to work on professional and public health issues with other physicians. It offers a variety of resources, categorized under “Physicians”, “Residents”, “Med Students”, and “Patients” to provide ease of use. The page itself is centered on offering an overview of e-prescribing and answers questions such as “What is it?” and “How does it work?”. It has numerous links for users interested in any facet of e-prescribing and offers links to other pages on the site for further information. The page includes a fairly easy to understand description on e-prescribing and all that it entails and the website is simple to navigate.
This page is useful for anybody looking to find an e-prescribing system (it also has a section for that), deciding whether or not to have one, or just looking to gain more knowledge on e-prescribing. There is a useful calculator users can use to calculate how much e-prescribing can benefit their practice in terms of time saved and Medicare incentive payments. There are also video testimonials, a FAQ page, a glossary, and a quiz you can take to help you find out which system is best for your practice.
This website is designed to be a “one-stop shop” for those is the healthcare field and interested in following developments in healthcare technology. It allows for people to keep up with advancements in the technological sector of the medical field, and promotes the use and implementation of these new technologies. The page offers a definition of CDSS, explains the functions of CDSS, and offers an interesting timeline/glossary of previous tools that have been used in the past just so it becomes apparent how far technology has come.
The page also has several links to AI systems in clinical practice, benefits, drawbacks, success factors, and evaluations related to CDSS. Because the website is dedicated to all healthcare technology, users can find links to other topics such as CPOE, EMR/EHR, and e-prescribing. Open Clinical is a non-profit site under the supervision of an international technical advisory board; much of its information appears likely to be applicable in several countries, not just the UK (it obtains funding from Cancer Research UK). The website seems reputable and has a search engine to narrow down categories. This website could be of use to any healthcare professional using any of the above listed systems, as well as many others, and looking for a way to keep up with all the new technological developments.
This website is created by a group of researchers from Oregon, named the physicians order entry team or POET, who has been studying the effects of implementing computerized physician order entry (CPOE). These effects include successes as well as negative consequences due to CPOE in various healthcare settings. The purpose of their site is to provide readers with information about their CPOE research along with their recommendations for implementing it in a healthcare practice.
This site is valuable because it gives a detailed definition of what CPOE is and its potential benefit especially in conjunction with clinical decision support systems (CDSS). It also provides links to the research they have conducted and the successes and failures associated with this research. Finally, the website provides readers with considerations for those interested in implementing CPOE in their practice sites. This includes things to consider such as the proper environment, leadership and administrative needs, workflow issues, etc.
The purpose of this website is to educate healthcare providers, managers and other professionals about CDSS. They hope to be a “one stop shop” in order to deliver information to individuals and allow them to keep up with advancements in this software and future technology. Also, they want to promote the use of CDSS in various healthcare settings.
Although the website is based out of the UK, it seems like much of their information is still generalized and relevant to understanding CDSS in the U.S. This site provides background information in regards to clinical decision support as well as research information to describe what developments have occurred and other important issues. Also, under their “Clinical tab” you can learn more about initial CDSS used in hospitals such as HELP and APACHE. Open Clinical has another tab titled “Commercial” where individuals can learn more information about suppliers of clinical knowledge management products. The information is organized in a table format and separated based upon the specific country that the retailer is located in. It is easy to read and includes summaries about each supplier’s product, where specifically (i.e. city) the supplier is located, and a link to their website.
The purpose of the HIMSS website is to educate and provide useful information for its members, consumers and anyone else who may be interested. In doing this, they collect information from various sources in order to provide a comprehensive understanding about CDS Also, they hope their readers may take the information and consider becoming active in improving the system and making strategic decisions.
First of all, the site defines CDS and provides readers a general overview of what it entails. There is a fact sheet where readers can discover the goals of CDS, how it can impact patient outcomes, and what to do next. It provides links to information regarding successful implementation of CDS programs and guidance about what is considered “meaningful use” so that providers can receive funding under ARRA. The site has a “wiki” as well, that allows readers to stay updated on current CDS news and provide feedback about these issues. By clicking on one of the tabs (titled CDS Guidebook Series), users can purchase step by step guides in improving patient outcomes by using CDS. The website provides multiple resources about patient safety, outcomes, and step by step guides to implement CDS in healthcare settings.
The purpose of the Massachusetts Hospital CPOE Initiative is to attempt to implement CPOE in all acute care settings in the state over the next four years. By doing this, they hope to improve patient outcomes, improve quality of care, and lower overall healthcare costs associated with preventable errors.
This project began by using an initial readiness assessment to determine which hospitals were prepared to implement CPOE in their healthcare setting. Throughout this, they determined that thirteen of the hospitals were “most ready” to put into practice CPOE and began to gather feedback from these organizations to develop things such as benefits (cost and quality of care), funding, etc. associated with implementing CPOE. All of this information is provided on their website for users to read. One of the most valuable aspects of this organization’s website is that they created CPOE University. This is an educational program for physicians and other clinical healthcare providers consisting of full day courses and seminars to educate them about CPOE implementation. The course dates and registration information are provided on the website. Also, according to the CPOE Initiative, the use of CPOE in Massachusetts’ hospitals will be required by 2012 to ensure state licensing; therefore, it is important for physicians, especially those in Massachusetts, to become educated about CPOE use and implementation.
The purpose of this group is to encourage changes in healthcare that include improving patient safety, affordability and quality of care. In order to achieve these goals, the Leapfrog Group supports informed decisions about healthcare made by consumers and payers (i.e. insurance companies) as well as promotes an increase in care by offering incentives and rewards.
One of the most valuable tools this group provides is an evaluation survey that various hospitals can utilize to assess the effectiveness and adequacy of their CPOE implementation. Currently, this assessment is free and accessible to the public; however, the Leapfrog Group is considering enhancing the evaluation and charging a fee to use it. Also, the website identifies potential benefits of applying CPOE such as decreasing hospital stay, repeated tests, and other costs associated with treatment errors. In their fact sheet, the Leapfrog Group provides readers information about the prevalence of medication errors, as well as the ability of CPOE to reduce these errors. Their information is helpful because it provides percentages and dollar amounts so that users have a better understanding about potential cost savings and benefits. Finally, they define their standard for CPOE programs and explain how their evaluation tool is used to assess these standards.
Open Clinical: Knowledge Management for Medical Care
The Open Clinical Website is for healthcare professionals who are interested in advanced knowledge medical technologies. They want to unite professionals who believe in the value of knowledge management. These individuals will also want to contribute to the formation of open technical standards for medication applications. Decision support and clinical workflow will be promoted for patient care. They will also spread tools and methods for building healthcare knowledge applications that conform to the highest standards of safety, quality, and ethics.
This is a good site because it is a not-for-profit organization of international leading research and teaching organizations. The website is easy to navigate because it is divided into five zones. The first is a general overview of clinical knowledge management technologies and applications. The second involves current research, while the third demonstrates with videos the use of clinical knowledge management applications. The fourth zone has information about commercial suppliers, and the fifth zone is about public e-health applications.
There is also a recent books section, and if you register there are additional benefits. You can get updates about new research that might interest you. A listing of events and information about international organizations is also given.
The Oregon Health & Science University Physician Order Entry Team
This site presents the results of research by the Physician Order Entry Team of the Oregon Health & Science University. The team studies success factors for implementing CPOE and also researches the results of implementing CPOE. There are also links provided that present more information about CPOE. A listing of conferences is also shown.
I found this site useful because it gives extensive information about implementing CPOE. There is discussion of ten factors that you should consider when setting up CPOE. The team also summarizes controversial issues involved with CPOE. These are important factors to consider, such as should you include decision support when you implement CPOE. They also discuss principles like financial concerns, integration of multiple systems, personnel training, and technical support.
I like the format of the website. The information that they present is given in outline form, and it is all pertinent to the topic of starting CPOE in an organization. The team also presents details of their research and the organizations that they investigated. This is a good site for someone who is a complete novice when it comes to the pros and cons of CPOE installation.
Patient Safety and Quality Healthcare: The Leapfrog Group’s CPOE Standard and Evaluation Tool
This site gives good information about how the quest to alleviate excessive Adverse Drug Events led to the development of CPOE. It is also stated that CPOE implemented together with appropriate clinical decision support could likely prevent a lot of the ADEs that do occur. Leapfrog collects data on hospital specific status reports on adopting CPOE. The Leapfrog Group is an organization of large employers that has come up with a series of CPOE Standards. The goal of their standards is to promote the usage of CPOE with clinical decision support.
I like this site because it focuses on the actual effectiveness of the CPOE systems at various hospitals. The site also lists extensive tables of their CPOE Evaluation Tool Procedure. You are shown how Leapfrog actually ranks each hospital’s CPOE System. Feedback in the form of scores for different categories of CPOE attributes are also sent to hospitals so they can have guidance for improving their protocols.
The site also provides information on the background of various experts on CPOE implementation. There is also an extensive listing of references. Useful links for further information on evaluating the efficacy of CPOE systems are also provided.
HIMSS: Transforming healthcare through IT.
This site provides a lot of germane information about Clinical Decision Support. There is information presented on how to receive stimulus funding under ARRA through the implementation of successful CDS. Criteria are also presented for making a meaningful EHR. A useful article on using CDS with the high risk elderly is also presented. You are also shown how to maintain a listing of problems that might occur with certain disease states through the use of CDS. There is also a Clinical Decision Support Guidebook Series that can be bought. It provides a step-by-step approach for implementing a CDS system.
I like the section on Patient Safety and Quality Outcomes. There is a section on committees, task forces, and work groups in the field. You can also learn about how health information technology is impacting the medical industry through Clinical Decision Support and e-prescribing. The archived position statements give further information about HIMSS. Material is also presented about networking CDS with medical device systems. An additional perk is the “news” section which discusses conferences and success stories in CDS.
EMR Consultant: What is E-prescribing and What are the Benefits?
EMR Consultant’s website gives a definition of e-prescribing, and then provides reasons to physicians for adopting e-prescribing. Some of the reasons listed are avoiding the pitfalls of illegible handwriting, a warnings and alert system is provided, and the patient’s EMR can be viewed. There are also links to other websites provided. Perhaps the best feature is EMR Consultant has a menu that can lead to pages with information about EMR, EHR, resources, and there is also a link for requesting more information.
The value of the website is that it is user-friendly and directed toward prescribers. There are user forums for physicians. Another plus is that a physician can enter information about their practice, and the practice profile will be matched with their database of EMR manufacturers to see which ones are most appropriate. It is also a free service.
There are also opportunities for EMR/EHR education. With this website, a physician can learn about what software would be best for their particular specialty. There would also be the opportunity to contact physicians of the same specialty in order to discuss how they like the software that they are currently using in their practices.
1. Agency for Healthcare Research and Quality http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html
AHRQ is a part of the U.S. Department of Health and Human Services. On the main page of AHRQ, there are numerous links including: News and Events, Clinical Information, consumers and patients, Health IT, etc. There is also a link for Publications; under this link you can look up Clinical Decision Support Systems. AHRQ’s publication on this topic is very informative and provides ample information on topics such as types of clinical decision support, the impact and effectiveness of CDS, design and implementation, and so on.
This site would be very beneficial for looking up the facts about CDSS as well as other Health IT topics and information. Those who visit the site can subscribe to updates in order to stay informed on what is going on with health information technology.
2. Open Clinical: knowledge management for medical care. http://www.openclinical.org/about.html
This site is geared toward healthcare providers. This site has links to various topics such as CPOE and e-prescribing. You can read the background on each topic. If you click on Decision Support Systems, the background contents include: definitions, functions, early decision support, myths affecting the development of CDSS, and CDSS in clinical practice.
This site is valuable in that it keeps its viewers up to date on developments in advanced knowledge management technologies such as CDSS. The site basically claims it is a “one stop shop” and this is fairly accurate with all the information that is accessible on the site.
3. CPOE.org http://www.cpoe.org/
This site is an extension of Oregon Health and Science University. CPOE.org provides results of research by the Physician Order Entry Team (POET) at Oregon Health and Science University. It renders the success and consequences of implementing CPOE. The site gives a definition of CPOE. There is also a link you can click to learn more about Oregon University’s research and the implementation of CPOE. On the home page, they list questions that their current research aims to answer. There is also a link for POET Recommendations, where you can get detailed descriptions of specific items as well as opinions of POET.
This site is helpful for healthcare providers in that it allows them to see the strengths and weaknesses of CPOE in systems that are currently implementing it.
4. Allscripts http://www.allscripts.com/products/electronic-prescribing/default.asp
Allscripts offers software, services and information for healthcare providers. The site has several links including Company-basically an “about us”, Solutions-you can learn about solutions-see demonstrations-hear client testimonials, Services-and support, News and Events, etc. Electronic Prescribing can be found under the solutions link. Allscripts ePrescribe is web-based software that does not require hardware or downloading. It is accessible by Internet on computers, cell phones, etc. You just purchase the software and have a client login. Toll free phone support is included, along with other benefits.
This site is valuable for those wanting to purchase web-based e-prescribing software. There are several different options that can be chosen from ePrescribe Basic to ePrescribe Deluxe depending on the preference/needs of the buyer.
This site is very broad, providing information on topics such as career services, drug information and continuing information for pharmacists, technicians and students. The home page has the slogan, “the leading web portal for pharmacy resources, news, education and careers.” Links include: News, Pharmacy Careers, Resources, Education, Business, and Marketplace. Under Marketplace, you can find information regarding e-prescribing. The site provides links to companies that have developed e-prescribing along with a short description of each companies system.
This site is valuable because it provides information on several categories. It is useful to those considering implementing e-prescribing because it lists all of the companies that offer e-prescribing systems.
This site is an agency under the Department of Heath and Human Services. Part of their mission is to support the use of health information technology to improve health care outcomes. They feel as though effective clinical decision support (CDS) will support their mission by improving health care quality. The site has several links to support their initiative. The links include: Demonstrations, White Papers, Guide, Podcast Series, Town Hall Meeting, Challenges and Barriers. One of the most valuable components of the website might be the podcasts which are part of their “Health 411” series. They have been awarded two $5 million contracts to develop, implement, and evaluate CDS. One of the contract’s approach and progress is detailed on another site, Clinical Decision Support Consortium (see next blog entry). AHRQ also held a town hall meeting in 2008 with the American Medical Informatics Association (AMIA) to discuss the current challenges of CDS and efforts to promote its adoption.
This site would be a valuable first stop in educating someone about CDS. It details how the government is researching the topic and looking to implement changes in health care to achieve improved outcomes.
This website is one of AHRQ $5 million contracts for CDS being carried out at Brigham and Women’s Hopsital and Harvard Medical School. The have partnered with Regenstrief Institute, Veterans Health Administration, University of Texas School of Health Information Science, Oregon Health Sciences University, Kaiser Permanente, NextGen, Siemens Medical Solutions, and GE Healthcare. They are seeking to “assess, define, demonstrate, and evaluate” the best practices of CDS. Their research should have been completed by March 5, 2010.
This site would be valuable for someone looking to see the progress of the latest research in this field. They are developing CDS for coronary artery disease, diabetes mellitus, and high blood pressure. Specific practice guideline goals are detailed on the site for each of these conditions.
This website’s main goal is to address the national effort to create an Electronic Health Record or EHR. They believe one of the components of EHR is the effective use of CDS. They have assembled a task force to address how CDS is to be incorporated into the EHR as directed under the American Recovery and Reinvestment Act.
The value of this site can be seen in its development of task force. This task force has been using a wiki for over a year to develop policies to address the issue. They have been developing a model of CDS that could be used for venous thromboembolism. Their site includes the latest links on CDS in the news.
This website from a UK nonprofit organization called Open Clinical. They are seeking for their site to be a “one stop shop” for anyone seeking information about CDS. They have a link to document they have developed called OpenClinical White Paper. A white paper is authoritative document that addresses and issue and how to solve it.
This site is valuable because it provides the software necessary so that individuals can develop and collaborate on CDS for specific conditions.
Elsevier is a vendor of CDS and their purpose is promote their software products. They have partnered with industry leaders in health IT to develop CDS tools and resources. They seek to provide support that will “improve outcomes, streamline workflow, and enhance care.”
This site would be valuable for a hospital looking to implement new CDS. On the right side of their page is a scrolling banner that includes the conferences they will be attending and presenting information. They also have interactive component to their site that allows you to view videos from physicians about the role of CDS in practice as well as demos for their software.
Healthcare IT News is a website dedicated to updating their readers on the latest developments, laws, regulations, and information regarding today’s healthcare technologies. They have over 54,000 subscribers in various levels and areas of healthcare and partner with HIMSS (a similar organization) in informing these subscribers. CPOE is obviously a big topic that can be researched on their site seeing as it can and does have a huge impact on the healthcare world.
The website’s value to its readers is providing a way to get up to date information regarding healthcare technology all from one trusted, easy to access and utilize site. It can inform and benefit anyone from the most inexperienced reader to the heads of IT in different hospitals and clinics. It offers a wide scope of topics, covering all that is pertinent and desired by readers.
CPOE.org is a site set up and run by the Oregon Science and Health University. It is an accumulation of their research and study of the topic out for all to see and explore. They wanted to investigate both the benefits and pros for having a CPOE program in place and then compare those to the problems that are faced CPOE programs once they are in place.
This website would be extremely valuable to a company or organization that was considering implementing a CPOE program and wanted to know what to expect and how to go about it successfully. The site provides links to other resources and is very thorough in its content.
e-Health and its CPOE Initiative is a website dedicated to digging deeper into the issue of CPOE and seeing how it saves money and lives. It is a site that was set up by Massachusetts Technology Collaborative and its goal is to help establish CPOE in all acute care hospitals in the state within four years. This is quite a lofty goal, but if the push to do so is as organized and thorough as this site, then there might be a chance.
The value of this site is similar to CPOE.org. Although this one is geared specifically toward the hospitals within Massachusetts, it could still be a good roadmap to help guide other care settings in establishing a CPOE program. They have a readiness assessment for hospitals/clinics to use in order to see where they are in the process of preparing for such a program and what they need to work on. They also hold conferences, provide outside resources, publish reports, and give updates on CPOE efforts and information.
The Leapfrog Group is an organization that was founded to find a way to provide more effective and safer healthcare. They wanted to have a venue to display safety practices used by hospitals and a way to reward those hospitals who implemented these programs and improved the safety of their patients. This program researches the safety practices of hospitals and then uses their website to describe these to other hospitals and practice settings. This is a way for healthcare providers to be aware of the developments and improvements being made and get in on the action. The Leapfrog Groups has determined that if these safety practices were put in motion in all hospitals, then we could “save over 57,000 lives, prevent as many as 3 million serious medication errors, and save $12.0 billion each year.” This website builds a strong case for CPOE and explains to its readers how CPOE can help in reaching this cost and life saving goal.
The website provides valuable resources and studies on various topics concerning healthcare safety practices. CPOE is one that it presents to its readers and explains the importance of establishing such a program. CPOE is one of the Group’s top 4 safety practices it is encouraging. Organization who go to this site for help and information can find the studies and resources very helpful in motivating and guiding them in their implementation process.
AHRQ is a part of The U.S. Department of Health and Human Services. It is committed to monitoring and progressing the quality of America’s healthcare system. It takes different topics concerning this subject and provides a place for people to read about the steps being taken and the progress being made in American hospital and care settings.
This website provided above is specifically useful for organizations looking to implement a CPOE program. AHRQ has done a thorough job of researching the pros and cons of the business and laid it out in a way that is easy to understand and access. The report even provides several studies of established CPOE- the study design, outcome, and the results. This is a good way for fellow hospitals and practices to get a feel for how the process goes.