Be Warned: e-Prescribing's 6 Big Challenges for Doctors

Kenneth J. Terry, MA

Disclosures

November 01, 2012

In This Article

Renewals: Machines Don't Talk to One Another

Experienced e-prescribers can write new prescriptions electronically as fast as they can on paper. "E-prescribing has never slowed me down," says Morrow. And electronic renewals are often viewed as a time-saver, especially for patients with multiple medications, the JAMIA study notes.[1]

But renewals can also present problems if physician offices and pharmacies don't communicate well with each other or practices haven't established a workflow for renewals. That may be one reason why, according to Surescripts,[3] the number of electronic refills is only one fifth the number of new e-prescriptions, says Joy Grossman, a researcher at the Center for Studying Health System Change (HSC).

When a pharmacy requests a prescription renewal online, notes Grossman, there's nothing in Surescripts' system that alerts a physician that he or she has to respond to the pharmacy within a certain period of time. If the physician doesn't reply within a reasonable amount of time, the druggist might call or fax the office with the same request. That creates a second workflow that the office has to respond to manually.

According to Steve Waldren, many physicians complain about getting faxes from pharmacies in addition to the original electronic request. But sometimes doctors make things worse by sending a new prescription in response to a refill authorization request. That goes into the pharmacy system as a new prescription, which may be filled without satisfying the renewal query from the pharmacy, Joy Grossman says.

Robert Lamberts, MD, a medicine/pediatrics specialist in Evans, Georgia, says that he sometimes gets repeat requests for renewals when the first request comes in on the weekend. An even bigger problem is some pharmacies' practice of automatically requesting renewals when a patient has met their quota of refills. Because of those policies, he said, he often gets requests for medications that he has discontinued for particular patients.

Even when the renewal authorization request is legitimate, Lamberts can run into trouble with pharmacy systems on automatic pilot. "With some pharmacies, I'll say yes to the refill request, and then the next day they'll send the same thing, and the next day, they'll do it again. One pharmacy was so bad about it that we threatened to ask our patients to switch pharmacies. It was just a poorly run pharmacy. I guess their technicians weren't trained properly."

Decision Support: Alerts Gone Wild!

Most e-prescribing systems have some kind of clinical decision support; the most common type is drug interaction alerts. But many e-prescribers lack drug-allergy and drug-condition alerts, notes a study from the Center for Studying Health System Change.

Stephen Mascio says that his EHR fails to notify him when a medication he is about to prescribe conflicts with a patient's known allergy. His e-prescribing module does have decision support that will warn him if a drug is otherwise contraindicated or has side effects related to a patient's history. But a lot of these warnings are unimportant. If an alert is meaningless, he'll turn off that particular warning. "It's kind of a safety net there that I'm almost always ignoring at this point," he notes.

Nevertheless, both Mascio and Lamberts keep their alerts at the highest level, just to make sure they're not missing anything.

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