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

Kenneth J. Terry, MA

Disclosures

November 01, 2012

In This Article

Medication Histories: the Good, the Bad and the Ugly

The use of community medication histories is also on the rise, according to Surescripts. Medication histories show what was prescribed for a patient by all providers that made claims tracked by Surescripts. The information comes from pharmacy benefit managers and health plans, but not all health plans participate; for example, Medicaid plans may not be included.

In 2011, the company says, 31% of patient visits to doctors generated an electronically delivered patient history -- a 72% increase over the previous year. But here, too, there are information gaps and other issues that discourage some physicians from using this service. According to the HSC survey,[4] medication histories are available on about 50% of patients, although the percentage varies by region.

Community medication histories don't include medications not covered by insurance, Steve Waldren points out. "A lot of people buy $4 generics at Wal-Mart, which are not going to show up in histories," he says. "The more reliable, accurate, and comprehensive the data are, the more likely doctors are to use them."

Robert Lamberts has found that medication histories are available for the majority of his patients, although they take several minutes to download. They're useful, he says, in detecting patients who are shopping for narcotics, and he also likes to see what specialists have prescribed for his patients.

James Morrow, who says he gets "fill histories" on about 75% of his patients, says they can be very beneficial."It's just a godsend when you have it for a patient in the office, especially a new patient, so you can have that information right there in hand," he says. Although the histories don't include drug samples or medications they pay cash for, that's okay with Morrow. "It's not 100%, but it's 100% better than what we had before," he says.

In conclusion, many of the challenges in electronic prescribing have been overcome, but others remain, including the difficulty of e-prescribing controlled substances and the shortcomings in the renewal process, drug formulary information, and community medication histories. By being proactive, physicians can sidestep some of the obstacles in e-prescribing. But to do so, they have to fully enlist their staff in changing workflow, and they must improve communication with pharmacies.

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