How e-Prescribing Can Land You in Court

Ronald B. Sterling, MBA


July 10, 2014

E-prescribing has become a regular part of many physicians' daily routines. Yet, there's a problem within the e-prescribing process that can cause serious issues with physicians and their patients, and even lead to claims of malpractice by patients.

According to Surescripts, which runs the nation's largest e-prescribing network, 58% of prescriptions were submitted electronically in 2013.[1] Electronic prescriptions are one of the meaningful use requirements, and as a result, e-prescribing will continue to grow. E-prescribing offers compelling benefits to providers, patients, and the healthcare industry. For example, New York State requires electronic prescriptions for all prescriptions by March 27, 2015.

However, there is a weak link in the e-prescribing infrastructure that delays the practical availability of new drugs and prevents physician access to the latest drug information, including changes to drug/drug interactions and drug allergies.

Drug compendia are the catalogs of drug information that sit behind e-prescribing. The drug compendia market is dominated by four vendors: First Data, Medi-Span, Elsevier, and Cerner Multum. The drug compendia include product information about drugs, dosage forms, and packaging, and even patient education materials.

In addition, the drug compendia include drug interaction information, clinical references, and warnings. The US Food and Drug Administration (FDA) maintains the National Drug Code (NDC), which is assigned to all drugs for people in the United States. The NDC code is the "product ID" used in e-prescribing.

The weak link is a delay of up to six months between approval of new drugs by the FDA, publication of new drug information, updates to drug/drug interactions and drug allergies, and the availability of the information to several electronic health records (EHRs) for their e-prescribing features.

Publishers of the drug compendia post the new information as soon as they receive it. But the drug compendia have to be delivered to the EHR vendors, and then the EHR vendors have to roll out the updates to their EHR customers. The EHR vendors may get their copies on a periodic basis (eg, monthly or quarterly). The rollout to EHR users out varies from updating a cloud service (typically within 30 days of the update) to downloading the update (or even mailing CD-ROMs) to a practice. In some cases, the practice has to apply the compendia update to their local server-based EHR.


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