E-Prescribing is growing rapidly, not just because the technology has improved, but because of the substantial benefits for patients and physicians. Every state in the U.S. now allows e-prescribing, including e-prescribing of controlled substances.
Over 70 percent of U.S. physicians have transmitted at least one prescription electronically, up from virtually zero physicians in 2007, according to the Office of the National Coordinator for Health Information Technology (ONC).
A major barrier to the growth of e-prescribing was removed when the Drug Enforcement Agency (DEA) implemented the Electronic Prescriptions for Controlled Substances (EPCS) interim final rule in 2010, giving practitioners the option to electronically transmit prescriptions for Schedule II-V controlled substances (10-11 percent of all prescriptions). The regulations also permit pharmacies to receive, dispense and archive electronic prescriptions. As a result, three states (New York, Maine, Minnesota) require virtually all drugs to be electronically prescribed.
The DEA’s policy shift has prompted physicians and patients to realize some key benefits of e-prescribing:
E-Prescribing eliminates handwriting errors/illegibility and gives both physician and pharmacist access to a patient’s prescription history to reduce the chance of the wrong drug being dispensed. According to the FDA, more than 95,000 prescription drug errors have occurred since 2000, mainly due to mistakes when reading a handwritten prescription and dispensing a similar-sounding, but different drug. Brintellix, for example, is a brand name drug used to treat depression, while Brillinta is a brand name drug that treats acute coronary syndrome. You wouldn’t want to confuse the two.
Many drugs are available in multiple strengths or forms. E-Prescribing removes the guesswork by prompting prescribers to completely fill out the dose, route, strength and frequency and providing drop-down lists of the most common sig information. It also includes dosage checking and duplicate therapy alerts. Most e-prescribing applications, including DrFirst’s Rcopia, use standard drug dictionaries, select parameters from lists and have required fields. This helps alleviate some of the risks associated with generating and filling prescriptions.
Clinicians can instantly view a patient’s medication history and won’t have to manually reconcile medication lists or commit clinical information to memory, such as drug-drug interactions. Tools such as Rcopia automatically pull 12-24 months of data from the most comprehensive medication history network available on the market, including pharmacy fill data, pharmacy benefit management (PBM) data, hosted payer and data from 55,000 physicians and 340 EMR/EHR partners using the Rcopia e-prescribing platform.
Electronic prescribing (eRx) is a basic foundation of meaningful use.
E-Prescribing gives physicians full visibility into all of a patient’s documented allergies and previously prescribed drugs and will trigger clinical alerts if a newly prescribed drug has any potential for negative reactions. Alerts in the system will notify the prescriber of allergies, interactions with other drugs the patient is taking, duplicate therapy, as well as pediatric, pregnancy and geriatric issues that would preclude a patient from taking a particular drug.
Once a physician gives a patient a handwritten prescription, there is no effective way to track whether the prescription was filled. Patients often forget to fill prescriptions, can’t afford the drug, lose the piece of paper, or start to feel better and decide not to take the medication. E-Prescribing allows physicians to verify whether patients fill prescriptions, and to counsel patients on medication management if they haven’t. Physicians also gain insight into the frequency with which patients are filling prescriptions for controlled substances, making it easier to spot potential drug abuse.
When patients receive paper-based prescriptions, the prescriptions sometimes are forgotten and never filled, or are lost by the patient and must be re-written or called into the pharmacy. E-Prescribing sends the prescription directly to the pharmacy.
E-Prescribing software such as EPCS Gold enables providers to seamlessly send electronic prescriptions for controlled substances to retail or mail-order pharmacies within the same workflow used to e-prescribe legend drugs. It makes your workflow more efficient, supports medication adherence, and increases convenience for patients.
With e-prescribing, physicians can track how many controlled substance prescriptions a patient has received, reducing the likelihood of over-prescribing or doctor shopping. It’s also easier for states to track this data across multiple pharmacies. In New York, for example, which requires e-prescribing of all drugs as of March 2016, most prescribers are required to consult the state’s prescription monitoring program (PMP) registry when writing prescriptions for Schedule II, III, and IV controlled substances.
One of the biggest administrative burdens to physicians and clinical office staff is the need to respond to prescription refill requests. E-Prescribing enables providers to review, authorize and transmit 20-30 refill authorizations in a matter of seconds. It’s also easier to execute an emergency refill for a patient who is traveling and runs out of medication.
Built-in safety features such as clinical alerts and duplicate therapy alerts reduce the risk of adverse drug reactions. Roughly 20 percent of all hospital readmissions can be traced to adverse drug reactions.
Chronic underuse of medications is the most common form of non-adherence, with patients using a lower dose than was prescribed or prematurely stopping therapy. Studies have shown that e-prescribing increases first-fill medication adherence by 10 percent. That’s a big step in the right direction, since about one in five prescriptions are never filled, and about half of all prescribed medications are not completed as prescribed.
E-Prescribing tools make it easier to choose formulary medications that will be covered by the patient’s drug benefit. Prescribing a drug the patient can afford makes it more likely that the patient will fill it and take it.