May 15, 2014
In this next installment of my blog series on increasing quality in the e-prescribing marketplace I want to focus on the question of provider behavior. As I mentioned in my introduction to this series, there is a tendency to place nearly all of the blame for e-prescribing quality issues squarely on the shoulders of providers, which I believe is largely counterproductive. At the same time, input errors from staff or providers are the primary cause for the overwhelming majority of quality issues in e-prescribing.
Put simply, physicians who are overwhelmed by heavy workloads and the incredible burden may fail to be precise and meticulous in writing prescriptions. One of the things I want to highlight in this series is that there are a number of ways in which the healthcare IT and e-prescribing industry can adjust e-prescribing software and in order to alter outcomes in e-prescribing and improve overall quality in the market place. In this blog, I want to tackle the “elephant in the room” by suggesting a series of strategies aimed at altering provider behavior.
First, however, I do want to call attention to a few things which providers need to do for themselves. The most transcendent of all of these changes needs to be a renewed focus on “self-policing.” Providers must slow down and pay increased attention to their work in e-prescribing if we are going to cut down on the number of needless errors. I understand that patient volumes are already large and are only growing larger as the population ages. In addition, more patients and more prescriptions mean that pharmacists are handling larger volumes of prescriptions. As such, there will be an increased risk of pharmacists not catching errors, leading to adverse reactions and an overall decrease in the quality of care provided by our healthcare system administers. There is no other way to see this picture.
In addition to paying more attention to the scripts that they are writing, it is also important for providers to avoid skipping important workflows in the interest of saving time. Prescriptions should not be renewed without first checking a patient’s current medication history. Alerts to medication reactions and patient allergies should not be quickly passed over by harried providers with a severe case of alert fatigue. The primary impetus for the development of HIT and its widespread standardization across the industry is the development of Clinical Decision Support (CDS), but when providers do not take the time to make adequate use of the features which vendors have built into their systems, CDS is not only ineffective, it is non-existent. To further support CDS, it would be helpful if vendors were more judicious in the number of alerts as a means of cutting down on alert fatigue, but providers also need to pay adequate attention to what could be highly impactful clinical information. There must be responsibility and accountability on both sides.
Finally, providers need to begin adapting to the new methods of script writing which e-prescribing requires. The old days of simply writing whatever one wants down on paper and letting the pharmacist ‘figure it out’ have long passed. Providers need to adapt in the interest of moving the healthcare industry forward. Having worked in the healthcare field for several decades, I am well aware that ‘adapt’ is not a word which providers typically look upon with enthusiasm. Like many professionals, physicians and other providers find process they like, which they then become accustomed to over the course of many years, and are therefore loath to change. But healthcare is going through a massive high-tech revolution, and change is inevitable. Failure to adapt to these changes will only make the healthcare industry lurch forward haphazardly, and providers are the most essential gear in the industry’s broader machine.
Having called attention to the changes which providers absolutely need to make in the way they approach e-prescribing, I now want to address what vendors can do to help support providers in improving e-prescribing quality. To me, these fall into two broad categories: training and feedback.
There is a very real need for more comprehensive training as part of the sale of healthcare IT products. Vendors need to focus on adapting their training programs in order to ensure that providers are being spoken to in “their” language, and that the reasoning for specific workflows is fully explained to the people who will be using them. As an adjunct instructor at two schools of pharmacy, and having attended many healthcare vendor training sessions, I would like to recommend that training sessions be broken down into comprehensible chunks. There is only so much information that the human mind can successfully absorb in one sitting, and most vendors try to get through training as quickly as possible. Making these simple changes will translate into improved product understanding and adoption on the part of providers.
Finally, I believe that vendors need to solicit the input and feedback from providers as they design their products. For a long time, the healthcare IT industry has been guilty of designing and developing products with very little provider input, and then passing these products on to their clients without ever having considered how the products will work within a real healthcare setting. Computer programmers and developers, for all of their wonderful talents, are not doctors—they don’t think like doctors, and they cannot be responsible for fitting products into a clinical setting that is dynamic, fast paced, and difficult. This is one area where I am particularly proud of DrFirst, because as a company we truly strive to put doctors first and foremost in the design of our products.
At essence, providers must be more attentive during the prescription writing process, and comply with workflow best practices. Healthcare IT companies need to consider the provider’s prescribing environment and process when developing products, and then deliver training that speaks to the providers’ needs. I truly believe that if we as an industry can accomplish these things, we will see a dramatic improvement in e-prescription quality.