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Can We Do Better Than a Doctor's Scribble?

May 02, 2014

New research suggested using computers instead of paper and faxes to generate, transmit, and fill prescriptions could result in $27 billion in annual cost savings by reducing adverse drug events, improving prescribing efficiencies, and giving prescribers improved access to formularies to select lower-cost medications.

The study’s authors said e-prescribing offers the highest potential benefit to outpatient pharmacies, where paper-based systems remain prevalent and prescribing errors persist. Their systematic literature review uncovered several benefits of the technology.

Physicians use the systems to send prescriptions directly to pharmacy computers, which results in fewer medication errors, limits call-backs from pharmacists seeking clarification of drug orders, and reduces mistake associated with handwritten notes.

“The Institute of Medicine has estimated that 1.5 million preventable ADEs [adverse drug events] occur in the United States each year and more than 7,000 patient deaths can be linked to poor handwriting and prescription filling errors,” the researchers wrote.

E-prescribing can be incorporated into electronic health records (EHRs) — giving prescribers access to vital patient information such as lab results, clinical notes, and lab orders and reports — or serve as standalone systems in ambulatory pharmacies, according to the researchers.

They claimed patient safety is increased when e-prescribing works in concert with EHRs, because the systems alert prescribers to drug allergies and potential interactions with other medications and health conditions. The study cited previous research that showed e-prescribing linked to EHRs decreased medication error rates from 42.5 to 6.6 errors per 100 prescriptions just 1 year after 12 community-based practices adopted the technology.

Entering prescriptions electronically actually takes about 20 seconds longer than paper-based prescribing, according to the study, but the extra time is more than made up for with less paperwork demands and fewer medication issues that need resolving. Pharmacists spend less time on the phone clarifying medication orders with prescribers, which ultimately decreases the time it takes to fill prescriptions and get needed drugs into patients’ hands, noted the study. 

Despite the many reported benefits of e-prescribing, widespread use of the technology is lagging. The researchers said implementation costs remain a significant barrier, with more than 80% of primary care physicians claiming a lack of financial support for adding the technology to their practices. 

Hardware and software problems, workflow issues, and connectivity delays were also among the design drawbacks identified in the study that caused caregivers to stop using the technology. Concerns over the security of patient information and a highly regulated process for ordering controlled substances have also stalled frontline acceptance. 

“The benefits of e-prescribing to patients, providers, and pharmacists far outweigh the barriers to its implementation,” commented Dr. Alberto Coustasse, study co-author and associate of the healthcare administration program at Marshall University’s College of Business in South Charleston, West Virginia. “The process enhances patient satisfaction and compliance with prescription regimens.” 

The study was published in the online journal Perspectives in Health Information Management.


—Dan Cook



1. Porterfield A, Engelbert K, Coustasse A. Electronic prescribing: improving the efficiency and accuracy of prescribing in the ambulatory care setting. Perspectives in Health Information. Spring 2014:1-13.

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