E-Prescribing

E-Prescribing or electronic prescribing refers to the practice of doctors creating electronic e-scripts, rather than paper prescriptions for their patients' drugs. These e-scripts can be sent directly to your pharmacy. E-prescribing is just one aspect of medication management that also includes patient compliance. Adoption rates vary across nations.

While medical billing has been done electronically for years, medical software with e-prescribing capability has until recently been slow to be adopted by those in United States (US) health care. Less than 2% of eligible prescriptions were sent electronically at the end of 2007 and most of these were by fax. The US 2009 economic stimulus package allocated funds for up to a 2% e-prescribing incentive program to Medicare e-prescribers who used the required medical coding to encourage adoption. Many of these changes were announced at the US national e-prescribing conference in 2008 and (videos of plenary sessions are available.

One hinderance to adoption in the US has been the prohibition of e-prescribing controlled subtances. A large number of prescriptions for medications considered controlled substances are currently ineligible for e-prescribing. This means medical practices need a duplicate paper system for controlled substances even if they are one of the few to have deployed an e-prescribing system.

There are other implementation challenges besides policy issues. The National Health Service (NHS) of the United Kingdom published a report in the summer of 2009 "Electronic prescribing in Hospitals - Challenges and lessons learned" http://www.lse.ac.uk/collections/LSEHealth/pdf/information%20systems/eprescribing_report.pdf Even a relatively straightforward technology like e-prescribing introduces change into healthcare organizations.http://sites.google.com/site/hcinfosys/literature/e-prescribing There is a growing body of e-prescribing literature in the academic communityhttp://sites.google.com/site/hcinfosys/literature/e-prescribing. To say it is merely user resistance is a gross over-simplification of the changes to an organization and its social structure introduced by e-prescribing. In January 2010, Australia canceled its e-prescriber tender after six months of deliberation.http://www.theaustralian.com.au/australian-it/e-prescribing-tender-cancelled/story-e6frgakx-1225818883921

Medical practices considering the adoption of e-prescribing should carefully consider these workflow changes. The changes vary depend on the software vendor is chosen. Make sure the vendor demonstrates the workflow embedded in the software so the degree and extent of impact to your organization can be determined before making a procurement decision.

What e-prescribing is supposed to do is well known. What are the experiences of the pharmacists and physicians actually using e-prescribing? Here are a collection of blogs and articles.

The Angry Pharmacist blog has a post with over 70 comments called "eprescribing for eidiots"http://www.theangrypharmacist.com/archives/2009/05/eprescribing-for-eidiots.html

The Doctor Grumpy in the House blog has a post called "E-prescribing crap"http://drgrumpyinthehouse.blogspot.com/2009/05/e-prescribing-crap.html

Pharmacists rally for tougher e-prescribing rules in Healhcare IT Newshttp://www.healthcareitnews.com/news/pharmacists-rally-tougher-e-prescribing-rules

Physicians can get a free web-based stand-alone e-prescribing solution through Allscripts (e-prescribing software company) and "dedicated organizations" (e.g., insurance companies) from the National ePrescribing Patient Safety Initiative.http://www.nationalerx.com/

Practice Fusion that offers a free Electronic Health Record has added a free e-prescribing module.http://www.practicefusion.com/pages/pr/11310_release.html

In the US, E-prescribing of controlled substances has been prohibited by the Drug Enforcement Agency. The DEA will now allow it (60 days from March 31st) requiring two factor identification (two of the following: password, token, biometrics).http://www.healthleadersmedia.com/content/TEC-248742/DEA-Proposes-Allowing-Biometrics-to-Identify-EPrescribing-User## Given the preponderance of surrogate prescribers, you can guess which factors will be used. In addition, the current SCRIPT e-prescribing standard doesn't allow for two-factor authentication messaging.

E-prescribing systems certified by SureScripts that include at a minimum Prescription Benefit (most with Reporting) and Retail Prescription Routinghttp://www.surescripts.net/certification-status.html

ABELMed EHR-EMR/PM v 9

Agastha PM and EMR v 2.0

Allscripts Enterprise EHR v 10.1.1

Allscripts Misys EMR v 9.10.0.0

Allscripts MyWay v 2008

Allscripts Professional EHR v 4.8.1

Allscripts ePrescribe v 11.5

Alteer Office v 7.1

OncoEMR v 2

Patient Relationship Manager v 9.0 Patch

athenaClinicals

Elysium v 9

PrognoCIS v 1.8.1

PowerChart v M2007

PowerWorks ePrescribe

ClinixMD v 7.5.0

Medgen EMR v 5.0

CureMD EMR v 10

Doctations v 1.01

eClinicalWorks v 8.0

Sunrise Ambulatory Care Manager v 5.0

Eclipsys PeakPractice v 1095

eHealthSolutions v 4.4

Care Revolution 5.2b

ClinicianRx v 6.7x

e-MDs Solution Series v 6.3

Epic Summer 2009

escribeHOST v 4.2

GE Centricity EMR 2005 with Kryptiq eSM 3.0

gloEMR v 4.0

gCare 4.0.8.5

Digital Rx v 2.1.x

MediFile v 4.1

MicroMD EMR v 7.0

TurboRx v 1.4.0

CareTracker v 6.2

InteGreat EHR v 6.2.1

STIX EHR v 9.0

HELP Eprescriber v 1.0

iScribe v 6.4.1

DocLinksTM v 7.0

Medical and Practice Management Suite Version CS 5

CattailsMD v 5

CareGroup WebOMR v 3.0

Horizon Ambulatory Care v 9.60.1

iScript v 4

iSuite v 4.0

MedConnect EHR v 1.0

MEDENT v 18

emr4MD v 6.0.2

NetPractice-EHRweb v 6.8

NetPracticeERX v 6.9.6

Rx Cure v 2.0

Longitudinal Medical Record (LMR) v 7.2

Prairie Quality Initiatives v 3

Prematics v 2.2

Pulse Patient Relationship Management v 4.1

INPC

eScript v 8.2.20

EMR LITE v 7.0

RxNT v 6.1.4

SequelMed e-Health v 8.0

SequelMed EMR v 8.0

SequelMed e-Prescribe v 8.0

SOAPware v 2009.0

SRSsoft Hybrid EMR v 7

EMRge v 6.0.57

ChartMaker v3.2

SynaMed v 4.0.040423

Web Based EMR & Practice Management System v 3.0

PocketScript v 6.9