Electronic prescribing is much more than it appears. While the basic definition speaks to the technology framework that allows doctors and other prescribers to electronically write and transmit prescriptions to patients and pharmacies, the system as a whole can achieve much more. One general benefit of e-prescription is that it assists with eliminating prescription errors in several ways, but importantly, it can be used as part of a system of medication management.
There are many problems associated with the current paper-based prescription system, which presents major risks to patients' safety and negatively impacts medication-therapy outcomes. These include illegibly written prescriptions; missing prescriber or patient data; risk of losing or damaging paper prescriptions; rewriting of prescriptions by prescribers and pharmacies; slow prescription processing - long wait times; failure to identify drug interactions, causing the potential for adverse reactions; possible prescription fraud; no standard drug-coding system; and the high cost of handling prescriptions.
The most common drug dispensing error is due to the misinterpretation of handwritten prescriptions. E-prescriptions eliminate this issue because information would be clearly typewritten. Such a system can store prescriptions for patients in a database, and over time, compare current prescriptions with those of the recent past to check for interactions before dispensing.
This would be part of the patient's overall electronic medical record, providing caregivers with holistic information from which to determine the best course of action for treatment regimes.
Any effective e-prescription system needs to have several other elements to enable optimum medication management, including the capacity to quickly undertake drug-drug interaction, drug-allergy, and drug-food checks during prescription preparation.
This information for every 'prescribeable' drug would be registered in the database. A plus to the system is also its ability to provide direct information to patients in a form that they can understand. The best systems would include this in their make-up, providing patient education leaflets via email or in an app to ensure that patients are part of their health management. This would improve health literacy and invariably result in better health outcomes.
FIGHT AGAINST FRAUD
E-prescriptions can also be a vital tool against fraudulent prescriptions and the hoarding of drugs, especially for the public health system. The use of the Caribbean Drug Codes (CDC) can assist with this aspect of dispensing.
The CDC codes drugs based on formulary, and so the dispensing person would be alerted if a patient is trying to get the same medication in a different brand before the prescriptive time has passed. In addition, if such a system is connected to pharmacy inventory, the prescriber can check for availability, interactions, and substitutes.
Apart from the obvious system benefits, another plus is that the e-prescription can be dispensed before the patient gets to the pharmacy, and so a lucrative delivery service could be developed.
Medication management facilitated by the use of e-prescription and using the right combination of technology can significantly improve the prescriber, dispenser, and patient experience. Most importantly, this approach can save lives and improve health.
Jamaica has not yet decided on whether and in what format the country will move forward with e-prescription. However, the world is moving at such a fast pace with health technology that we cannot afford to be left behind.
Once we start viewing e-prescribing as bigger than just an electronic means of sending a prescription, like "faxing" for example, then, perhaps, we will have a better appreciation for the fact that this is something that requires almost immediate action.
E-prescription represents an entire medication-management system rather than just an alternative means of sending a prescription from doctor to pharmacy.
The University Hospital of the West Indies, which is almost completely digitised, has seen major improvement in the area of pharmacy as it has been able to use the features of the
e-prescription component of the health information management system within the hospital. I am told that patients have been very happy about the improved efficiencies.
My recommendation is for us to swiftly put in place the required policy for the use of e-prescription and adopt the Caribbean Drug Codes nationally for use as part of the system. Delays in this regard could have adverse consequences to you and me - the patients.
- Doug Halsall is chairman and CEO of Advanced Integrated Systems. Send feedback to doug.halsall@gmail.com.
Published:Sunday | May 6, 2018 | 12:00 AM