To E-Prescribe or Not? That Is the Question
Dr. Kaushal, chief of the Division of Quality and Medical Informatics at Weill Cornell Medical College, said she knew that the transition from paper to electronic was difficult for most physicians. She was surprised to learn that even for experienced e-prescribers, the move to a new system can be challenging. Dr. Kaushal, who was involved in the transition studied for the report, said she found the experience to be “exceedingly difficult.” She wrote:
“We thought it would be more of a seamless transition because people were already accustomed to sitting in front of a computer, entering in orders and so on, so they didn't have to get used to that piece. But each electronic system has its nuances and learning how to utilize it and optimize the physician-computer interaction takes time. Every time a switch is made there are important issues that arise.”
In contrast, Kate L. Lapane, Ph.D., and her colleagues reported in The Journal of Pharmacy Benefits, March/April 2011, a study of 64 e-prescribing practices using six different e-prescribing software programs. In their focus groups, it was noted that prescription errors were still occurring. Prescribers cited difficulties using drop down, menus which resulted in the wrong medication or dose, and problems with small phone screens, as well as access to incomplete information and accidental duplication of prescriptions.
In another study in the Journal of the American Medical Informatics Association (June 29, 2011), Dr. Karen C. Nanji and her colleagues looked at 3,850 electronic prescriptions written over 4 weeks and found an 11.7% error rate, comparable to the error rate with handwritten prescriptions. They noted:
“Providers appear to be rapidly adopting electronic health records and computerized prescribing, and one of the major anticipated benefits is expected to be through medication-error reduction.... Many of these benefits will not be realized if the electronic prescribing applications are not mature and either do not catch or even cause new medication errors.”
I’m left to conclude that the jury is still out, both on whether e-prescribing is time-efficient and on whether it decreases the morbidity and mortality associated with medication errors.
—Dinah Miller, M.D.
If you’d like to read Dr. Jeffrey Soulen’s discussion of what he likes about e-prescribing, please see his guest post on our Shrink Rap blog by clicking HERE.
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Dr. Miller is the co-author of Shrink Rap: Three Psychiatrists Explain Their Work, recently released by Johns Hopkins University Press.
