E-Prescribe

Adverse drug events are less common among patients whose providers more frequently use electronic prescribing, according to a study published in the Journal of the American Medical Informatics Association, FierceEMR reports.

Details of Study

For the study, researchers -- including former National Coordinator for Health IT Farzad Mostashari -- examined patients with diabetes who were covered by Medicare Part D. The study included patients in ambulatory settings, as well as hospitals.

The researchers analyzed adverse drug events that occurred among patients of two groups of physicians, including those who used e-prescribing for:

• Less than 50% of their orders; and
• More than 50% of their orders.

The 50% threshold corresponds with the meaningful use Stage 2 requirement.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Study Findings

The study found a small but statistically significant link between e-prescribing in ambulatory settings and lower rates of adverse drug events.

According to the researchers, the study supports previous findings that the meaningful use program can be associated with fewer adverse drug events. However, the association was not constant among different patient populations.

For example, the risk of an adverse drug event was higher among black patients, compared with Hispanics. In addition, the study found that:

• Younger, female or rural providers were less likely to see adverse drug events among their patients; and
• Providers with sicker or lower-income patients had a higher likelihood of having such adverse events among their patients (Hall, FierceEMR, 5/6).

The Office of the National Coordinator for Health IT has released a guide designed to assist providers with electronic prescribing, Becker's Health IT & CIO Review reports (Jayanthi, Becker's Health IT & CIO Review, 2/19). 

Background

About 70% of physicians e-prescribe, and about 90% of pharmacies are able to accept e-prescriptions, according to ONC.

Studies have shown e-prescribing can reduce drug costs and assist with medication management (Durben Hirsch, FierceEMR, 2/17).

Meanwhile, e-prescribing of controlled substances is legal in just 48 states and Washington, D.C. Legislation to allow e-prescribing of such medications by mid-2015 is pending in Missouri and Montana (Surescripts release, 2/19).

Guide Details

According to FierceEMR, the guide, called "A Prescription for e-Prescribers: Getting the Most Out of Electronic Prescribing," aims to help prescribers learn about e-prescribing. In addition, the guide shows prescribers ways to improve their use of e-prescribing and outlines the eight stages of the process. Those stages are:

• Identify the patient;
• Review existing patient data;
• Select a drug from a menu in the electronic health record;
• Enter information for the pharmacy;
• Review advisories and alerts;
• Choose a pharmacy;
• Authorize and sign prescription; and
• Review expectations with patients, monitor e-prescribing logs and manage electronic renewal requests.

The guide also poses some questions for e-prescribers to consider, such as whether the EHR lets a prescriber store a patient's preferred pharmacy (FierceEMR, 2/17).

"Some of these changes can result in decreased pharmacy call backs to the practice, increased patient satisfaction and improved e-prescribing productivity," according to the guide. It added, "Recommendations to create unambiguous prescriptions with standardized information enable effective clinical decision support and enhanced patient safety" (Walsh, Clinical Innovation & Technology, 2/19).

ONC has said the guide is best-suited to prescribers who use EHRs to send e-prescriptions, rather than a standalone system (FierceEMR, 2/17).