Electronic Prescribing


The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 proposed that healthcare professionals throughout the United States have access to EHRs [electronic health records] and use them meaningfully according to standards set by the Centers for Medicare and Medicaid Services (CMS)…

As mentioned previously on my blog, patients should be aware that anything entered into your EHR cannot be removed, whether it’s correct or not.  For instance, if a doctor believes a chronic pain patient is a “drug seeker,” and enters that information into the patient’s EHR, that label is there forever.

An important factor in the quality of patient care is whether medical errors are present. In the United States, an estimated 200,000 deaths occur yearly from preventable medical mistakes and hospital infections. Errors in medication prescribing and filling are some of the most common types of medical errors. Medication errors have been defined by the National Coordinating Council for Medication Error Reporting and Prevention as preventable events that may cause or result in inappropriate use of medications or harm to patients while the medication is being used by a healthcare professional, patient, or consumer. These errors can occur in any part of the medication use process, which includes mistakes from prescribing to dispensing of the drug and monitoring of how it is taken. The ambulatory care setting is the most common place for prescribing errors to occur. (See Table 1.)

An adverse drug event (ADE) can be the result of preventable or non-preventable medical interventions related to medications. ADEs are considered preventable if they are caused by medication errors, and potential ADEs are errors that could result in harm to the patient. The Institute of Medicine has estimated that 1.5 million preventable ADEs occur in the United States each year and more than 7,000 patient deaths can be linked to poor handwriting and prescription filling errors…

Through the EHR incentive program, CMS has provided incentive payments of $44,000 for Medicare-eligible providers demonstrating meaningful use of EHRs through 2014; then, starting in 2015, eligible providers failing to demonstrate meaningful use will receive Medicare payments reduced by 1 percent, with penalties increasing to 5 percent in 2020. Though these efforts have helped to increase the use of e-prescribing from 38 percent of prescriptions dispensed in 2011 to 44 percent in 2012, most prescriptions are still sent to pharmacies outside of an electronic system…

Legal issues arise when providers need to prescribe controlled substances. On March 31, 2010, the DEA made a final ruling on e-prescribing of controlled substances that took effect on June 1, 2010. The rule made it legal to transmit controlled substance prescriptions electronically, though the many standards contained in the ruling make it cumbersome to implement…

This would not include certain controlled substances, like the recent changes for hydrocodone, which require a handwritten prescription (like oxycodone).

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