Electronic prescriptions are not a panacea
Bad handwriting accounts for a small (but significant) percentage of medication errors, as was reported in a study I wrote about a few days ago. It is not the biggest problem, but it is a real problem. Techies and techno-literate healthcare professionals like to tout the advantages of e-prescribing systems to get around this problem. And indeed, often electronic prescriptions are blessedly clear compared to their handwritten counterparts.
And sometimes they're not.
Allow me to explain… This past week, we received a electronic prescription for Vagifem that had contradictory directions in the sig code. While not exact, it was something like "Use once a week for two weeks for two weeks twice a week for a week once a week."
Yeah, I couldn't wrap my brain around it either. So I called the prescriber's office. Over the course of two days(!) we finally got the correct directions: "Use twice a week for two weeks then decrease to once a week" with several refills.
So while electronic prescriptions solve legibility issues, they're no help at all when a prescriber doesn't look over what s/he has entered for instructions. And this happens all the time. I can think of 3 different prescribers off the top of my head in my area that regularly send us junk electronic prescriptions. The worst offender is an oncology doc who will regularly prescribe 4-6 medications in one go — and 50% of the time, more than one makes no sense at all. It's a real burden on the patient and the pharmacy staff when you've got to get the real story on 3 of the 6 scripts.
Electronic medical records systems (EMRs) can help with the problem. Often you'll talk to a nurse who merely looks at the doctor's notes to determine what's the scripts should be when you get someone on the phone. When and if EMRs ever standardize a way to share patient information, problems like this will be greatly reduced, because even if an electronic prescription makes no sense, the pharmacist will be able to look at the doctor's notes to find out what they really want. (Not to mention crap like this won't happen nearly as often when everyone's on the same page.)
But we're nowhere close to that point, yet. So while electronic solutions help, they aren't a Holy Grail in any shape or form.
[tags]Medicine, pharmacy, electronic prescriptions, e-prescribing, technology, EMR, medical records[/tags]
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[...] Yesterday I spoke about electronic prescribing. Perhaps I may have sounded a little down on technology, but in reality, I'm not. I'm a technophile. I love what technology has given us in the way of scientific, cultural, and medical advancement, and I'm looking forward to seeing what it brings us in the future, though I don't believe it is the be-all and end-all of medicine. [...]
Pingback by A primer on evidence-based medicine :: OnThePharm — July 24, 2006 @ 9:03 pm
[...] should remind you, however, that electronic prescriptions are not a magic bullet, either, though they certainly mitigate problems like [...]
Pingback by Can you read these prescriptions? :: OnThePharm — March 21, 2007 @ 2:49 pm
[...] people. Proofread your goddamn prescriptions. To make sure that gibberish that your EMR spits out is REALLY what you want. And that you've actually heard of the drug you are prescribing. It [...]
Pingback by “Oops, I picked the wrong one.” :: OnThePharm — August 28, 2007 @ 4:16 am
Just wanted to mention a free medical dictionary visualization tool we developed:
Visual Medical Dictionary
We hope to integrate some of our tech into EMR systems to enable quick evidence checks… and give warnings if no reference to the drug-disease relationship is found in peer reviewed lit.
Comment by CureHunter — August 29, 2007 @ 12:45 am