Electronic prescribing systems that reduce the possibility of human error could cut clinical negligence claims by more than 70 per cent, according to US hospital chain Banner Health.

The company, which has worked with national IT programme supplier Cerner to evaluate the impact of its electronic prescribing system, said systems that reduced the possibility of human errors such as illegible handwriting or misrecorded doses had led to a 72 per cent reduction in the cost of clinical negligence claims at one of the group’s hospitals.

The National Patient Safety Agency has estimated that 9 per cent of patient safety incidents relate to medication errors, which together constitute some 20 per cent of all clinical negligence claims against the NHS.

In 2007-08, the NHS Litigation Authority paid out approximately £64m in damages for cases involving misprescribing.

Banner Health’s system director for care transformation Judy Van Norman told HSJ: “Some clinical leadership in the hospitals are interested and enthused about being involved but the resources at the individual hospital level to really lead the adoption of this is a frustration.”

Above article published on http://www.hsj.co.uk/news/technology/e-prescribing-could-cut-cost-of-human-negligence/5003930.article

By Ed Edelson

HealthDay Reporter

An electronic prescribing system that tells doctors which drugs are the least expensive can save millions a year, a new study finds.

“One of the challenges physicians face is that they don’t know which drugs are preferred or not preferred,” said Dr. Michael A. Fischer, an assistant professor of medicine at Harvard Medical School and lead author of a report in the Dec. 8/22 issue of the Archives of Internal Medicine . “The insurance companies involved in the study provided that information by a color code — green for drugs that were preferred, red for drugs that were not preferred.”

The study of 17.4 million prescriptions filled by more than 1.5 million patients of nearly 1,200 Massachusetts physicians found that use of the least expensive drugs — classified as “tier 1″ for the study, such as those available generically — increased by 3.3 percent when e-prescribing was used. Use of more expensive “tier 2″ preferred brand-name drugs decreased by 1.9 percent, and use of “tier 3″ non-preferred brand-name drugs decreased by 1.5 percent.

The result was an estimated savings of 70 cents per patient a month — not much per individual, but it added up to $845,000 a year for every 100,000 people filling prescriptions.

And those savings were possible when just 20 percent of the doctors who had access to e-prescribing used it. “The potential savings increase with more availability and use of e-prescribing; for complete e-prescribing use, the projected savings are $3.91 million per 100,000 patients per year,” the report said.

The U.S. government is pushing hard to increase electronic prescribing. Medicare is offering a 2 percent bonus over its regular fees for physicians using such a system in 2009 and 2010. The bonus will be 1 percent for 2011 and 2012, and 0.5 percent for 2013.

A number of different electronic prescribing systems are available, but many doctors have been reluctant to use them. Establishing a system can cost an estimated $3,000, with maintenance costs estimated at $80 to $400 a month. A study earlier this year found that only 17 percent of U.S. doctors have embraced electronic medical record systems.

The system used in the new study was established by two large insurance companies, which provided doctors in private practice with free wireless devices and access to a Web portal that color-coded drugs according by co-payment.

“Nothing in the system forces the doctor to make a choice of drugs,” said Fischer, who is also an internist at Brigham and Women’s Hospital in Boston. “But just color-coding, without forcing them to do anything, led to a movement to lower-cost drugs.”

The e-prescription system is growing rapidly, said Kate Berry, senior vice president for business development at SureScripts-RxHub, a company formed in the recent merger of two former competitors. The company is an electronic middle man, maintaining a master index of patients of a large number of physicians, and matching requests for their prescriptions with offers from participating pharmacies.

“Right now we have almost 70,000 active subscribers,” Berry said. “They are using more than a hundred different electronic medical record systems. We have added about 4,500 new active doctors in the last three months, and the level of use of those who have adopted the service is also increasing.”

The decision to use an e-prescription service is up to the doctor, Fischer said, “but patients can certainly ask their doctors if they are e-prescribing.”

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The results of the year-end report weren’t surprising. Since the middle of last year, physicians, pharmacists and law enforcement officials have warned of a near-epidemic of deadly prescription medicine abuse. In 2005, the Medical Examiners Commission began reporting the drugs discovered in bodies subject to autopsies. The percentage of decedents with at least one drug in their bodies has increased each year; to 53 percent last year.

“The vast majority” (4,924) of the 8,556 drug-related deaths studied last year by the state’s medical examiners involved the presence of more than one drug, according to the 2008 report. The presence of at least one prescription drug caused the death of 2,184 people last year.

To put the scale of those numbers in perspective, consider: There were 2,983 deaths on Florida’s roads last year; 1,169 of those fatalities were alcohol-related. Prescription drugs caused more deaths than alcohol-related crashes in Florida.

Of particular concern: Death-related occurrences of both benzodiazepines and oxycodone were up by more than 20 percent in 2008 compared with 2007. The drugs that caused the most deaths in Florida: oxycodone (941), benzodiazepines (929), methadone (693), cocaine (648), alcohol (489), morphine (300), hydrocodone (270).

This year, the Legislature finally passed a law that calls for creating an electronic database to monitor the prescription and sale of certain painkillers and tranquilizers. The database should help investigators track the worst offenders once it is operational next year, but even proponents of the law concede it was watered down.

Other initiatives are likely to be necessary because the personal and societal problems associated with the misuse of prescription drugs aren’t getting better.

Above article published on http://www.gainesville.com/article/20090723/OPINION/
907229907/1017?Title=Editorial-Prescription-abuse

Electronic prescribing systems that reduce the possibility of human error could cut clinical negligence claims by more than 70 per cent, according to US hospital chain Banner Health.

The company, which has worked with national IT programme supplier Cerner to evaluate the impact of its electronic prescribing system, said systems that reduced the possibility of human errors such as illegible handwriting or misrecorded doses had led to a 72 per cent reduction in the cost of clinical negligence claims at one of the group’s hospitals.

The National Patient Safety Agency has estimated that 9 per cent of patient safety incidents relate to medication errors, which together constitute some 20 per cent of all clinical negligence claims against the NHS.

In 2007-08, the NHS Litigation Authority paid out approximately £64m in damages for cases involving misprescribing.

Banner Health’s system director for care transformation Judy Van Norman told HSJ: “Some clinical leadership in the hospitals are interested and enthused about being involved but the resources at the individual hospital level to really lead the adoption of this is a frustration.”

Above article published on

http://www.hsj.co.uk/news/technology/e-prescribing-could-
cut-cost-of-human-negligence/5003930.article

Surescripts, formed as a result of the 2008 merger of RxHub and Surescripts, has been conducting the survey over the past four years to gauge the use of high-tech service delivery in medicine.

North Carolina, which ranked seventh nationally in 2007, was e-routing about 1.5 million, or 3.07 percent, of prescriptions that year. By 2008, Surescripts found, the volume had increased to 3.3 million, or 6.4 percent.

Among the 50 states, Massachusetts ranked first in 2008, e-routing 20.5 percent of all eligible prescriptions, according to Surescripts.

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“Although we found that the implementation of an electronic prescribing system at our institution had no substantial impact on the rate of medication errors, we did see considerable gains in efficiency for the ordering process,” said William M. Stone, MD, FACS, of Mayo Clinic Arizona.

“Patient safety is not simply reducing the number of medication errors. The use of this system makes obtaining treatment more efficient, could significantly lower health care costs and may also improve patient outcomes. Further study will show if these are additional benefits.”

Researchers reviewed the implementation of an electronic prescribing system in a multispecialty surgical practice using a prospective and retrospective analysis of patient-safety measures. Other outcomes measured included order implementation and entry times, personnel requirements and costs. Medication errors were recorded using a standard self-reporting technique at Mayo Clinic Hospital. Order-implementation times (time from initiation of the order to order being available to the health care provider) and order-entry times (time for the provider to find or access a patient record and write or enter the order) were obtained electronically or by hidden observation.

There were 1,836,239 orders placed during the implementation process. Six months before the implementation of the system, 15 medication errors were identified (0.22 percent), and no trends were noted in these errors. After implementation of the system, 10 errors (0.16 percent) occurred during the first six months. During the second six months, 13 errors (0.21 percent) were noted. Rates of medication errors were not statistically significantly different during any of these time periods. Researchers stated that a low baseline rate of errors before implementation of the system may have been a contributing factor to the lack of improvement.

Before the implementation of the electronic prescribing system, the time required for a provider to place an order was 41.2 minutes. With the system, this time decreased to only 27 seconds (p<0.01). Additionally, personnel were no longer required to clarify and transcribe written orders into an accessible format. Due to the decreased work load, 11 of 56 (19.6 percent) personnel positions were eliminated, translating to a yearly financial benefit of $445,500. The total capital cost for the implementation project was $2.9 million, with additional operating cost of $2.3 million

Above article published on

http://esciencenews.com/articles/2009/05/04/electronic.prescribing.
systems.boost.efficiency.may.lead.improved.quality.care