In a recent study, researchers found that physicians override more than three-quarters of drug interaction alerts provided by e-prescribing software. These alerts are decision support tools for physicians in order to avoid errors related to drug interaction and/or allergic reactions, together called adverse drug events or ADEs.

ADEs are a major focus of the Obama administration in eradicating human error and in turn increasing overall health care system efficiency. A reduction in adverse effects increases the quality of patient care while reducing health care costs through the elimination of unnecessary medical care (fixin’ you up after an ADE injury).

The scientific literature reports that one-quarter of patients experience an ADE episode and one-third of those are preventable. Yikes. In this recent study, a tri-state approach yielded similar findings to traditionally smaller studies—physicians override alerts frequently. Physicians, on average, received an alert for almost 7 percent of their prescriptions (over 3 million records were sampled)—of those, they accepted only 9.2 percent of drug interaction alerts and 23 percent of allergy alerts. There is no specialty that overrides more than another though the majority of the sample was primary care physicians. Should we be concerned? Well, yes and no.

Luddite Distrust or Decision Support Overkill?

Why are physicians overriding alerts at such high rates? Researchers are not clear about why physicians override the alerts but they suggest that 1) generally, the alerts are inadequate; 2) physicians discriminate based on the type of drugs a patient is taking (heart issues are weighed more seriously than less potentially emergent conditions); 3) unless addressed, physicians will develop “alert fatigue” and continue to be dismissive of alerts to the detriment of patient health.

So, maybe docs don’t trust technology to guide them in their decision-making and are uncomfortable using an electronic format? The study found that, on average, physicians had over a year’s worth of experience using an e-prescribing system. It appears that Luddite tendencies are not to blame for physicians overriding habits but rather an annoyance with many alerts that do not mirror the clinician’s knowledge base. According to users, the e-prescribing alerts are like a hyperactive child that asks you ten times to eat candy when you said “no” the first time. The complaint is that by alerting doctors numerous times and hyping up potential threats (not discriminating enough regarding what is a high alert interaction versus a more moderate ADE) threatens the utility of the entire system. The problem is a lack of congruency between clinical decision support and physician’s experience and practice style.

Matching Physician Insight with Electronic Ease

Clinical decision support regarding ADEs must be an important part of patient care. The system, however, is clearly imperfect. Physicians maintain that the clinical decision support around prescribing is inadequate. Researchers argue that software companies and their partners should take into account clinician insight and alert override practices. In short, software systems should alter alerts based on the acceptance and override rates by clinicians themselves.

While this appears to be good advice, there also needs to be attention paid to the patient outcome. How did the patient fare when there was a drug prescription override? Is the physician prudent in overriding an ADE alert? These are important questions yet to be addressed by researchers and software companies engaged in clinical decision support.

Above article published on

http://ohmygov.com/blogs/general_news/archive/2009/05/04/e-prescribing-systems-challenged-by-doctors.aspx

Wireless Technology Boom: Conduit to E-Prescribing

The healthcare industry’s transition from paper-based record to electronic record is witnessing yet another revolution- Electronic Prescription. Healthcare facilities of all sizes today are employing the advantage that comes with the mobility of wireless technologies. The market for wireless technology in Europe is becoming a ‘mass market’ and is increasingly gaining momentum. With the advent of wireless networking, many organizations are exploring how wireless mobility can change the way they work. The popularity of wireless and handheld devices is increasing in healthcare for its mobility and flexibility. Mobile and wireless healthcare means the mobile access to patient health record, prescription, clinical and pharmacy order entry (CPOE) and management systems and so on. The number of medical accidents due to prescribing errors is increasing, with more than 0.1 million lives being lost every year. Electronic prescribing and computer prescribing are gaining its importance in reducing medication errors and transcription errors in the ambulatory healthcare market by providing unambiguous, clear and timely information and thus saving lives.

E-Prescribing- A Consolidating Process

Electronic prescription systems can be defined as a solution that eliminates hand-written prescriptions from the health care services provided by physicians, other prescribers, and pharmacists. It has to be seen as a combination of three other separate services- Decision Support, Electronic Transmission of Prescriptions and Electronic Medical Records. The functional capabilities of the system extend up to integration into the electronic medical records (EMR), which includes the patient’s medication history, eligibility checks, and formulary functions. Hence, an e-prescribing system is not only a simple tool to generate prescriptions electronically, but it is making the entire health care service more secure and reliable through electronic decision- making database systems. Hand-written prescriptions can be difficult to read, and also the authenticity of the prescription can be doubtful, as could be the case with prescription authorizations given over the phone and by fax. Some important information such as dosage, frequency of medication, and signature may also be missing in hand-written prescriptions. Electronic prescriptions not only consolidate the process of prescription for creating, transmitting, and checking authenticity, but it also makes it mandatory for all the important information to be present on the prescriptions for transmission.

Technology Itself as a Driver

The healthcare industry can no longer be complacent towards its technology due to the escalating costs, technology savvy patients, and also due to the healthcare regulations like the Healthcare Information Portability and Accountability Act (HIPAA). The electronic economy is finding itself a new set of opportunities, challenges, and restraints in the healthcare environment in Europe and when it comes to the usage of information systems/information technology (IS/IT) in healthcare management, the healthcare industry is finding itself in a state of turbulence and flux. The rise in healthcare expenditure has lead to the uptake of key healthcare IT solutions such as e-prescription, shared medical records, primary care information systems, triage solutions and management information systems. Pharmacists around the world have long before been facing the challenge to cope with pharmacist storage and dispense a large number of prescriptions, while increasing their practices for more patient care activities. E-Prescription has experienced a phenomenal growth in United States (US). The technology is on course to be accepted by the European healthcare system. With healthcare being the foremost concern for many, demand for faster and efficient service is on a rise. With 0.1 million lives being lost every year owing to medication errors, there is a rising demand for an infallible and dedicated technology which ensures that such errors are kept low. E-prescription provides a solution to all this and hence seems to be on the fast track now. Moreover, e-prescribing is driven by the fact that there has been an express growth in software development and usage to support health care services. The other trends that are driving this market are integration of more information systems, short life span of computers and increased electronic data interchange in healthcare. Increased uptake of e-prescription and Electronic Medical Record (EMR) systems has significantly boosted the quality of healthcare and patient safety.

Differences in Contrast Environment

Prescribers in the ambulatory care segment have increasingly realized their ability to save lives and costs through clinical automation as well as economical and consolidated e-prescribing systems. It should be noted that with the complexity in the applications increasing in terms of infrastructure, the number of actors and the skills needed by the user also increases. This leads to a substantial difference between the countries adopting e-Prescription. Denmark, with 97% of the GP’s using e-prescription has the highest rate of adoption in Europe. On the other hand, countries such as Italy has negligible rate of adoption of this technology. The difference in adoption is not just seen between countries, but also between the primary care and secondary care to a large extend. Electronic prescribing in primary care and secondary care are very different in terms of its application. A quarter of all the expenditure in primary care is on drugs. The primary care which still uses FP10 prescription, involves solutions such as clinical noting, decision support and documentation functions in its e-prescribing. Clinical decision support is more widespread in primary care. Due to the standardization of products and coherent user group, e-prescibing is more successful in primary care. On the other hand, electronic prescribing in secondary care involves a closed loop process. The systems of EP are concerned with the total medicines management process from prescribing to dispensing to medicines administration and monitoring. It incorporates the recording of drug administration or omission. The decision support required during the point of administration and prescribing is different. Since the application requires experienced physicians to use it, the key users are hard to engage. All these makes the process complicated in secondary care. Current estimates show that the number of hospitals that have fully implemented electronic prescribing is very low in Europe.

Talk the Challenge

E-prescribing systems have not experienced optimum sales because of the limitations placed on e-prescribing due to culture change between the nations. The reluctance of physicians to adapt to electronic prescription is yet another major hurdle faced today. There is a difficulty to market the new technologies in physician practices. Good change management and stakeholder engagement is vital to improve this situation. Limitations placed on controlled drugs, due to misuse and security concerns is also upsetting the sale of e-prescribing systems. As information is propagated through internet, chances of health insurance details and other private data being hacked is rather high. Hence the system demands for highest levels of encryption and data coding measures. This issue however has been resolved with the introduction of data security and privacy acts such as HIPAA. There is a high need for standardized drug name and database. The situation can be improved if facilities for online checks and authorization to ensure the process is tamper proof is offered. It is vital for the regulatory bodies to draw the guidelines and criteria that need to be satisfied for enabling the e-prescription of controlled drugs. Interoperability issues can challenge the market participants if the physician already uses clinical automation solutions, such as practice management from another vendor. To offset this concern, vendors can build a comprehensive product that includes Practice Management Systems (PMS), Computerized Physician Order Entry (CPOE), and integrated to Electronic Medical Records (EMR) to automate the entire clinical and management workflow of a physician’s practice to save workload of staff and licensing costs. Poor domain expertise among the software providers is yet another major reason for the slow growth of e-prescription in Europe. This can be overcome through increased number of publications that can showcase the potential benefits of electronic prescription through quantitative analyzes.

Legend

C – Challenge

R – Recommendation

Optimistic Future

Every country’s tradition, culture, patient expectation, and payment mechanisms shape the healthcare systems there. Healthcare organization of tomorrow must consider a wireless delivery platform as a strategic necessity, if it is to survive and thrive in today’s challenging healthcare environment. In spite of the current credit crunch that is having a holistic effect on the healthcare IT budget in Europe, we expect e-prescription to have a slow and steady penetration in the coming years. This is expected to happen with the encouragement from physicians and pharmacies to adopt the technology. E-prescribing is expected to find its huge benefits and relatively few drawbacks in the coming future. This would set this technology to find its acceptance for a broader use in the European healthcare. With contributing factors such as increased mobility, changing lifestyles and the increasing ageing population in the European nations, the market for electronic prescription is expected to grow. Regional interconnectivity to ensure prompt transfer of patient information has become the need of the hour even as the patients increasingly travel across countries. Hence, besides the obvious advantages of reducing medication errors and saving upon time and money, e-prescription is building path for a global healthcare structure

Above article published on http://www.frost.com/prod/servlet/market-insight-top.pag?Src=RSS&docid=163558282