Running

Head: ANALYSIS OF ELECTRONIC PRESCRIBING 1

Analysis of Electronic Prescribing

Meghann Wheeler

University of North Florida

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Technology in healthcare is constantly developing and expanding to improve the healthcare

field. One recent technological development in healthcare is the use of electronic prescriptions

(ePrescriptions). Electronic prescriptions are utilized by healthcare providers to allow for a faster

and safer way to send a prescription to a pharmacist, and is defined as “the process of electronic

transfer of a prescription by a healthcare provider to a pharmacy for retrieval of the medicine by

the patient” (Kauppinen, Ahonen, & Timonen, 2017). Before the development of ePrescriptions,

prescriptions were handwritten on prescription notepads by healthcare providers. The patient

would then have to take the prescription to their pharmacist to get the prescription filled. This

traditional method has many flaws, and ePrescriptions seek to fix the many weaknesses associated

with the traditional handwritten prescriptions, including: difficulties interpreting handwriting, the

possibility of falsifying a prescription, and difficulties in communication and feedback between

pharmacist and prescriber (Astrand, Monetlius, Petersson, & Ekedahl, 2009). These weaknesses

can delay the time it takes for a prescription to be filled, and can lead to patient dissatisfaction. By

using ePrescriptions, healthcare providers “can improve safety, quality, efficiency, and [the] cost-

effectiveness” of the prescribing process (Astrand et al., 2009).

Electronic prescription systems are managed many different ways, from directly from one

prescriber to one pharmacy, to a nationwide network system involving numerous healthcare

providers and pharmacists (Lamsa, Timonen, & Ahonen, 2018). While these systems are still

relatively new and have room for improvement, their implementation shows great promise.

Electronic prescription systems utilize data from many different sources. One large source of data

utilized by ePrescription systems is the patient’s electronic health record (EHR). Some countries,

such as Finland, use a national prescription center with the EHR to ensure safety and accuracy in

prescription use and to aid doctors and pharmacists (Kivekas, Enlund, Borycki, & Saranto, 2016).
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Aside from the development of national prescription centers, another source of the data utilized in

ePrescriptions is both the pharmacist’s data and the prescriber’s data, each operating separately

from one another. Pharmacists utilize data from a large variety of sources, such as data from

insurance companies regarding patient coverage, and data regarding possible hazards associated

with prescription medication, including side effects and possible drug interactions (Salmon &

Jiang, 2012). This large variety in data sources is in place to ensure that the patient is prescribed

the right medication while limiting the safety risks. Currently, aside from the countries that have

implemented national prescription centers, the data involved in ePrescriptions is managed and

stored in separate databases through both the prescriber and the pharmacist. The separation of these

databases makes the transmission of data from prescriber to pharmacist difficult, and this

disconnect is one large limitation of ePrescriptions. Research has shown that the healthcare

industry “is finding that more comprehensive, rather than segmented databases… can create better

platforms for clinical and epidemiological research” (Rudorfer, 2017). This revelation has led to

the introduction of databases that operate similar to the “cloud” in that the data from both the

prescriber and the pharmacist can be combined into one large database, managed by both parties

(Rudorfer, 2017). The use of ePrescription systems eliminates much of the key security issues

previously associated with writing prescriptions, such as the possibility of false prescriptions being

written by someone other than the physician (Gider, Ocak, & Top, 2015). While it is still

theoretically possible for prescriptions to be falsified through ePrescription systems, it is much

more difficult than falsifying traditional handwritten prescriptions. In addition, because

ePrescription systems allow for easier two-way communication between prescriber and

pharmacist, it is much more likely that if a false prescription were to be written, it would be

discovered by either the prescriber and the pharmacist before being filled.
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The end user in ePrescription systems are all the healthcare employees who utilize the

system, specifically the prescriber and the pharmacist. The prescriber is typically a primary care

physician, but can also be physicians at hospitals or other health care facilities. Many studies have

been conducted regarding prescriber and pharmacists’ attitudes towards the implementation of

ePrescription systems and, in the beginning, it was found that there was some difficulty in adjusting

to the new system. One study conducted in Sweden during the beginning of the implementation of

an ePrescription system in 2009 found that electronic prescriptions had to be sent back to the

prescriber for clarification more often than traditional handwritten prescriptions did (Astrand, et

al., 2009). Although there are some issues with end user acceptance during the implementation of

ePrescription systems, the overall perception of ePrescriptions by end users is that they improve

the process of getting a prescription. One study conducted in Finland after ePrescription systems

had been fully integrated into healthcare found that pharmacists had positive attitudes towards

ePrescriptions (Kauppinen, Ahonen, & Timonen, 2017). Electronic prescription systems are

extremely beneficial to the end users, not only by making the prescription writing and filling

process easier, but also by improving the quality of care for their patients (Kivekas, et al., 2016).

Another benefit to ePrescriptions is that it saves the end user time by making the process of

communication between prescriber and pharmacist easier, meaning that if a pharmacist has any

questions regarding an ePrescription, they can easily communicate with the prescriber

electronically and in effect fill the prescription faster (Kivekas, et al., 2017).

Electronic prescription systems provide tremendous benefits, not only to the end users, but

to the healthcare system as a whole. Many of the benefits of ePrescriptions revolve around the

central topic of improving the quality of care and the delivery of healthcare. Some benefits of

ePrescriptions that involve improving the delivery of healthcare include: reducing medication
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errors through software that ensures the proper drug is being prescribed at the proper dose,

reducing the occurrence of adverse drug reactions, and reducing healthcare costs (Salmon & Jiang,

2012). These benefits are due to the software programs that are utilized in ePrescription systems,

which can work with the patient’s EHR to prevent mistakes that could prove harmful, such as

prescribing a medication that the patient has adverse reactions to, or prescribing a medication that

may have a negative interaction with another drug the patient is taking. In addition to improving

quality of care, ePrescriptions also benefit the healthcare system by decreasing costs and

improving efficiency when compared to traditional handwritten prescriptions. One review found

that ePrescription systems can help physicians manage patients through ways such as checking to

make sure a patient is taking their medication correctly through online refill date records and

making refilling prescriptions easier for physicians as they can use such systems remotely (Zadeh

& Tremblay, 2016). In addition, the review also noted one study conducted by Goldman et al that

found that the use of ePrescription systems in physicians’ offices resulted in an “approximately

50% savings in time spent on refills per day” (Zadeh & Tremblay, 2016). Aside from saving

physicians and pharmacists time, ePrescriptions can also reduce healthcare costs. Electronic

prescription systems reduce costs by reducing the chances of medication errors, which in turn

reduces the chances of unnecessary hospitalization and/or visits to a primary care physician (Zadeh

& Tremblay, 2016). Many of these benefits are measured through surveying the physicians and

pharmacists that utilize ePrescription systems.

Although there are numerous benefits of ePrescription systems, the development of

ePrescriptions is still relatively new, and as a result there are some challenges and limitations

associated with these systems. One of the largest concerns associated with ePrescribing is “the cost

of implementation and maintenance, as well as the time needed to integrate new systems into the
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workflow” (Zadeh & Tremblay, 2016). Implementing any new HIT requires high costs upfront as

well as time for user training, and these challenges are largely outweighed by the long-term

benefits of implementing an ePrescribing system. One solution to overcoming these challenges is

to make current ePrescription systems more user-friendly, thereby reducing the time spent

integrating these systems into the workplace and improving the efficiency of such systems. Even

with these challenges, ePrescription systems are still proving to be more effective and safer than

traditional handwritten prescriptions. Many studies have been conducted and all have found similar

results: ePrescription systems allow physicians and pharmacists to “provide better services to

patients as well as [enhance] patient safety” (Kivekas, et al., 2016). It is because of this usefulness

that these systems have been implemented in many countries, and are now becoming the standard

in prescribing.

In conclusion, ePrescribing has shown through multiple studies that it is more efficient and

safer than traditional handwritten prescriptions. One of the main goals of healthcare is to improve

patient safety and quality of care, and ePrescription systems help drastically reduce the errors

associated with prescribing medications. Many of the pharmacists and prescribers who already

utilize ePrescription systems feel that it has drastically improved their practice and efficiency. The

benefits associated with ePrescribing continue to grow as current systems are improved upon.

Electronic prescribing is quickly becoming the norm and it continues to grow in popularity as

health care providers become aware of these benefits.

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References

Gіder, Ö, Ocak, S., & Top, M. (2015). Evaluation of Electronic Prescription Implications in Turkey:

An Investigation of the Perceptions of Physicians. Worldviews on Evidence-Based

Nursing,12(2), 88-97. doi:10.1111/wvn.12082

Kauppinen, H., Ahonen, R., & Timonen, J. (2017). The impact of electronic prescriptions on

medication safety in Finnish community pharmacies: A survey of pharmacists. International

Journal of Medical Informatics,100, 56-62. doi:10.1016/j.ijmedinf.2017.01.014

Kivekäs, E., Enlund, H., Borycki, E., & Saranto, K. (2016). General practitioners attitudes towards

electronic prescribing and the use of the national prescription centre. Journal of Evaluation in

Clinical Practice,22(5), 816-825. doi:10.1111/jep.12548

Lämsä, E., Timonen, J., & Ahonen, R. (2018). Pharmacy Customers’ Experiences With Electronic

Prescriptions: Cross-Sectional Survey on Nationwide Implementation in Finland. Journal of

Medical Internet Research,20(2). doi:10.2196/jmir.9367

Rudorfer, M. V. (2017). Psychopharmacology in the Age of ‘‘Big Data’’: The Promises and

Limitations of Electronic Prescription Records. CNS Drugs,31(5), 417-419. doi:10.1007/s40263-

017-0419-y

Salmon, J. W., & Jiang, R. (2012). E-Prescribing: History, Issues, and Potentials. Online Journal of

Public Health Informatics,4(3). doi:10.5210/ojphi.v4i3.4304

Zadeh, P. E., & Tremblay, M. C. (2016). A review of the literature and proposed classification on e-

prescribing: Functions, assimilation stages, benefits, concerns, and risks. Research in Social &

Administrative Pharmacy,12, 1-19. http://dx.doi.org/10.1016/j.sapharm.2015.03.001

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Åstrand, B., Montelius, E., Petersson, G., & Ekedahl, A. (2009). Assessment of ePrescription

quality: An observational study at three mail-order pharmacies. BMC Medical Informatics and

Decision Making,9(1). doi:10.1186/1472-6947-9-8