Transcript Electronic Prescribing

Electronic Prescribing
Jill Mulderig
Objectives:
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Describe Electronic Prescribing
Discuss tools and information system needed
Evaluate the Nurse Informaticist role in
EMR/Electronic Prescribing
Discuss safety, ethical and confidentiality issues
Discuss Advantages/Disadvantages with
Electronic Prescribing
Electronic Prescribing or E-Prescribing
is:
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Computer based mode of communication
Electronic mode of generating prescriptions
Part of the growing Electronic Medical Record (EMR)
Designed for improved communication with pharmacies
and to reduce errors.
Commercially available software- can be used with or
without EMR.
(Finkelstein, 2006)
Main Goals of E-Prescribing:
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Reduce medication errors
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Improve patient safety
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Increased access to medical information
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Improved reporting ability
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Cost and time effectiveness
( Barber, Cornford, Klecun 2007)
Hardware for E- Prescribing
Can be used with :
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Laptops
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Desktop PC’s
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Pocket PC’s
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Tablet PC’s
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PDA’s utilizing a wireless network
Personal Digital Assistant (PDA)
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Handheld computer with many similar functions
Works with an operating system
Personal computer needed for syncing data and
updating.
Organizing while mobile
Compatible with innumerous programs and software
titles.
(Carmack, Freudenrich, 2003)
PDA’s in E-Prescribing
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Valuable tool to have all information needed at hand
Information can be saved to sync with office computer
Software easily compatible with PDA’s
Time saving
Helps eliminate written errors
Great start for streamlining to the EMR
Electronic communication between physicians and
pharmacists
Software for E-Prescribing
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Commercially available software
Physician or provider chooses based on
preference
Many assist with patient tracking, ICD-9 codes,
interactions, pricing, and warnings.
Work with desktop computers, laptops, PDA’s,
and tablet pc’s.
Accurate drug databases in tune with health
insurances
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(nationalerx, nd)
Commercial Software Vendors
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SureScripts
RxHub
ProxyMed
MedicWare
National E Rx
eRX Software:
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National ePrescribing Patient Safety Initiative (NEPSI)
was enacted due to the large number of medical errors
in the healthcare system.
Free program to all physicians and medication
prescribers
Created through an advocacy initiative – with
Claims to be simple, safe, and secure
Designed to increase patient safety and reduce errors.
Designed from funding to assist physicians in the
advanced technology without the high costs to them.
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(nationalerx, nd)
E RX software is designed to:
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Eliminates handwriting issues and error
Creates electronic records to ensure prescription information is
saved.
Reduces healthcare costs by improving efficiency and identifying
generic drug options
Checks for allergies, drug interactions, dosing errors, and many
other patient specific factors
Maintains an comprehensive drug database
Expedites prescription refill requests and saves staff time
Provides up-to-date formulary and insurance information
Improves data exchange between pharmacists and prescribers
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(nationalerx, nd)
Included in the free program:
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Partnership with ALLSCRIPTS and PocketScript
Six months of connectivity available (cell data
exchange or high speed internet access
available
Cell phone and WAN option available
Installed access area - connected to either DSL
or cable high-speed internet
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(Mandel, Boulter, nd)
Usability of Software:
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The system appears to be user friendly for both beginners and
experts with minimal training.
Pilot program in 2001 for physicians to evaluate
Two pilot projects confirmed better ease of use and usability for
physicians.
There is an iterative design – which can cause less anxieties.
There are icons and visual aids for the users to see.
Workarounds possible but less likely
Cognitive work analysis- program was developed under influence of
physician’s concerns.
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(Mandel, Boulter, nd)
Evaluations on Usability
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A pilot study with a focus group was enacted before release.
Collaborative is staffed by members of involved organizations for
feedback.
Forums and meetings for prescriber education and training
(cognitive walkthrough).
Evaluation after pilot to discuss and change
Study found a decrease in ER visits and reduction in safety errors.
Positive feedback received would indicate positive usability.
Qualitative evaluations done via studies to evaluate
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(Mandel, Boulter, nd)
Information System
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E-prescribing is an information system
that is available as a stand alone
configuration.
It is also part of a larger information
system- Electronic Medical Record (EHR)
Many use e-prescribing as a starter or part
of the electronic transition into the EMR.
Clinical Information System: EMR
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EMR is an electronic record with ability to
generate a complete record of a clinical
patient & supporting care related activities
through an computerized interface.
Use specific software to personalize
specific needs.
Electronic Medical Records:
Medicware
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Clinical information system
EMR and components are used by physicians,
nurses, hospitals, support staff, billing
departments, and other personnel
Available in many configurations such as
workstations, Tablet PC’s, and servers.
Networking capabilities
Some information available on PDA
Electronic Medical Records
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Computer-based
Systematic documentation of a clients health
status and health care in a secure format
Can be processed, stored, transmitted, and
accessed by authorized professionals for the
purpose of supporting efficient, high quality
health care and accurate sharing of information
across the continuum
(McGonigle, Mastrain, 2009)
MedicWare EMR Software System
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Clinical Information System
Centralized computerized patient medical record
software
Streamlined diagnostic and treatment processes
Available online or via software purchase
Houses data and information regarding the
health status of a client
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(Medicware, 2008)
Components to Medicware include:
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Clinical Data Repository (CDR)
Clinical Decision Support System (CDSS)
Electronic Prescribing with Alert messages
Medical Vocabulary
Evidence-based decision support with outcome reporting
Billing and scheduling
HIPAA compliant
Automated task management
Nurses notes
Patient Education materials
Quality management and control
HL7 interface
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(Medicware, 2008)
Data Standards for Medicware:
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American National Standards Institute
(ANSI)
Healthlevel 7 (HL7)
Continuity of Care Record (CCR)
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(Medicware, 2008)
Classifications compatible with
Medicware:
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ICD-9, ICD-10 - International Statistical
Classification of Diseases
CPT – Current Procedure Terminology
SNOMED – Systemized Nomenclature of
Medicine
HCPCS - Healthcare Common Procedure Coding
System
NANDA – used only for nursing SOAP notes
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(Medicware, 2008)
EMR advantages to Nursing:
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Promoting standardized nursing language
and terminology
Error reduction
Improve medication safety
Fast, clear access to patient information
Time saving
E-Prescribing Advantages
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Cost saving (over time)
Time saving
Error reduction
Medication Tracking
Easy access
Better formulary compliance
Provider/Nurse mobility
Improved quality of care
E-prescribing Advantages:
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Possible Medicare bonuses for eprescribing
Disadvantages/Barriers to eprescribing
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Staff resistance
Cost
Security concerns
Lack of IT staff
Technology Mistrust
Possible reduction in staff
(Anderson, 2007)
Ethical & Legal Issues:
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Security
Privacy Concerns – HIPAA
Legal barriers
(Anderson, 2007)
Informatics Competencies Required
for Eprescribing and EMR:
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Health information literacy
Privacy and confidentiality knowledge
Technical security knowledge
Basic computer literacy skills
Informatics skills – acquiring, processing, and
sharing knowledge
* Above required by the Professional Nurse
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(McGonigle, Mastrain, 2009)
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(Miller et al, 2005).
Informatics Nurse Role:
Eprescribing and EMR
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Education
Lead projects
Assist in implementation, access and support of eprescribing leading
to the expansion to the EMR.
Ensure security processes are correct and in place
Clinical resource person
Facilitates the integration of data, information, and knowledge to
support patients, nurses, physicians, and staff.
Assist and lead research
Tech support
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(McGonigle, Mastrain, 2009)
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(Miller et al, 2005).
SUMMARY
With proper implementation eprescribing can:
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Reduce medication errors
Increase access to medical information
Reduce cost and increase time effectiveness
Ease into the transition to Electronic Medical Records
Improve patient safety
Increase direct care time to patient
Space Savings
Legibility of Notes – reduce errors cause by
Summary Cont:
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Accessibility of Charts
Transcription Costs Savings
Space Savings
Eliminate Staff
Eligibility for Pay-for-performance
Multiple Users Use a Chart Simultaneously
Automatic laboratory and radiological reports
Electronic Prescriptions
System Recovery
Drug to Drug Interaction and allergy interaction
checking
REFERENCES
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Finkelstein, J (2006).E-Prescribing first step to improved safety. Journal of the
National Cancer Institute. 98, 1763-1765
Barber, N, Cornford, T, & Klecun, E (2007). Qualitative evaluation of an electronic
prescribing and administration system. Quality and Safety in Health Care. 16, 271-78.
Anderson, J (2007).Social, ethical and legal barriers to e-health. International Journal
of Medical Informatics. 76, 480-83.
Miller, MD, R, Gardner, PhD, R, Johnson, MD, MS, K, & Hripcsak, MD, MS, G (2005).
Clinical decision support and electronic prescribing systems: A time for responsible
thought and action. Journal of the American Medical Informatics Association, 12,
403-09
Carmack, C, Freudenrich (2003, 06, 12). How PDAs work. Retrieved September 30,
2008, from HowStuffWorks.com. Web site:
http://communication.howstuffworks.com/pda.htm
Retrieved September 30, 2008, Web site: http://www.nationalerx.com/
Anderson, J (2007).Social, ethical, and legal barriers to E-health. International
Journal of Medical Informatics. 76, 480-83.
REFERENCES
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Mandel, MD, BCBSMA, B, Boulter, MD, P, E-Rx collaborative, E-Prescribing: A bridge to
the 21st century. Retrieved October 5, 2008, from www.HCTProject.com Web site:
http://www.HCTProject.com
What is HN7?. Retrieved October 26, 2008, from What is Web site:
http://www.hl7.org/
Conn , J (2007, February 13). Standards rivals’ collaboration could have major
impact. Retrieved October 26, 2008, from EMRAdvice Web site:
http://emradvice.wordpress.com/category/continuity-of-care-record
2008, September). Retrieved October 26, 2008, from Center for Disease Control Web
site: http://www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm
von Krogh, G, Dale, C, & Naden, D (2005). A framework for integrating NANDA, NIC,
and NOC terminology in electronic patient records. Journal of Nursing Scholarship.
37, 275-81
(McGonigle, Dee., & Mastrain, Kathleen. (2009). Nursing Informatics and the
Foundation of Knowledge. Sudbury, Massachusetts: Jones and Bartlett Publishers)
Medicware Electronic Medical Records. Retrieved November 15, 2008, from
Medicware.com Web site: http://www.medicware.com/emr-software.html