Transcript What e-prescribing cannot do

Summery of 1st ten chapters of
E-PRESCRIBING
The Electronic Transformation of
Medicine
d/JACK E.FINCHAM
by
Nisreen Gamal Ali Atallah
nes.rin`[email protected]
E-prescribing
Can be defined as the use of computing devices to
enter, modify ,review ,and output or communicate drug
prescriptions
N.B earliest application of e-prescribing in hospitals in 1970
Implemented use of health it will
1- Improve HC quality
2- Prevent medical errors
3 -Reduce HC cost
4- Decrease paper work
5- Expand access to affordable care
Also bring many public health benefits
include
1-Early detection of infection diseases ,outbreak
around the country
2-Improved tracking of chronic diseases
3-Evaluation of health care
Issues to be considered when entering the e-prescribing
-Various features and function that are apart of vendor
system
*Regulatory compliance
*EMR solutions
*H.W-Mobile
-Desktop
-Remote computing
*Services-Training
-Support
-System interface
-Updates
*Cost –H.W
-S.W
-Free trials; other discounts
*Functionality
*Functionality
-Refill authorization
-New prescription
-E-prescribing history
-User tools
-Drug interaction checking
-Formulary magament
What E-prescribing can do
A) Reducing adverse drug events
E-prescribing provides decision support for selection of :
1-Prescribtion product
2-Information about formula , dosing ,frequency
3-Chick for allergy &drug interaction
4-Avoidence of therapeutic duplication ,maximum and minimum
dose
B) Ability to detect Fraudulent Patient Activity
patient see numerous doctors
multiple precribtion of drug of
abuse , antibiotic ,antidepressent
Fraud detection capability that built into every e-prescribing
system
C) E-prescribing as means of enhance quality
Bell & al suggest developing frame work when we
need evaluation
They points services of 14 options that e prescribing
can help address:
1-patient selection or identification
2-diagnosis selection
3-medication selection
4-safty alerts :
a) drug choice errors ,including allergies
b) allergies drug-drug interactions
c) drug disease interactions
e) drug : lab (renal , hepatic junction )
D) Numerous Benefits of E-prescribing
1-Enhance the Accuracy of Drug Prescribing
(Bell &Friedman)
-Transmission of order accurately
-Adhering to guidelines (EBM)
-Monitoring of patient ‘s response ttt
-Stay current with information on ttt protocol
2-Value Added Aspect of e-Prescribing
3-Using e-Prescribing to Monitor Patient Medication
Compliance and Persistence
Numerous Benefits of E-prescribing
4-Cost Issues and Ramifications
Decrease cost by increasing the accuracy of
medication &decreasing medication errors
5-Better Control of Risky or At Risk Drugs
-Controlled substance
-Teratogenic drugs
-More accurate dosing with chemotherapy
-More control of Black Box Warning Affected
drugs
More limitation of e-prescribing
A) Increase of Self Medication &OTC drugs
1-increase locations from which to purchase OTC
2-patient comfortable of self diagnosis e self selection
Of OTC drug
3-many medication switched to OTC classification
B) Direct-To-Consumer Advertising (DTC)
C) System cannot indicate where consumer obtain medication
D) Lock Of Insurance Coverage
Actual incidence of ADR is unknown and still occure despite
sophisticated e-system
- There isn’t a floor poof system to report ADR occurrence
E) Complience
(patient drug taking behaviour is unclear)
Intervention
-patient counsling
-specialized packing
-varying reminder ex e-mail –tel call
-other types of socialized contact
F) Frank Errors
Error s in prescribing (wrong patient ,drug ,dose ,duration of action)
also pharmacist can make error in dispensing and labeling
N.B error will continue to be made as long as human included in HC
G) Wrong diagnosis
H) Tacking the place of face to face Encounters
HC professionals need to interact by phone as will as interact
electronically
What e-prescribing cannot do
1.
2.
Consideration of improper access and resultant impacts
Errors occurring with e-prescribing
-confusing on screen laboratory results review
-system usability difficulties
-user training problems
-suboptimal clinical safeguards
1.
Impact on formulary adherence and generic drug utilization
2.
Varying uptake by community pharmacy
3.
Varying factors influencing e-prescribing
-physician resistance to change
-inadequate planning to incorporate e-prescribing into existing
care process
-cost
Required Data Points Ideal For ePrescribing Accuracy
*Activity reports and :patient specific information
*Allergy data :drugs and other agents
*Available drug listing :for prescribing drugs
Drug reactions and interactions •
.Drug/allergy interaction
.Drug/drug interactions
.Drug/food interactions
.Drug/herbal supplement interactions
*Drug reference
*Drug reports :patient medication history •
*Eligibility check : insurance eligibility
*favorite prescription list
-for the prescribing physician ,the most commonly prescribed drugs
specific to the physician
*generic medication listing
*global pharmacy list :all pharmacies eligible to be used
-mail order pharmacy
Required Data Points Ideal For e-Prescribing
Accuracy
*last office visit
*medication history download for each patient
*patient medication history
*practice pharmacy list : favorite of physician or patient
*patient schedule
*patient sharing :other physician seeing patient can be viewed
*patient demographics :age ,gender, other patient notations
*pharmacy search :area specific or accessible at a specific point in time
*Prescription report : all drugs the physician(s) has prescribed
*rapid medication entry
-a character recognition system that displays the drugs with these
letters that have been typed
*renewals/refills :available for each of the patient’s prescriptions
*referrals: from and to the physician entering the data
*user preferences :favorite dosing parameters that are physician
specific can be added
Steps To Enable e-Prescribing
1 -One-on-one training and support upon initial
deployment
2 -Strong marketplace sponsorship
3 -vendor marketing and out reach
4 -Analyzing the workload impact upon physician
5 -Stimating the need for community wide
approach to implementation