What you need to know about electronic prescribing (I)
By Kabiru Abubakar Gulma –
Electronic prescribing or e-prescribing (e-Rx) is the computer-based electronic generation, transmission and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorisation to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the health care provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient’s team of health care providers to facilitate knowledgeable decision making.
A “qualified” e-prescribing system must be capable of performing all of the following functions:
- Generating a complete active medication list incorporating electronic data received from applicable drug plan(s), if available.
- Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks, using integrated decision support systems (safety checks include: automated prompts that offer information on the drug being prescribed, potential inappropriate dose or route of administration, drug-drug interactions, allergy concerns, or warnings of caution).
- Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any).
- Providing information on formulary or tiered formulary medications, patient eligibility, and authorisation requirements received electronically from the patient’s drug plan.
- Review patient’s current medication list and medication history information within the practice.
- Work with an existing medication within the practice. This can involve viewing details of a medication, removing a medication from the active medication list, changing dose, etc., for a medication or renewing one or more medications.
- Prescribe or add new medication and select the pharmacy where the prescription will be filled.
- The information is then sent to the transaction hub, where information on the patient eligibility, formulary and medication history/fill status is sent back to the prescriber.
- Patient-specific information capabilities (e.g. current patient medication list, access to patient historical data, patient identification).
- System integration capabilities (e.g. connection with various databases, connection with pharmacy and pharmacy benefit manager systems).
- Educational capabilities (e.g. patient education, provider feedback).
High-level dataflow diagram outlining the roles and processes involved in electronic prescribing.
The basic components of an electronic prescribing system are the:
- Prescriber – typically a physician
- Transaction hub
- Pharmacy with implemented electronic prescribing software
- Pharmacy Benefit Manager (PBM)
The PBM and transaction hub work closely together. The PBM works as an intermediate actor to ensure accuracy of information, although other models may not include this to streamline the communication process.
The prescriber, generally a clinician or health care staff, is defined as the electronic prescribing system user which is signed into the system through a verification process to authenticate their identity.
The prescriber searches through the database of patient’s records by using patient-specific information such as first and last name, date of birth, current address etc. Once the correct patient file has been accessed, the prescriber reviews the current medical information and uploads or updates new prescription information to the medical file.
The transaction hub provides the common link between all actors (prescriber, pharmacy benefit manager and pharmacy). It stores and maintains a master patient index for quick access to their medical information, as well as a list of pharmacies.
When the prescriber uploads new prescription information to the patient’s file, this is sent to the transaction hub. The transaction hub will verify against the patient index. This will automatically send information about this transaction to the PBM, who will respond to the hub with information on patient eligibility, formulary and medication history back to the transaction hub. The transaction hub then sends this information to the prescriber to improve patient management and care by completing and authorising the prescription. Upon which, the prescription information is sent to the pharmacy that the patient primarily goes to.
When the pharmacy receives the prescription information from the transaction hub, it will send a confirmation message. The pharmacy also has the ability to communicate to the prescriber that the prescription order has been filled through the system. Further system development will soon allow different messages, such as a patient not picking up their medication or is late to pick up medication, to improve patient management.