Assessment of ePrescription quality: an observational study at three mail-order pharmacies

Abstract

BackgroundThe introduction of electronic transfer of prescriptions (ETP) or ePrescriptions in ambulatory health care has been suggested to have a positive impact on the prescribing and dispensing processes. Thereby, implying that ePrescribing can improve safety, quality, efficiency, and cost-effectiveness. In December 2007, 68% of all new prescriptions were transferred electronically in Sweden. The aim of the present study was to assess the quality of ePrescriptions by comparing the proportions of ePrescriptions and non-electronic prescriptions necessitating a clarification contact (correction, completion or change) with the prescriber at the time of dispensing.MethodsA direct observational study was performed at three Swedish mail-order pharmacies which were known to dispense a large proportion of ePrescriptions (38–75%). Data were gathered on all ePrescriptions dispensed at these pharmacies over a three week period in February 2006. All clarification contacts with prescribers were included in the study and were classified and assessed in comparison with all drug prescriptions dispensed at the same pharmacies over the specified period.ResultsOf the 31225 prescriptions dispensed during the study period, clarification contacts were made for 2.0% (147/7532) of new ePrescriptions and 1.2% (79/6833) of new non-electronic prescriptions. This represented a relative risk (RR) of 1.7 (95% CI 1.3–2.2) for new ePrescriptions compared to new non-electronic prescriptions. The increased RR was mainly due to 'Dosage and directions for use', which had an RR of 7.6 (95% CI 2.8–20.4) when compared to other clarification contacts. In all, 89.5% of the suggested pharmacist interventions were accepted by the prescriber, 77.7% (192/247) as suggested and an additional 11.7% (29/247) after a modification during contact with the prescriber.ConclusionThe increased proportion of prescriptions necessitating a clarification contact for new ePrescriptions compared to new non-electronic prescriptions indicates the need for an increased focus on quality aspects in ePrescribing deployment. ETP technology should be developed towards a two-way communication between the prescriber and the pharmacist with automated checks of missing, inaccurate, or ambiguous information. This would enhance safety and quality for the patient and also improve efficiency and cost-effectiveness within the health care system.

Interoperability : - capability to interoperate in a shared work practice using information infrastructures

“…Other studies have addressed prescription errors from a pharmaceutical point of view. [161,[200][201][202][213][214][215] This study has contributed with empirical finding and insights, which are contributions to a theory on interoperation and interoperability. See further chapter 9 A practical theory on interoperation and interoperability.…”

“…Other studies have addressed prescription errors from a pharmaceutical or medical point of view [200][201][202].…”

“…With ePrescribing, this filter was removed and all the errors created in the formulation phase in the prescription were transferred directly to the pharmacy dispensing systems. While some errors declined with ePrescriptions such as the identification of the medical drug, still pharmacists have to correct many instructions for use before they can be communicated to the patient [200,223].…”

“…Studies have shown the importance of working with improving the quality of information in ePrescribing. [162,200] The tremendous growth of ePrescribing in Sweden, where more than 95% of all prescriptions are electronic, together with the growth of new public e-services, points to a need to develop and use models for conceptualization and guidance in analyzing and developing e-services. [73] …”

“…With ePrescribing, this filter was removed and all the errors created in the formulation phase in the prescription were transferred directly to the pharmacy dispensing systems. While some errors declined with ePrescriptions such as the identification of the medical drug, still pharmacists have to correct many instructions for use before they can be communicated to the patient [200,223].Another aspect to consider is the fact when more than 95% of all prescriptions are ePrescriptions, ePrescribing have become the new the role model for Prescribing.Hence, it is plausible to assume that ePrescribing as analyzed here in its evolution, now encompasses and had become the role model for the prescribing process in general. Thus, in the final analysis, ePrescribing and Prescribing can be used interchangeable in a theory on ePrescribing.…”