Report: E-prescribing held back by technical, data quality limitations
Researchers studying the implementation of stand-alone e-prescribing systems in ambulatory medical practices determined that although e-prescribing benefits are apparent, deriving these benefits will require clinical decision support (CDS) based on presentation of accurate and complete formulary and benefit (F&B) and medication history (RxH) data, according to a report published January in the Journal of the American Board of Family Medicine.
“Before implementation, few prescribers reported using F&B references when making medication choices; all used paper-based methods for tracking medication history,” wrote lead author Jesse C. Crosson, PhD, of the University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School in Piscataway, N.J.
“After implementation, some prescribers reported using F&B data to inform medication choices but missing information reduced confidence in these resources,” he continued. “Low confidence in RxH data led to paper-based workaround.”
Researchers conducted a case study of eight independent, New Jersey-based ambulatory medical centers without EHRs that implemented one of two stand-alone e-prescribing systems: iScribe (Caremark) and TouchScript (Allscripts). Findings were based on interviews and observations conducted pre- and post-implementation by field researchers.
Although the researchers believed that providers may manage to meet Stage 1 meaningful use requirements using the e-prescribing systems, they wrote, “Challenges experienced with formulary checks and RxH documentation led to prescriber distrust and unwillingness to rely on e-prescribing-based information. Greater data accuracy and completeness must be assured if e-prescribing is to meet meaningful use objectives to improve the efficiency and safety of prescribing in primary care settings.”
They determined that current technical standard for electronic determination of insurance eligibility, as well as the lack of claims information on more than 40 million uninsured patients nationwide, has resulted in RxH and F&B data that are often incomplete or erroneous.
“Our findings provide evidence that those coverage gaps have real effects on ambulatory care delivery, which limits both the potential quality and safety gains from e-prescribing in these settings and likely will limit the ability of current e-prescribers to improve care systematically while meeting meaningful use criteria relating to F&B and RxH functions."
Additionally, according to researchers, the benefits of e-prescribing cannot be fully realized because:
Researchers concluded that “until the technical and data quality problems we have identified here are addressed, it is likely that healthcare system-level quality gains and efficiencies expected from e-prescribing use will be realized unevenly as practices struggle to meet the meaningful use policy objectives relating to e-prescribing.”
“Before implementation, few prescribers reported using F&B references when making medication choices; all used paper-based methods for tracking medication history,” wrote lead author Jesse C. Crosson, PhD, of the University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School in Piscataway, N.J.
“After implementation, some prescribers reported using F&B data to inform medication choices but missing information reduced confidence in these resources,” he continued. “Low confidence in RxH data led to paper-based workaround.”
Researchers conducted a case study of eight independent, New Jersey-based ambulatory medical centers without EHRs that implemented one of two stand-alone e-prescribing systems: iScribe (Caremark) and TouchScript (Allscripts). Findings were based on interviews and observations conducted pre- and post-implementation by field researchers.
Although the researchers believed that providers may manage to meet Stage 1 meaningful use requirements using the e-prescribing systems, they wrote, “Challenges experienced with formulary checks and RxH documentation led to prescriber distrust and unwillingness to rely on e-prescribing-based information. Greater data accuracy and completeness must be assured if e-prescribing is to meet meaningful use objectives to improve the efficiency and safety of prescribing in primary care settings.”
They determined that current technical standard for electronic determination of insurance eligibility, as well as the lack of claims information on more than 40 million uninsured patients nationwide, has resulted in RxH and F&B data that are often incomplete or erroneous.
“Our findings provide evidence that those coverage gaps have real effects on ambulatory care delivery, which limits both the potential quality and safety gains from e-prescribing in these settings and likely will limit the ability of current e-prescribers to improve care systematically while meeting meaningful use criteria relating to F&B and RxH functions."
Additionally, according to researchers, the benefits of e-prescribing cannot be fully realized because:
- National Drug Codes are used as drug identifiers in F&B files, creating the need for dozens or even hundreds of entries to cover each drug that is on or off the formulary;
- Health plans are allowed flexibility in their use of the technical standard for handling F&B information and must pay to publish their F&B information, meaning some will opt out or only use selected elements of the standard; and
- Many e-prescribing systems group patients with different health plans together, limiting the utility of coverage information for informing medication choices.
Researchers concluded that “until the technical and data quality problems we have identified here are addressed, it is likely that healthcare system-level quality gains and efficiencies expected from e-prescribing use will be realized unevenly as practices struggle to meet the meaningful use policy objectives relating to e-prescribing.”