The latest issue of Future Practice features an introduction by CMA President Anna Reid in which she highlights the importance of E-Prescribing. She states, “E-prescribing has long been recognized as a fundamental requirement for the effective use of EMRs by the medical profession. This has been recognized in the United States, where the ability to prescribe electronically forms an important part of the current incentive program to speed EMR adoption. Here at home, on the other hand, an article published in the May 2011 issue of Future Practice noted that ‘asking why Canada does not have widespread electronic prescribing of patient medications can yield a multiplicity of answers, most of them less than satisfactory’.”
E-Prescribing is the last significant foundational component of EMRs that has yet to be integrated. Although most EMRs provide the capability to prescribe medications and perform drug-to-drug interaction checking, prescriptions are generally printed, signed by hand, and handed to the patient. Some EMRs allow prescriptions to be signed using a pen and tablet and faxed directly to the pharmacy. However, the process is essentially unchanged from this point onwards. Prescriptions cannot be transmitted electronically to a central drug repository or directly to a pharmacy. It is not possible for a pharmacy to send a renewal request directly to a physician’s EMR system and it is not possible to prescribe controlled substances.
These are all future functionalities that will progressively be added to EMRs as provincial drug information systems become more widely available. However, it is a big mistake to view E-Prescribing as simply the transmission of a prescription electronically from a prescriber to a pharmacy and then assume that the job is done. Physicians in the United States have been E-Prescribing for the past eight years. Over 50% of physicians now submit prescriptions electronically via their EMR or standalone E-Prescribing systems. More and more is taking place via EMRs as these become more widely adopted. Data is still not complete, as EMRs can generally only query drug payment information from a limited number of pharmacy benefit managers. But once the last pieces are in place, physicians in the U.S. will have one of the most sophisticated electronic drug management systems available anywhere in the world.
I have been talking with a number of EMR vendors about the challenges they face in deploying E-Prescribing in Canada, and I have been talking to U.S. vendors about best practices and lessons learned. There are many nuances, some of which cannot be anticipated until one has faced the challenges and has had to find practical solutions to complex problems.
I will be sharing these observations and lessons learned over the next year as I dig deeper into this complex and crucial area.
To read the latest issue of Future Practice, click here.