Prescribing Best Practices Using Your EMR

E-Prescribing is widely used in the United States as well as a number of other countries in which the majority of physicians use an EMR. In Canada, although medication management and prescribing capabilities are available in most EMR systems, the functions tend to be more related to use within the practice rather than submitting the prescription directly to the pharmacy.

Health Canada defines E-Prescribing as “a means of streamlining the prescription process by enabling prescriptions to be created, signed and transmitted electronically from practitioner to pharmacist”. The definition does not include other elements that are part of the medication management process such as dispensing, administration, monitoring, and receiving electronic renewals. The inability to currently E-Prescribe via an EMR limits current prescribing to what can be done using an EMR within the medical practice.

In this context, what are the best practices and how can you optimize the use of your EMR for medication management?

• Is the drug database in your EMR current and up to date? Prescribers that use EMR systems rely on the Drug-Drug interaction warning capabilities of within their systems. Unless an EMR company is extremely large, it is unlikely that the drug database is developed and maintained by that company. Usually, the drug database is licensed from another company such as First Databank, in which case it is updated according to a specific schedule (e.g. monthly or quarterly). It is important to know how frequently the drug database is updated. If your EMR is a local server system (i.e. hosted on a computer in your office), updates may take place when your EMR software is updated or manually based upon a specific schedule. With ASP (remotely hosted) systems, updates are made through a central server and do not require a manual update process. Find out from your EMR vendor how the drug information is managed and updated.
• Establish a practice policy to manage new medications that are added to your EMR system. Some systems allow users to manually add medications that are not listed in the drug list within the EMR. While this provides an easy mechanism to add the names of new medications, all of the supporting data regarding that drug will not be available, negating the benefits of drug interaction warnings. Only add medications with the knowledge that some of the safety features within the EMR will not generate alerts and warnings. When the drug database is updated by the EMR vendor, there may be more than one listing for the same drug requiring the reconciliation of previously added medications with full listings in the database.
• Set up commonly used formulae for prescribing at the practice level, e.g. 250 mg Tablet TID. Prescribers can then use a standard list of regimen formulae rather than each prescriber setting up their own lists.
• Many EMR systems allow the user to compile a commonly used list of medications.This will significantly speed up the prescribing process.

By following these simple rules (if the capabilities are available), you should be able to improve your medication management processes within the EMR.

Comments

[Dr David Rapoport, Toronto]

It took us 6 months to learn how to repeat just 1 of multiple prescriptions, and to learn how to fax prescription renewals internally to any of the 50 or more drug stores my patients prefer; this is inexcusable on the part of our vendor; I am 71 and my associate is 56, but we are not stupid or demented; our first instructor assumed we were incorporating all his instructions over 2 lessons--we obviously were not. A more patient instructor was not available until we had beed floundering for 3 months, doing entries that had to be altered. Finally, a video manual was created, enabling us to understand many procedures on our own time.
Things are humming now, but I resent the wasted time, the frustration, and the unspoken implication that we are clueless. This stuff is complicated, much of it involving 3 to 5 steps. I suggest spending an office day with a colleague who knows what he is doing.