How Will Canada Achieve E-Prescribing?

In the five years from 2008 to 2012, E-Prescribing in the United States became mainstream. According to health information network operator SureScripts, in 2008 only 1 in 10 physicians E-Prescribed. By 2012, this number had increased to greater than 2 in 3 physicians E-Prescribing (69% of office-based physicians). Click on the image to view progress during this period.

It is important to note that the adoption of E-Prescribing in the United States has taken place rapidly, with 380,000 office-based physicians actively prescribing — this in a country with 5 times the number of state jurisdictions and 10 times the number of physicians as Canada. So, how did they do it and what lessons can we learn?

• The Canadian Medical Association and the Canadian Pharmacists Association released a joint statement on E-Prescribing in May 2013. The Statement highlights the principles, vision, and benefits of E-Prescribing. In the document, the definition is as follows: “e-Prescribing is the secure electronic creation and transmission of a prescription between an authorized prescriber and a patient’s pharmacy of choice, using clinical Electronic Medical Record (EMR) and pharmacy management software.”
• In the U.S., E-Prescribing is defined more broadly than in Canada. I believe this to be largely responsible for setting expectations and determining measures of success in the U.S. program. The Clinician’s Guide to E-Prescribing (developed by The Center for Improving Medication Management) defines E-Prescribing as the use of a computer, handheld device, or other hardware with software that allows prescribers to:
  • With a patient’s consent, electronically access information regarding a patient’s drug benefit coverage and medication history.
  • Electronically transmit the prescription to the patient’s choice of pharmacy.
  • Receive electronically transmitted prescription renewal requests from a pharmacy when the patient runs out.
  • Support the entire medication management process: prescribe, transmit, dispense, administer, monitor.

While there may be different approaches in Canada regarding statement 1, namely the need to access information regarding a patient’s drug benefit coverage, the important differentiator is the description of a continuum of care, as in the last statement. Prescribe and transmit are just two components of a system that needs to function as a closed-loop in order to be successful. If we do not include electronically transmitted prescription renewal requests in the definition, key functionality (e.g. the need to reconcile the prescription renewal with prescribed medications — particularly if additional prescriptions have been written by a different prescriber — will not be built into the core systems.

We are on the right track; however, the U.S. must have done something right to have achieved the high levels of adoption of E-Prescribing that are currently in place. The definition is just a small piece of a big and complex system, but it is an important component.

My recommendation is to revisit the definition of E-Prescribing and ensure that it is sufficiently comprehensive that success can support the entire medication management process — prescribe, transmit, dispense, administer, renew, and monitor. If this is not done in advance, we may achieve 100% success, but end up with only half the needed systems and processes.

Share your thoughts on E-Prescribing. Should we revisit the definition or do you think we have enough to achieve our goals in Canada? Click on the “Comments” link below.

Comments

[Dan Zbacnik]

I am not an expert in this filed by any means. I just think that in 2014 and soon 2015, it is ridiculous to have a paper based system. Why is the patient made to be a delivery person? Can we at least start with the most common form of the transaction and add more over a short time?

[Karim Keshavjee]

In Canada, perfection is the enemy of good. We don't like having an improvement over the current system. We want to achieve perfection in the first iteration.

If we can't achieve perfection, we either wait until everyone on the planet has figured it out and then implement or we go ahead and implement and pretend it's perfect the first time around. We don't plan to iterate and improve our systems.

Time for us to grow up.