The Rx is On the Wall

How many times have your patients remarked, “But doctor, aren’t these drugs dangerous?” while you write out a script? And then you patiently explain that yes, drugs are inherently dangerous -- which is why they’re not on the grocery shelf next to the peanut butter -- but that you went to medical school so you could properly dope out all the complexities, including: the brand/generic drug name, available dosing, means of delivery, correct dosing, potential interactions, contraindications, and side effects.

Prescribing is, of course, something we do every day. Much of it becomes second nature, but we must stay cognizant of the potential for error.

Sounds like a job for a computer.

It makes sense to use computers to help with prescribing, as computers are adept at organizing and cataloging information.

There are two main options when considering computerized prescribing:

• Faxing prescriptions -- generally done in conjunction with an electronic medical record system. Our practice has been faxing prescriptions from our EMR for several years. It improves the process for everyone involved. Here are some of the biggest advantages:

• Sent by the EMR while the patient is still in the exam room, the prescription is usually ready when she gets to the pharmacy.

• Pharmacists receive a legible prescription, and they can see the phone number the order was faxed from (reducing forgeries).

• If either the pharmacy or patient has a question about the prescription, the EMR documents dosage and quantity clearly.

• Patients won’t forget to bring the prescription to the pharmacy. They may still forget to pick it up, but, overall, compliance is much higher.

On the downside, there is no way to check the formulary status of a particular drug, and certain narcotics prescriptions must still be hand-carried to the pharmacy.

• E-prescribing --the electronic transmission of a prescription from a physician to a pharmacy. The benefits of e-prescribing are:

• You are not required to purchase an EMR. There are both stand-alone products -- which generally use hand-held devices for prescribing -- and those integrated with an EMR.

• You can check -- in real-time -- payer formularies, thereby reducing headaches for you, your patient, and the local pharmacy.

• E-prescriptions go through a clearinghouse (the biggest is RxHub) which is connected to nearly all pharmacies. This means that a full prescription history (from all doctors) is available for every patient, making drug shopping very difficult.

• The prescription goes directly to the pharmacy database, not requiring data input by the pharmacy staff. This eliminates the possibility of transcription error.

Narcotics prescriptions must still be printed out or handwritten, at present. However, e-prescribing virtually eliminates the possibility of forgeries, so it may not be too long before legal statutes catch up with technology.

If you have an EMR and want to start faxing prescriptions or e-prescribing, you should contact your EMR vendor and see what options are available; many have add-on software available that seamlessly integrates with your present system. Make sure you check into your state laws regarding the transmission of prescriptions, as they can affect how you must use these tools.

If you don’t have an EMR and want to start e-prescribing, contact several vendors offering e-prescribing products. One good place to start your research and find impartial information on this topic is the HIMSS Web site.

Either way, you’ll have happier patients and you’ll be offering better care. Happy e-prescribing!

Robert Lamberts, MD, is a primary care physician with Evans Medical Group, in Evans, Georgia. He is board certified in internal medicine and pediatrics and specializes in the care of adults, pediatrics, diabetes, high blood pressure, asthma, preventative medicine, attention deficit disorder and emotional/behavior disorders. Dr. Lamberts serves on multiple committees at several national organizations for the promotion of computerized health records, for which he is a recognized national speaker. He can be reached at rob.lamberts@gmail.com.