E-Prescribing ... pros/cons?

Pharmer Jane's blog gave me a good topic to talk about tonight -- e-prescribing.

I'll admit it -- at the very beginning, I was totally drinking the Kool-Aid, believing this to be the answer to life's problems in the pharmacy. Finally! The doctor has to make the prescription clear and concise. The joke's on them! We will have our jobs done even more quickly and efficiently, PLUS, there's no hard copy for your typical Absentminded Abbie-type patient to misplace!

That was the beginning. It was quickly after e-prescribing started to filter through some of our regular doctors' offices that we realized what a headache it can be.

Sure, the e-scripting cuts down on a lot of errors. But, seriously? The local dermatology practices are huge on these systems, and change which one they prefer practically every 2 weeks. If I had even just a penny for every single issue with their rx's (no quantities, malformed sigs, typos, dosage forms being written for that don't exist, and so on), I could probably retire for at least a few years before I'd have to get back into the swing of things. But, when they write for "Plexion", how do we know if it's the cloths, the wash, or whatever else some pharmaceutical company churns out for another brand name zillion dollar "copay rape", as we've termed it at our store? They always write "as Directed in the qAM" or something just as ridiculous in the free-form text field that appears on their screens. It's also cute when the quantity field says "QS", and there's no duration specified. Just "as Directed". That's all they ever write.

And what about the doctors' office who can't even get their patient's chart correctly? Patient John McFarlander has been taking Diovan HCT for two years now, at least, and Dr. Idiot still thinks he's taking 80/12.5. Mr. McFarlander's been taking 160/25 for the two years. In fact, for the first 6 months, he took 2 80/12.5's a day. 2 tabs qd was what Dr. Idiot's nurse, Kathi, called into our pharmacist. We pulled all the 5 hard copies we had -- all phone-in's -- and they all said the same thing. "Per Kathi, please dispense at 160/25. Dr. Idiot states dose is correct at 160/25." Yet, it's always incorrect. Can you imagine an e-script from Dr. Idiot? Either he or his staff are desperately behind with their reading skills. In fact, Mrs. McFarlander sighed sympathetically with us as we frantically tried to get her husband's problem straightened out before he had to go to work. "They always do this, don't they? They can't keep it straight, can they? I can't believe this!"

E-prescribing was supposed to make it so much easier for someone to look at a patient's chart, and to find out where the problem lay. It was supposed to be fool proof! What happened to this dream world we were in with our Kool-Aid glasses held aloft to toast to this new technology?

I will be the first to say that I agree with e-prescribing, don't get me wrong. I'd rather sit and call Dr. Stupid's nurse 3 times a day to correct his malformed sig of "per Day or as Needed" on Peter Pan's amoxicillin than sit and try to decide if it says Duricef or Omnicef, let alone what strength it says for his wife. But, until humans are perfect, e-prescribing can't be. So, yes. There's a lot of issues. But, if it will help Mrs. Smith just once on her way out of the hospital and back home after contracting community-acquired pneumonia and bronchitis and needing to get some Augmentin, than I'm all for it. Just don't hit me with a retarded sig. Typically, these systems have some form of an input field for a sig. Don't fuck it up. It's simple.

I see the future moving towards e-prescribing as the only acceptable form of maintaining medication records for doctors and pharmacies, and even possibly, a system where we can share information easily from doctor to patient to see their previous history of medications, and any allergies known to either party, so when their Celebrex is denied, we can help the doctor figure out if it's easier to try some Anaprox DS, or maybe even meloxicam, if either are appropriate. Something like short-term antibiotics, and of course, controls/narcotics, should require tamper-proof, original hardcopies as many states require/request as it is, but hopefully the e-prescribing business continues to head in the right direction.

Sorry this isn't a 100% perfect entry, and that it sort of rambles a little. This is a big weekend at Casa CPhT, and it's not even here yet. There's still so much planning to do that this pharmacy tech is wondering how things will ever get done before the big start to the weekend tomorrow. What are your thoughts on e-scripting? I'm interested to see if anyone else is behind my thoughts on this one.