[e-drug] Guidelines for electronic prescribing

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E-DRUG: Guidelines for electronic prescribing
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[Crossposted from DRUGINFO; sourced from http://techrepublic.com.com WB]

From: HEALTHCARE IT E-NEWSLETTER for August 19, 2003

The topic of electronic prescriptions has been around for a few years, but
two recent events have brought it to the forefront. On June 20, the American
Medical Association (AMA) announced its adoption of guidelines for
prescribing medicine over the Internet.   Here are
some of the key provisions of the AMA guidelines:

* Physicians should obtain a patient's medical history and complete a
medical exam prior to prescribing electronically.
* Physicians should maintain and update patient medical records, including
electronic prescription information, and make them readily available to
other healthcare professionals.
* Physicians should follow up with patients as appropriate.
* Prescriptions should be transmitted securely and password-protected.
* Physicians should be licensed or, at a minimum, meet regulatory
requirements in the state in which the patient lives.
* Physicians should present appropriate dialogue concerning risks, benefits,
and alternative treatment options.
* Physician should clearly disclose identifying information on the Web, such
as name, address, and special relationships to products
prescribed.

In addition, the U.S. Senate and House of Representatives recently passed
two separate versions of Medicare legislation (the
Prescription Drug and Medicare Improvement Act of 2003) requiring the
Department of Health & Human Services (HHS) to develop standards for
electronic prescribing systems.

Key provisions of the proposed legislation address the following:
* Benefit design, including discount cards
* Medication Therapy Management program
* Patient choice and access to pharmacies
* Administrative Simplification requirements for the adherence to electronic
standards
* Adjustments to the Average Wholesale Price index
* Rules for the importation of drugs

Both the AMA guidelines and the proposed federal legislation are also in
line with international expectations.

For instance, the International Pharmaceutical Federation, headquartered in
the Netherlands, has issued similar guidelines in
its Statement of Professional Standards on Electronic Prescriptions.

Why are electronic prescriptions such a hot topic? There are two main
drivers for e-prescriptions: quality of care and cost. Other
benefits of electronic prescriptions include:
* Reduction of errors due to illegible handwriting, and confusing or
similar-sounding drug names
* Additional information for physicians concerning the prescribed medication
* Information on drug interactions
* Information on drug allergies
* Correct dosages
* Formulary status of the drug and drug preferences
* Generic drugs
* Step therapy
* Process efficiency, speed of prescribing and fulfilling, and improving of
patient care
* Security and prevention
* Improved integration with patient records, especially electronic records
* Ability to flag adverse interactions when more than one provider is
prescribing for the same patient

Unfortunately, adoption of e-prescription technology has encountered a
number of barriers. One of the biggest obstacles is affordability.
Currently, physicians face large up-front investment costs for the
technology. Because of this, many advocates consider it crucial for the
proposed Medicare legislation to include a financial benefit for providers.

Another barrier to adoption is providers' perception of the value of the
process. Some surveys indicate that providers perceive that
electronic prescriptions would provide limited value to their practices.
Poorly designed applications, lack of interoperability
with other systems, or legislation that, until recently, seemed to
discourage use also help support this belief.

Healthcare IT professionals are addressing these issues with the infusion of
new technology and reengineered applications. Web technology, secure
wireless networks, and small footprint devices such as PDAs are leading the
way. Standardization of data models, process workflow, and interchange
protocols will advance the goal further.   Healthcare IT professionals
implementing the technology within clinical environments may need to acquire
new skills, such as wireless networking  or programming for PDAs and tablet
PCs. In addition, IT pros must perform detailed reviews of applications'
impact on security and compliance.

Several vendors currently offer electronic prescription software solutions,
including AdvancePCS, Allscripts, and OmniMD.

Scott Withrow has more than 20 years of IT experience, including IT
management, Web development management, and internal consulting
application analysis.

Access Essential Drugs Monitor #32 at http://www.who.int/medicines/mon/mon32.shtml

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