E-prescribing has potential to improve medication safety and boost integrated health care

As more areas of health care are adopting advanced technology – including artificial intelligence to predict hospital flows and nanotechnology being used for drug discovery – others still rely on older analog methods. Prescriptions are still commonly sent to a pharmacy by fax or paper. These older methods aren’t just inconvenient and inefficient – they can also be harmful to patients because of the potential risk of errors.

Some jurisdictions and practices are now moving toward e-prescribing, which allows electronic communication between the patient’s prescriber and pharmacist. It reduces the need for paper, reduces the risk of human error, and simplifies the process for patients.

And there may be a particular benefit to the e-prescribing of opioids.

“Given that opioids are one of the higher-risk medications, there is a lot of potential for benefit and reduction of harm through e-prescribing.”

“Overall, e-prescribing minimizes the opportunity for error because you’re minimizing the paper trail and not relying on reading someone’s handwriting, and it allows for improved communication between the physician and the pharmacist,” says Sara Guilcher, associate professor at U of T’s Leslie Dan Faculty of Pharmacy whose research program focuses on health care delivery and patient outcomes. “Given that opioids are one of the higher-risk medications, there is a lot of potential for benefit and reduction of harm through e-prescribing.”

Canada Health Infoway, a federally funded organization that works to increase digital health care in Canada, partnered with Guilcher and other researchers at the Leslie Dan Faculty of Pharmacy and at the SPOR Evidence Alliance, to examine the evidence on e-prescribing for opioids. The results of their review were recently published in the Journal of Medical Internet Research.

Software features improve safety and communication

Reviewing the available literature on the subject, Guilcher and the research team found that certain features of e-prescribing software were key in reducing errors and differences from opioid prescription guidelines. Alerts embedded in the software could draw attention to potential drug interactions or other issues, and orders for opioids could be set to a default amount, which was shown to reduce doses and quantities of opioids prescribed in some cases. The software could also improve communication between prescriber and pharmacist, which also helped to reduce errors.

Positive outcomes of using e-prescribing also have potential to extend more broadly to health systems and administration. But there is a major gap in the literature: how to effectively implement e-prescribing systems in a way that addresses the concerns that physicians’ may have about integrating new technology into their practices and workflows and maintaining patient confidentiality.

“This is an area with a lot of opportunity for future implementation research.”

“I was surprised by the lack of guidance in the evidence about considerations for implementation. In any new intervention or program, it is important to understand the factors that enable uptake and sustainability and the barriers to implementation. This is an area with a lot of opportunity for future implementation research,” explains Guilcher.

Guilcher also says that more work needs to be done to understand patients’ perspectives and outcomes related to e-prescribing. This is particularly important in the context of opioids, where a patient who is just starting opioid therapy, when smaller quantities and doses may be appropriate, needs a different approach compared to a patient on chronic opioid therapy who could be harmed by reduced access or sudden dose changes.

Most of the e-prescribing research that the team examined was from hospital systems in the United States. While e-prescribing has been implemented in Canada, it is not widely adopted yet, Guilcher says that she expects that to change soon.

“I expect transformative change in this space in the next couple of years. Electronic health records and e-prescribing and other technologies like this go hand-in-hand in trying to integrate technology across our complicated fragmented health care system, and this is another way to help integrate care, reduce harm, and improve quality.”