Gov't support for research crucial to future of eRx success

Continuous studies on the impact of e-prescribing are crucial, according to a commentary published in the American Health Information Management Association's online research journal, Perceptions in Health Information Management.

Olufunmilola K. Odukoya, MS, research assistant and PhD student, and Michelle A. Chui, PharmD, PhD, assistant professor, both at the University of Wisconsin-Madison School of Pharmacy in Madison, wrote that the federal government has played a major role in influencing the adoption and use of e-prescribing.

In their commentary, the authors made the following key points:

• Due to financial incentives for meaningful use, and penalties for lack of implementation, many organizations have rapidly adopted e-prescribing systems.
• However, rapid implementation has uncovered long-term costs and unintended patient safety hazards that require empirical research to fully characterize the true contribution of e-prescribing to healthcare systems.
• Research initiatives have therefore shifted from a focus on e-prescribing usefulness to an emphasis on safety concerns and expanded use.
• Studying how users interface with this new technology, how systems have been implemented, and their impact on healthcare processes and outcomes is crucial.

The authors wrote that the Institute of Medicine’s (IOM) 1999 report, To Err Is Human: Building a Safer Health System, spurred the federal government’s decision to promote nationwide adoption of e-prescribing by estimating that the death rate associated with medication errors was approximately 7,000 annually. A report issued subsequent to the IOM report, Crossing the Quality Chasm, noted that the use of technologies such as e-prescribing systems could help reduce medication errors and improve patient safety.

Meanwhile, efforts expanded and culminated in the Health IT for Economic and Clinical Health (HITECH) Act of 2009 which authorized grants and incentives totaling between $14 billion and $27 billion to promote meaningful use of e-prescribing.

Educating organizations on the benefits of the ability of e-prescribing technology to improve safety was the primary focus of early studies, the authors wrote. Currently, e-prescribing research revolves around five main areas:

1. Comparing functional capabilities between e-prescribing systems so as to detect unintended hazards;
2. Examining how to facilitate the implementation to meet specific workflows;
3. Discovering new uses to improve efficiency and patient safety;
4. Evaluating the impact on processes and outcomes; and
5. Investigating how e-prescribing could be used to improve quality of care in patients with chronic conditions such as diabetes and hypertension.

“The most recent studies on e-prescribing systems involve identifying current problems, developing standards for e-prescribing design and applying human factor principles to redesign e-prescribing to suit individual organizational needs,” the authors wrote. Researchers also are studying ways to expand the use of e-prescribing systems to help organizations monitor patient compliance with medication use and response to drug treatments.

Aside from the ongoing research, the authors wrote that the federal government is beginning to see the need to develop standards to establish consistency of e-prescribing systems among all systems or geographic locations. Healthcare organizations also are interested in scientific evidence to show that the benefits of e-prescribing systems outweigh the long-term costs of maintaining these systems, they noted.

“The future of e-prescribing research largely relies on federal government initiatives shifting from incentivizing meaningful use of e-prescribing technology to supporting the identification and addressing of problems with this technology to reduce the likelihood of errors,” the authors wrote. “Many of these errors and problems have already been identified in the scientific literature. E-prescribing research initiatives should be targeted toward addressing safety risks associated with advancement of this technology.”

Healthcare organizations have considered the use of e-prescribing a primary way to reduce medication errors and improve patient safety but more and more organizations are beginning to question this assumption, the authors noted. “More research needs to be done to confirm or disprove the assumption of the IOM that HIT will reduce medication errors and healthcare costs. With federal incentives promoting meaningful use of e-prescribing systems, it is likely that more organizations will adopt this technology. The rapidly evolving nature of this technology makes continuous studies on the effects of e-prescribing systems relevant and necessary.”