Increased ePrescribing Interoperability is Needed for Patient Safety

Increased ePrescribing interoperability between prescribers and pharmacies is crucial to decreased prescription drug errors and increased patient safety, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).

Since its introduction in 2003, ePrescribing has brought a more convenient, cheaper, and safer prescribing alternative for prescribers, doctors, and patients. An increase of ePrescribing aims to allow for improved workflow, increased patient safety, and more drug price transparency in the future.

“With electronic prescribing, or ‘e-Prescribing,’ health care providers can enter prescription information into a computer device – like a tablet, laptop, or desktop computer – and securely transmit the prescription to pharmacies using a special software program and connectivity to a transmission network,” according to The Office of the National Coordinator for Health Information Technology (ONC).

In 2019, healthcare professionals saw the benefits of greater access to patient data information, according to a Surescripts 2019 National Progress Report. As a result of this access, ePrescribing rates increased between 2017 and 2019, alongside improved workflows, increased drug transparency, and increased automation.

But prescription drug errors still occur in community pharmacies. Common errors include an incorrect dosage or even incorrect prescription drugs.

“Automated product selection in pharmacy computer systems, if optimized, could help prevent medication misadventures due to human error,” the study authors wrote. “However, automated product selection failure for electronic prescriptions still poses risks to medication safety and efficiency.”

Researchers aimed to determine the success rate of e-prescriptions at a community pharmacy and analyze the cause of failures. Researchers also aimed to evaluate and compare the accuracy of ePrescribing at both pre-and post-intervention.

Initially, the two selected pharmacies received 888 e-prescriptions over a four-day period. Out of the 888 prescriptions, researchers found 180 (20.3 percent) failed ePrescriptions.

Researchers audited a random 65 failed prescriptions and found 39 were the result of a mismatched national drug code (NDC). Seventeen failures did not find the targeting prescriber because the prescriber did not have a profile in the platform. The remaining nine failures could not find the targeted patient because the patient did not have a profile on the platform.

Researchers drew a second random sample and received similar results.

Researchers then conducted another test over a week-long period. The two pharmacies received 1,016 ePrescriptions and researchers found 11 errors. There was one wrong drug error and one wrong dose error. This number decreased to seven errors in postintervention.

“Our results reveal that manual product selection is still required for an appreciable proportion of e-prescriptions received by community pharmacies, which poses risks to both medication safety and efficiency,” wrote the researchers.

In an attempt to boost the chances of connecting the targeting prescriber, researchers communicated with prescribers to connect their respective SureScripts accounts to the ePrescribing platform. However, there was only a slight success rate increase.

Researchers also could not design a successful way of decreasing NDC mismatches. While there was only one incorrect drug error and one incorrect strength error during the week-long period, both were due to the NDC mismatch.

“The incidence of wrong drug errors was low in our sample, but every once in a while, in the fast-paced environment of community pharmacies, the holes of Reason’s metaphorical Swiss cheese align, as they did in the wrong drug medication misadventure (omeprazole [PriLOSEC] vs fluoxetine [PROzac]) that served as the springboard for this study,” explained the study authors.

“Establishing strong and optimized error prevention strategies such as automated product selection to prevent potentially catastrophic wrong drug and wrong strength errors is essential for patient safety,” researchers continued.

The study authors noted the RxNorm concept unique identifier as a possible intervention to correct this issue. This platform is a prescription drug identifier system that intends to boost interoperability and standardize prescription drug names to alleviate mismatches. RxNorm would eliminate the need for NDCs. However, before widespread adoption, further research is necessary on the RxNorm platform.

“In addition, our results add to the body of literature demonstrating the drawbacks of using the NDC system as the drug identifier in transmissions between prescribing and pharmacy platforms and point to the necessity of a replacement for this purpose,” researchers concluded.

“RxNorm as the drug identifier for electronic prescribing could prevent wrong drug errors and increase efficiency at community pharmacies, though as Brailer stated, ‘Interoperability may be beneficial, but it is certainly not easy.’”