Diagnosis in ePrescribing – Now is the time for the next generation of ePrescribing!

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By Michael Burger, Senior Consultant

ePrescribing has now surpassed the “tipping point” with greater than 60% of prescriptions issued electronically. That percentage is expected to increase as the late adopters overcome objections and join the ranks of the majority.  

Reaching the tipping point has been 10+ years in the making.The design premise for ePrescribing years ago was to duplicate the paper prescribing process.This is because then, the competition was not between different EHRs and ePrescribing software, it was between using pen and paper versus using a computer. This meant that features that would add value (such as adding a diagnosis) were not included, because requiring a diagnosis for an ePrescription created a requirement that didn’t exist for paper prescribing – creating a barrier to adoption.

ePrescribing technology today is largely unchanged from its debut more than a decade ago. Now that basic ePrescribing is “mature,” the time is right for innovation to increase the value of ePrescribing past the bellwether administrative savings.

One such innovation is the inclusion of diagnosis with an ePrescription. A recently published study (Warholak et al. / Research in Social and Administrative Pharmacy 10 (2014) 246–251) highlights some very promising results of a pilot study regarding including diagnosis on electronic prescriptions.

The study, conducted at a community health center over two four-week phases evaluated a total of 1,888 ePrescriptions at the center’s pharmacy. The first phase investigated conventional ePrescriptions that did not contain a diagnosis. In the second phase, prescribers were asked to include the patient diagnosis in each ePrescription.

The results of the study are interesting, and in some cases, surprising. The study found that the rate of intervention was 3.9% for the ePrescriptions without diagnosis, compared to a 1% intervention rate for ePrescriptions with diagnosis.   Potential drug-drug interactions, missing information, therapeutic duplication and excessive dose were the most frequent reasons for intervention in the pre-diagnosis group. In the post-diagnosis period, the results were similar except that excessive dose did not rank among the top 3. The most common actions in both phases were to consult the prescriber and to review the patient profile/medication history.

Instinctively, one would think that providing the pharmacist with diagnosis would increase the incidence of drug therapy problems. The study found the opposite, with almost a 3-fold decrease in pharmacist/prescriber consultations to clarify or correct prescription orders. The authors suggest that “a greater understanding of the prescribers’ reasoning may help the pharmacist better reassess the medication related problems during DUR.”

The authors further observe it is possible that by virtue of asking prescribers to cite the diagnosis, they became “better” prescribers. This possibility requires further study to determine if requiring a diagnosis does yield higher quality prescriptions, and if the change in quality is temporary or permanent. 

Despite the widespread adoption of automated formulary and DUR checking within electronic prescribing applications, doctors and patients still rely on pharmacists to be the final “quality check” to ensure safe and effective prescribing.  Given that very important role, it seems a very small investment of a prescribers’ time to include diagnosis when ePrescribing.  

Tony Schueth

Tony Schueth


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