The HIT Contrarian: ePrescribing: Not So Fast, Amigo!

Electronic Health Records (EHRs) and other healthcare information technology (HIT) enjoy a tidal wave of support from politicians, including the leaders of our national medical societies, who constantly tout the benefts of HIT. We’ve been told that adopting ePrescribing in particular helps avoid prescribing errors, improve adherence to treatment guidelines and formularies, and monitor patients’ compliance with and response to treatment. It’s also touted as an excellent way to introduce informatics-phobic physicians to the wonderful world of HIT. In the face of all this enthusiasm, I was persuaded to take the plunge. I bought software, a PDA, a router, a dedicated printer (all interconnected wirelessly, of course), imported all my patient information from our practice management system to the new ePrescribing program, took the training, and was ready to go! Or so I thought. The plunge turned out to be into some very cold waters.

My practice management system (like many) is incapable of storing patients’ pharmacy or pharmacy plan data, which is fine, because the ePrescribing system I purchased couldn’t import this data anyway (or information about insurers). It all had to be entered when we wrote the first ePrescription for each patient. Furthermore, this information is a moving target—my patients frequently change insurers, pharmacy plans, and pharmacies, which means this data must be updated at every patient visit. Since I write prescriptions for 50 to 60 patients a day (25 or so clinic appointments plus messages I receive from patients and pharmacies for new prescriptions and renewals), the time required per patient for gathering and documenting this new information adds up to minutes and even hours of extra work time each day. In my experience, there’s been no time saved and thus no money saved. We’ve merely replaced phone/fax/writing time with an even greater amount of computer time.

My patients’ medication lists are no more accurate than before, as there is no way to import medication lists from patients’ other doctors. In addition, no technology will ever help us get a complete list of all the over-the-counter medications and herbs a patient is currently taking. We’ll have to continue to rely on the patient’s memory and willingness to share this information. My ePrescribing system does not have much of a pop-up alert system for drug interactions or allergic reactions. The medical informatics literature reports that when ePrescribing systems provide these alerts, they are frequently ignored, overridden, or disabled by physicians.

The literature also reports that formularies are not readily available, and if available, are rarely up-to-date or accurate; thus, pharmacy callbacks are not reduced. The roll-out of even the simplest standalone ePrescribing system can be complicated and time-consuming, and the time required to ePrescribe is often equivalent to the old pen/paper/fax/phone method. My own experience is that although ePrescribing can save some non-clinical staff time, it actually requires more clinical staff time. Current available ePrescribing systems are neither “plug-and-play” nor user-friendly.

After spending thousands of dollars to acquire the necessary ePrescribing software and hardware and spending hours in installation and training, I asked myself, “Was this the best use of these resources?” Could the time and money have been better spent? I also need a new EKG machine, some new oto-ophthalmascopes, and office furniture that is more comfortable for my patients. My wonderful staff definitely deserves a raise, which has now been directed to ePrescribing. Who has gained in all this? My patients may be a bit happier now that they no longer have to carry a written prescription to the pharmacy and wait for it to be processed. The pharmacist is probably happy that she no longer has to decipher my writing. The insurers and pharmacy benefit plans will probably be happy to save money when ePrescribing is able to keep my prescriptions in line with their formularies. I am sure Newt, Hillary, and Teddy are happy. As for me, I have spent a huge amount of time and money just so I can work longer and harder to provide the same service to patients as before. With apologies to all the technophiles out there, I am underwhelmed.

Everest “Tad” Whited, MD, PhD, is a board-certified family practitioner with a solo practice in Plano, TX. E-mail tkunkler@mdng.com to share your opinion on ePrescribing.