Communication Breakdown: Have E-Prescriptions Lived Up to Their Promises?

FEBRUARY 22, 2017
Dylan Girardi, 2017 PharmD Candidate, the University of Connecticut

Each year outpatient medication errors account for approximately 3.3 million outpatient visits, and cost an estimated $8 billion. Pharmacists are the final step in a system of checks and balances that should prevent medication errors, yet they often encounter problems while filling prescriptions. (See table 1)
Table 1  
Administrative Problems Clinical Problems
  • Prior Authorization Approvals
  • Dose clarification
  • Formulary issues
  • Patient instructions
  • Refill status clarification
  • Allergies or drug interactions
E- prescribing has been widely adopted over the past decade, accounting for 75% of all prescriptions written in 2015. Accordingly, we expect to see an improvement in information transmission between physicians and pharmacies, and a resulting decrease in the number of physician callbacks. However, the impact of e-prescribing on pharmacy communication patterns has not been well studied. 
Recently, 2 researchers in Connecticut examined a group of independent pharmacies to quantify e-prescribing's impact. They performed a convenience sample and cross sectional study in 5 locations over a 14-day period. Participants included pharmacists and technicians. 
During the study period, 141 prescriptions required clarification. Surprisingly, the prescribing method most often implicated was e-prescribing. Pharmacists had to clarify prescriptions transmitted by e-prescribing 4 times more often than faxed prescriptions and twice as often as hand-written prescriptions.
Most often, a pharmacist clarified the problem by telephone, and resolved the majority of incidents during the first . Phone communications had a resolution rate of 80%, versus fax communications with a 55% resolution rate. 
The researchers noted that the majority of office s involved communication with medical assistants or clerical staff (58%), followed by physicians (24%), and nurses (18%).  This challenges what many physicians believe ­– that nurses have the most with pharmacists.
The high volume of e-prescriptions requiring clarification are attributed to incomplete information, software incompatibility, and inability to discontinue old medications. 
The researchers recommend that interoperability standards be implemented to standardize e-prescribing data.
Finally, they encourage e-prescribing vendors to experiment with new features and interfaces to assess how changes may affect the need for prescription clarification. 
This article appears in the Journal of the American Pharmacists Association.
Smith M, Sprecher B. Pharmacy communication with physician offices to clarify prescriptions. JAPhA. 2017; 1-5.