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When the Institute of Medicine (IOM) of the National Academy of Sciences issued its shocking report on medical errors and patient safety last year, the committee recommended physicians adopt automated prescribing systems. But a recent survey of physician leaders and physicians in large- and medium-sized practice groups showed that while many physicians use the Internet to look up information on drugs, only 7% have started using automated systems for prescribing.
"It was really a surprise that the penetration was so small, considering that pharmaceutical and other companies have made this technology available," says Genny Jacks, senior advisor with the San Francisco-based Health Technology Center, one of the sponsors of a recent survey on physicians and the Internet.
Automated systems for prescribing have the potential to greatly reduce medication error rates and can save busy physicians time, says Henry Golembesky, MD, FAAP, a pediatrician and principal with CSC Consulting in San Francisco. "The availability of information at the point of care is going to be critical. When physicians can have access to things like electronic order entry, it has been shown to markedly reduce the chance of medication errors," he says.
For instance, if a physician miscalculates the dose he or she wants to give a patient, the computer can automatically question the dosage and check for allergies and drug interactions. These kinds of applications can eliminate the problems pharmacists often have in reading physicians’ handwriting. "With diagnoses, it can suggest to me laboratory and X-ray studies I haven’t ordered that I might want to consider," Golembesky says.
"This is a critical issue because it allows physicians to track whether the patient actually bought the drugs and if they got it refilled regularly, in addition to tracking what drugs the patient is on and if the prescribed drug will interact with any of them," Jacks adds.
Golembesky noted that one practice saves 30 to 45 minutes per day per internist by using hand-held computers for prescription writing and refills. Also, many hospitals across the country have implemented computerized ordering systems in the inpatient setting. Some large clinics have such a system in the outpatient setting, he says. "The problem has been getting medical staff to start using it and to be comfortable with it," he notes.
Software is available that allows you to write prescriptions and have them checked against the payers’ formulary, screened for drug interaction, and sent electronically to the pharmacy. Some companies offer hand-held computers that allow a doctor to order prescriptions and laboratory and radiology studies, Golembesky says.
"Everyone is looking for a new model. No matter who we talk to — pharmacists, providers, or payers — they recognize that the current system is close to breaking," asserts Lee Akay, managing partner for PricewaterhouseCoopers MCS Healthcare Practice in Pasadena, CA, co-sponsor of the Health Technology Center study.
Some physicians have complained that devices provided by pharmaceutical companies may favor that company’s products. However, there are ways around this, Akay says. "If we look at the error rate and the potential that this [automated prescribing systems] would offer, the benefits definitely are bigger than the disadvantages," he says.