e-Prescribing resources

Great discussion! As a physician with an interest in medication safety, there is a gap with communicating the need and rationale for indication on prescriptions to physicians and trainees. I do not believe indication is included in the standard of practice for a prescription in Alberta where I work. I am a preceptor for the medical student session in the upcoming weeks and the material does not include teaching about including indication on the prescription.
A multi-pronged approach would be necessary to change physician behavior regarding including the indication for a medication on the prescription. At this point it is not even articulated as an expectation. The first step would be engaging the stakeholders including but not limited to colleges of physicians/surgeons and pharmacists, undergraduate and postgraduate medicine programs, practicing physicians, etc.

I have a few thoughts after reading yours. I believe that it would be the prescriber's decision to add the indication at the time of prescribe rather than the pharmacist adding it when dispensing. If an unorthodox indication is the case, the prescriber may choose not to provide it...As a pharmacist, I'm not sure I'd be comfortable providing it if the prescriber had not. if provided by the patient I would want to be able to indicate as such...perhaps as a note rather than the 'official' indication.
As for the Acetaminophen piece, I think we have to stick to the generic names...perhaps avoid brand names completely. using your example, many people recognize Atasol and not Tylenol so by sticking with acetaminophen, we cover most unless they originate from UK. this is perhaps a unique example. I'm not familiar with any others that have different 'chemical names'. just my opinion...

Dr. James,

Thank you for your presentation that I viewed as a Webinar. Your efforts in moving practice forward is exceptional. I liked what you said about the significance of a dynamic medication profile.
In my pharmacy practice, patients remember the 'indication' for their medication. So, I'm pleased that PrescribeIT has that facility.

A specialist may choose to prescribe in an 'unauthodox' manner as all options in the evidence based guidelines have been exhausted. What would a community pharmacist do then when assessing the appropriateness of the prescription and will a community pharmacist feel comfortable including this indication?

Again from personal experience, patients get really confused with APO-acetaminophen vs, ACT- acetaminophen, instead 'Tylenol' (in Canada) 'Paracetamol' in the UK is clearer/ and less confusing to the patient. Can we consider using names that are clear to the patient when creating the profiles please.

Those are my thoughts for now.

In my thesis on the Medication Profile, I gathered evidence as to the value of various items of medication data. "Indication" was the most important for all of the use cases (in patient care and clinical research) that is *not* routinely available from any of the medication activities. One of my key recommendations was therefore to update specifications, both for the activities themselves and for the sharing of the data from those activities to include indication for use. So I'm pleased to see that the FHIR spec for PrescribeIT does have that facility. We need to use the evidence to encourage clinicians to record and share indication data, and to make sure our systems facilitate that for them.

I'd be interested to know what data set is being used in PrescribeIT. our provincial DIS can accept indication for use. At this time the only code set supported is ICD-10CA so I'd be interested to know where this is going to allow for discussion with our vendor to be able to possibly support other code sets...

Hi
Lisa - thankyou for bringing this forward to the community.
In the e-prescribing specification we are finalizing, we do have a value set for Indication for Use. therefore it will be available for use in PrescribeIT implementations early next year. I do recall in the e-prescribing work group we had differing opinions on the type of content, and acknowledge this is not something provided often today.

I look forward to further discussions on this topic. and look forward to hearing if anyone has a system that makes the selection of a medicinal product along with the Indication for Use easier.
Beverly