What Do People Think? - Why ePrescribing in Canada needs a kick-start (TELUS Health Article)

Hello,

I came across this article late last week and thought it would be interesting to the group: Why ePrescribing in Canada needs a kick-start - TELUS Health

I thought this section was particularly thought-provoking:

"...DIS {Drug Information System} implementation does not necessarily lead directly to the adoption of ePrescribing. Pharmacies would need to have ePrescribing integrated seamlessly into their existing pharmacy management system and workflow. And...a critical mass of physicians must also participate to make ePrescribing feasible for pharmacies."

The author of this article, Vincent Ng - Health Business Consulting Sr. Manager - TELUS Health, takes the position that it might be more beneficial in the short term to get smaller groups of physicians and pharmacists connected for the purposes of ePrescribing. The likelihood of a physician needing to send a prescription to pharmacy located far away from his or her office is small so we should look to get pharmacists and physicians connected in logical geographical areas before we try to connect whole jurisdictions or provinces. This could even be done in the absence of a fully operational DIS or could happen in parallel to a DIS implementation and roll-out.

Mr. Ng concludes his article with a compelling list of why "starting smaller" might be the key to get ePrescribing implemented widely:

"There are several reasons why a regional approach to electronic prescribing can kick-start Canada’s progress:

1. Achieving critical mass. It is worthwhile and sustainable for physicians and pharmacists to participate in ePrescribing only if they can do so for a significant proportion of their patients and prescriptions. This means that a critical mass of physicians and pharmacies who deal frequently with each other must participate. This needn’t be all physicians or pharmacies in a province. A DIS can ensure that a physician in Belleville can electronically transmit a prescription to a pharmacy in Timmins, but it is unlikely to occur frequently enough to make a difference to the physician, and vice versa to a pharmacist. Concentrated pockets of high adoption and usage will drive progress.
2. Applying competitive pressure. Competitive pressures will drive pharmacies to participate in electronic prescribing if a significant number of their immediate competitors are also participating. This in turn drives up participation of local physicians and creates a virtuous cycle of adoption. This is what was observed in Ontario’s two Electronic Prescribing Demonstration Projects in Sault Ste. Marie and Collingwood, where 100% of area pharmacies participated in the pilot.
3. Knowing the network. Rolling out in regional clusters is more likely to create a network of known participants. This means pharmacists can more readily verify the authenticity of a prescription and the prescriber, and physicians can more easily identify which pharmacies can accept electronic prescriptions.
4. Involving insurers. Third-party payors can be engaged in regional initiatives to limit the potential financial liability of pharmacies. Many are unaware that pharmacists have financial reasons, in addition to their professional obligations, to ensure the authenticity of prescriptions. If a pharmacy dispenses a prescription deemed to be illegitimate by third-party payors, the pharmacy must pay back the costs. For example, a 2014 audit in BC found that 10% of the recoveries sought from pharmacies by insurers were the result of physicians not having provided dispensing directions, dates or signatures.
5. Creating ePrescribing communities. Regional electronic prescribing communities can create a “regional DIS” fairly readily. The Group Health Centre in Sault Ste. Marie shares the medication profile stored in its enterprise EMR with participating local pharmacies, which provides practical value to participants. In time, when a provincial DIS is implemented, participants can switch to a provincial view.
6. Testing full workflow. Finally, by implementing the full electronic prescribing process – Prescribe, Authenticate, Transmit, Dispense, Renew and Monitor – in regional clusters, we can evaluate, refine and test the full workflow, clinical and financial benefits of a fully electronic medication management process to all participants."

What do people think of this approach to ePrescribing? Can anyone think of any regions where this strategy might make sense?

For me, I echo Mr. Ng's statement that I quoted at the beginning of this post ("Pharmacies would need to have ePrescribing integrated seamlessly into their existing pharmacy management system and workflow."). I, too, think that we would need to have full integration of an ePrescribing order into the Pharmacy Management Systems (PMS) either out of the gate or very soon after ePrescribing is turned on for a region. Having a prescription order automatically entered into the PMS without human intervention (but in a state that a pharmacist can verify and possibly communicate with the prescriber prior to finalizing the order in the computer) would drastically reduce transcription errors. However, that adds a layer of complexity that may slow adoption.

What are your opinions on this topic?

Thanks,

Brad