ePrescribing

I’m probably the only person here who is going to feel this way, but I think this whole ePrescribing shit is bad juju.
Sure, doctors obviously lack some gene to write well, but ePrescribing is going to end up killing more people than saving.
Why? Take your typical doctor. Brilliant medical mind, but can barely point-and-click. Now throw that doctor in front of a computer with a tiny little drop-down box that has such winners as:
Hydralazine
Hydroxyzine
and
Lamisil
Lamictal
and
Topamax
Toprol
In tiny tiny font all right next to each other in the drop-down drug selection menu. Ever click on the wrong thing on the screen? Yeah, I think you can see where i’m going with this. Uh-oh! Here comes hydralazine 25mg 1 q8 prn itching come racing into our fax machine. Uh-oh! That patient just died! Uh-oh! That pharmacist was a major dumbass (*ahemwalgreensahem*) 🙂
To make matters worse, the doctor probably has someone talking to them while they are trying to place that little mouse pointer on exactly the right drug in the huge huge list thats scrolling down past the bottom of their screen. Click on the wrong drug, type in their magical password so it prints their signature on the dotted line, and blam-o, your pharmacist just saved you from lawsuit city. Now if this doctor has a 21″ flatpanel that drop-down box is pretty damn big, and the click-space between similar sounding drugs is pretty big too, but what about PDAs? Now that big screen is a tiny tiny little screen with a tiny tiny little stylus that you select the drug from a tiny tiny little list. Fun shit technology is.
Now I know you all are probably thinking; “Gee! This happens with paper-and-pad Rx’s all the time too!”. However, using a mouse does not involve 20+ years of muscle memory. Ever drive on autopilot to the office and wonder “why did I come here?”. Any schmo doctor can write out Amoxicillin 500 tid x10d #30 while talking, doing surgery, and taking a dump. They have been writing Drug X with Sig X and Quanity X for 20 years. Drug matches Strength matches Quanity. If they error, they error (you hope) on the side of just writing the wrong drug and a safe sig to go with that drug. Sure, the patient is getting the wrong drug but I’d rather have him get the wrong drug and a correct sig for that wrong drug than the wrong drug and an overdose sig intended for the correct drug. Make sense? Confusing isnt it.
What about forgeries? We all know Windows is a exploit riddled piece of crap operating system, but 99.999% of ePrescribing is written for it. Send an office staff a little happy email with a virus, and you have an endless supply of vicodin and soma that you can send to ANY pharmacy and have it be “legit”. You think a minimum wage front-end office staff girl is going to question Norco 10/325 #240 1 q4 prn pain with 5 refills when it clearly shows that on their computer screen? Hell, I bet the software even helps them with the sig and everything! At least with phone-ins you get a gut feeling when its a phony by the way they call it in (or its a voice you dont recognize) or the red flags with a stolen Rx pad.
To make matters worse – patients come waltzing into your store expecting their Rx to be ready (because doctor was typing it in while they were at the office an hour ago) only to have it NOT be at your store because their ePrescribing auto-fax software screwed the pooch (or they have your fax number in wrong). So it takes a phone call from you to a dumbass at the doctors to get a verbal. All when 2 extra seconds and a hard-copy Rx is all thats needed. Horrible, absolutely horrible.
Now I know all the doctors at home will say “But it makes reviewing my patients medication SO much easier”. Thats great, but does your software talk with the patients cardiologists software? How about the patients neurologist who prescribes Tegretol 1600mg/day and you’re giving them Nizoral 200mg qd (I caught that one today, +1 for me!). ePrescribing is all fine and dandy, but if your records are going to be electronic, at least interlink them with other doctors offices (oh, I can see the HIPAA police frothing at that one). Of course the same could be said about independant pharmacies as well, but at least we talk to each other on a regular basis.. 🙂

Comments #

Comment by BlueTech on 2007-04-09 20:44:53 -0700 #

E-RXing evenscrews over the corporate pharmacies. We get something the doctor types in, it doesnt match our drug inventory, they put /too much/ patient info in, so we cant match it to a patient because _our_ software sucks, and of course, until we manage to locate the correct patient file, enter in the drug (which is spelled wrong half the time), and bill the usually-expired insurance, we can’t do anything else on the terminal. Almost makes me wanna work in the photo department.

Comment by MrHunnybun on 2007-04-10 01:10:23 -0700 #

Yes, I see the same problems happening here. Already I’ve seen prescriptions for Quinidine instead of Quinine, the Hydralazine/Hydroxyzine one you mentioned and Paroxetine instead of Fluoxetine (that happens a lot both SSRIs, both 20mg maybe?)
I see it only getting worse with prescription transfer over the internet-coming here soon.
My favourite oops-
Doctor clicked on Reductil 10mg caps(Sibutramine) Instead of Ramipril 10mg caps 🙂

Comment by #1 Dinosaur on 2007-04-10 03:34:19 -0700 #

Not that I want you to faint dead away with shock (oh what the hell: yes I do. I need some excitement in my life) but I agree with you about e-prescribing. From the drop-down lists to asking for forgeries, you are spot on.
And although I know the snarky generalizations are part of your persona, I’d like to go on record that *not* all doctors have illegible handwriting. Between those of us who do calligraphy and those of us (older) who went to Catholic schools, not every Rx reads like bird shit smeared on a sidewalk.

Comment by Amanda on 2007-04-10 07:08:06 -0700 #

I guess everything has its pros & cons. When it comes to becoming technology savvy, it’s a practice makes perfect thing, is it not? I wonder whether e-prescribing will be available over here or not.

Comment by Lamprx on 2007-04-10 10:51:03 -0700 #

My only problem has been signing DAW but phoned in rxs are not so indicated. Call them and they say generic is OK so how can you tell when they really mean it?

Comment by The Independent Urologist on 2007-04-10 14:59:46 -0700 #

Nice template! Good post.

Comment by Greg P on 2007-04-10 17:54:42 -0700 #

I have my own system. It could involve faxing, but generally doesn’t.
I make my own prescriptions using either templates in Wordperfect (if I’m using Windows), or with my own concoction using Latex in Linux.
I have coached myself to look up medicines excessively in the PDR (usually on my system — I’ve got my own search program that works better than what they send out on the CD). I write in plain English – 3 times a day instead of tid, for example, so the patients can read the prescription themselves.
I think it shocked some pharmacists when they started seeing them, but I have never gotten any complaints.

Comment by Judy on 2007-04-10 21:29:56 -0700 #

Computers can make things so much more fun. Doc ordered filgrastim for my patient (handwritten, faxed to the in-house pharmacy. The pharmacy sent me furosemide. 10 mg/kg.
Yes, decimal point error there as well as wrong drug.
No, of course I didn’t give it. It wasn’t ordered.
What happened? Filgrastim is right above furosemide in the pharmacy computer. Point, click, print label. Someone else snatches it up and decides to help out by filling it.
I can totally see that happening without benefit of a nurse who has seen patient, physician, and medication order. So who gets sued, Bill Gates?
Yeah, right.

Comment by Nic on 2007-04-11 08:50:18 -0700 #

Thank goodness I’m not the only one who hates E-prescribing. Just last week I had a woman come storming back in to the pharmacy demanding to know why we had dispensed an injectable (depo-provera) instead of the dostinex she normally took. How the hell did we screw that one up, I wondered. Pull the hard copy, it’s an e-rx from her clinic (same one I use, so I’m familiar with the system). Rx is for Depo-Provera. I show the patient and she’s like “How the hell did that get over here?” Easy. The clinic’s software has all the pt’s meds in alphabetical order. The CMA (clinic medical assistant, a barely-trained nurse wannabe) clicked on the wrong drug, the doc authenticated it assuming it was right, and it got faxed to me. Even though I had filled it correctly and had no way of knowing the drug was wrong, I had to take it back and send it for salvage. Of course, if the pt had paid any attention at consult, the error would have been caught right away, but unfortunately many of my colleagues don’t consult as well as I do.

Comment by Ty on 2007-04-12 08:54:29 -0700 #

Hey – I wondered if you might shed some light on an issue for me..this is in regards to your “Lovenox, Heparin, and Mr Clot” post awhile back. I have a family member who recently had a DVT and was treated with Heparin while in the hospital but the also given 5 days for the Coumadin to build up before she was released. The problem I am having is that she is also bi-polar and has been stable for 8 years on a mix of prozac,haldol,and zyprexa…it seems that about the time she was released (and the coumadin had built up) she started showing major bi-polar symptoms…I am afraid that the coumadin might be having an effect on her other meds but she is to take it for 6 months…she is in the psychiatric ward of the hospital right now because things are so bad. Are there any other anticoagulants she could take for a long period of time to get her off of the coumadin. Your help would be greatly appreciated, please just email me at the email above if you have the time. Things are pretty time sensitive right now as you can imagine…Thanks again.

Comment by The Owl on 2007-04-12 21:17:38 -0700 #

Yeah! Got a nice e-Rx today for Auro Ear Drops 6.5% 1-2 gtt ad qid prn pain. Mom was pissed it took an extra 20 min to call the office to make sure they REALLY meant aurALGAN! e-prescribing…just another Pandora’s Box where pharmacists will catch all the evil for mistakes…

Comment by Kristin on 2007-04-13 05:30:05 -0700 #

In regards to the iScribe not sending information and you having to make a phone call, I bet you also get this a lot too…a patient came into our pharmacy and was looking for their RX, alas! It is no where to be found, so I called the Dr’s office and asked them to give it to me over the phone. They tell me “no” that they are going to iScribe it again! Ummm, it didn’t work the first time…just TELL me, it’ll take 2 seconds! No no, it simply MUST be iScribed. Fast forward 3 hours later, patient is calling non-stop and still no RX, make a second phone call. *ring ring* Out to Lunch. After about 2-3 more calls they finally get their iScribe running right and it sends, but who gets the wrath of the patient/custormer…surely the Dr’s office, right? WRONG! ME! Down with iScribe!

Comment by just a tech on 2007-04-13 14:14:57 -0700 #

No, you aren’t the only one who isn’t all too fond of it.
“Take 1 tablet po 2 times daily bid q12h” etc. etc. etc. gets annoying.

Comment by madge on 2007-04-14 07:27:19 -0700 #

yep, e-prescribing is just another disaster waiting to happen for which pharmacists will be blamed. of course, none of the software used is designed by companies that seek pharmacists’ input. that would make sense.

Comment by KC on 2007-04-17 11:39:10 -0700 #

I hear your frustrations but there are e-prescribing systems that offer drug to drug, drug to allergy, and drug to diagnosis warnings before sent to the pharmacies. So they are being red flagged before they send the scripts.

Comment by Pharmacy Peddler on 2007-04-19 12:00:52 -0700 #

Jim (or any other pharmacist that wants to answer),
What is your honest feeling about other types of technology for the pharmacy like automation?

Comment by dawna_macg on 2007-05-02 20:58:18 -0700 #

I work in Canada and a narcotic cannot be written on anything but a triplicate (thank God)…I have seen so many Lenoltec #3 on e-prescriptions and people actually think that they can get them like that.

Comment by JC on 2007-05-09 19:46:36 -0700 #

My personal favorite, easy to fix but none the less annoying…
ZMAX-2t stat then 1t qd.

Comment by Tom on 2007-05-23 14:58:32 -0700 #

1. Faxing is not e-prescribing. Faxing is just that — faxing. E-prescribing is a computer to computer exchange of prescription information, including refill authorization requests.
2. Despite the “e” in “e-prescribing”, the prescription information is not actually emailed, therefore your concerns about viruses and forgery are unfounded. E-prescribing is conducted over a secure network.
3. More than 1.5 million Americans are injured annually by medication errors resulting from illegible handwriting, unclear abbreviations and dose designations, unclear telephone or verbal orders, ambiguous orders and fax-related problems. E-prescribing has been shown to prevent these types of errors.
4. With e-prescribing, physicians have the ability to view a patient’s medication history across multiple providers thereby reducing the risk of medication errors.
5. Comprehensive studies show pharmacy labor cost savings from e-prescriptions to be $0.97 for every new prescription managed electronically and $0.37 for every renewed prescription managed electronically.
   In short, e-prescribing prevents medication errors and saves physicians and pharmacists time. Do not confuse faxing with e-prescribing.

Comment by kris on 2007-08-26 17:24:28 -0700 #

Fun story of the day, from my local ER. I get a prescription for oxycodone written on some 3 week out of school resident’s PDA for:
oxycodone (Roxicodone, Oxycontin)
10 mg Q 12 H #20.
So obviously I call and ask, so exactly what drug do you want? The “nurse” on the other end is confused and takes my message… doesn’t call back. During all of this my mentally challenged patient starts to cry. Super.
She’s scaring my other patients.
I call the ER again… to get a REAL nurse and she explains to me that their E prescribing system has a glitch and they’ll fix it “right away” but the patient has to go back to the ER and pick up a new prescription. Oh and did I mention that the Dr also picked the wrong strength on his pull-down menu?
The real kicker – what did the patient pick up at the ER? A hand written prescription.

Comment by Dr. V on 2007-10-19 13:30:28 -0700 #

What is a good E prescribing software? I used to use Proxymed for refills five yearss ago but I stopped because every month there were dumplicate refill requests for patuents who had paper refills. I am looking for some thing free if possible.
Dr.V