Like his peers, Joel Gallant, MD, MPH, used to prescribe medications by pulling a pad from his pocket, writing the script, and handing the piece of paper to his patient. Today, while he continues to handwrite an occasional prescription, Gallant has switched to e-prescribing, and says he would never want to go back to relying on the old paper prescription pad.

Gallant, associate professor of medicine and epidemiology at The Johns Hopkins University School of Medicine in Baltimore, simply walks over to the exam room computer, pulls up the patient's name on the screen, and either clicks "refill" or chooses from menus of options to create a new prescription. The automated system sends the prescription, by fax with an electronic signature, to the patient's pharmacy.

"That way patients do not have to wait around for the drug when they arrive at the pharmacy, and there is no question of misreading handwriting. The doses of the drugs are shown to me as options, so I am not going to put down the wrong dose," Gallant says. He notes that the system can also alert physicians to possible drug interactions, a particularly important benefit for patients who are taking multiple medications.

Physicians prescribing electronically generally do so either through a handheld personal digital assistant (PDA) or from a computer terminal. Some e-prescribing systems, like Gallant's, transmit physicians' prescriptions directly to pharmacies, using e-mail or fax. Others electronically generate prescriptions but have not yet been set up to send scripts directly to pharmacies. 

Michael Saag, professor of medicine and director of the AIDS Center at the University of Alabama at Birmingham, has been using a form of e-prescribing since August 2004. At UAB, an electronic medical record system checks for errors and drug interactions and electronically prints prescriptions that doctors hand to patients.

"We have not yet gone to e-mailing pharmacies, but that is a relatively straightforward thing once we get it set up," Saag says.

Eliminating errors

The American Pharmacists Association is behind e-prescribing, according to Susan Winckler, RPh, vice president for policy and communications at the Washington D.C.-based trade organization. When transmitted by e-mail, prescription information can populate the pharmacy's dispensing software, eliminating data entry and the potential for transcription errors on the pharmacy's end, she says.

Gallant says there is no more guessing about handwritten or verbally delivered drug names that look and sound similar and are a major reason for prescribing mistakes (see chart, page 58). The problem of handwritten abbreviations is also eliminated by the e-option. "In an e-prescribing system you would look up the generic or brand name and it would be printed out, with no handwriting problems," he says. 

The fact that many systems alert physicians to possible drug interactions should also serve to cut down on prescribing errors.

Saag says that while he cannot say that switching to e-prescribing has saved anyone's life, he feels better about the decreased likelihood he will miss any potential drug interactions.

"It's a nice reminder about interactions," he says. "Every time we prescribe a new medicine, [our] system compares the new medicine to all other medicines that the patient is currently taking and will alert the provider to the nature of the interaction and the degree to which the interaction is a danger."

Promotes communication

Saag likes the idea that the system is educational for physicians.

"Every time one of those interactions comes up, it reinforces for the provider that the threat of interaction exists," he says.