The vast majority of physicians have always written their prescriptions by hand (and still do). There are several inherent problems in doing so, but until recently these problems were a moot point because no other options were available. Today, technologies exist that can eliminate manual prescribing altogether, but there are also many barriers that prevent widespread acceptance and adoption of those technologies.

Why prescribe electronically?

Safety. How might physicians and their patients benefit from electronic prescribing? The most important benefit is related to patient safety. Every year, thousands of poorly scribbled prescriptions are misread by pharmacists. This results in the wrong medications, doses and instructions being given to patients. Many medications have very similar names to begin with, which has resulted in various lists of such products and warnings to physicians to be aware of "sound-alike" and "spell-alike" products. One example, of which there are many, is the medications clonidine and Klonopin, the branded version of clonazepam. Klonopin was originally spelled "Clonopin," but the Food and Drug Administration ordered that the name be changed to start with a K because of numerous mix-ups.

Throughout the 1990s, the Department of Veterans Affairs became particularly aware of these human errors due to manual prescribing, noting many resultant problems (including deaths) in their patient population. Those incidents have resulted in the VA becoming a leader in both the development and use of electronic prescribing systems.

Another patient safety issue that electronic prescribing will eventually help address is the abuse of controlled substances by a small percentage of patients. If the electronically generated prescriptions of every prescriber in a region could be cross-checked, for example, it would make it more difficult for those patients to "doctor-shop."

Benefits of e-prescribing

Cross-checking of prescriptions written by one or several prescribers for a single patient will also be of value in determining if the patient is being subjected to potentially harmful drug interactions.

Electronic prescribing systems are also able to automatically alert prescribers to news pertinent to medications, such as new indications, product warnings and even rare product recalls. In such cases, the system can be instructed to pull up the name and phone number of every patient in the practice who is on that recalled product so a staff member can call those patients with instructions. Those instructions might include switching to an alternative medication, which, by the way, the electronic prescribing system can also be programmed to suggest.

Economics. As we all know, "time is money." Electronic prescribing, once instituted, will likely save significant time and money for many of the participants in the healthcare system. As pharmaceutical representatives well know, formulary issues often play an important role in determining whether a particular medication gets prescribed. Physicians are besieged on a daily basis by call-backs from pharmacies due to prescriptions that are high-tier or not covered at all by particular insurance plans. These call-backs are expensive and time-consuming for the physician, who must have a staff member pull the chart, take time to choose an alternative medication or convince the patient to buy the more expensive one, and then take time on the phone with the pharmacist. The patient must also waste time as this process takes place. If prescribers begin to use electronic prescribing programs that contain accurate and frequently updated data on local formularies, this waste of resources can, for all intents and purposes, be eliminated. Also, doctors and patients will be able to address medication issues in private, in the doctor's office, without the intervention of pharmacists and other people after the patient has left the office.

For example, if the average primary care physician sees approximately 25 patients a day, writes an average of three prescriptions per patient and gets call-backs on just 10% of those scripts, he is dealing with seven call-backs a day. Assuming 10 minutes of wasted time per incident, this would result in more than an hour a day spent attending to these issues!