|"Electronic Prescribing" By Allen Weiss, MD, MBA, President and CEO|
September 1, 2008 - Ever have trouble reading a physician's handwriting? If so, you are not alone. Physicians communicating with pharmacists and nurses by written prescriptions and orders make this point daily, with 98% of 3.5 billion prescriptions given yearly being done in the traditional written format. Exact figures are not known, but it is estimated that over 90% of orders issued at the nation's 5,000-plus hospitals are still handwritten.
As a left-handed person, my own handwriting has needed improvement ever since I learned to write. During college and medical school, while taking copious notes my writing got even worse which made me more enthusiastic to embrace the digital age. Normally, bad handwriting would be a person's own problem, but when transmitting information such as prescriptions or orders affecting patient health, we are all involved.
As of this past March, according to a recent New England Journal of Medicine editorial, only about 7% of the 560,400 office-based physicians in the U.S. were using electronic methods to order medicines. In contrast, about 73% of the 57,500 pharmacies are capable of receiving electronic prescriptions.
Moreover, e-prescribing, as this is called, can add value by including the patient's allergies, drug interaction alerts, and warnings about side effects given a person's medical conditions and history. Additionally, insurance, formulary (what medicines are included in a patient's pharmacy plan) and billing information can be added to streamline the paperwork process which saves on the cost of the transaction. Finally, security can be improved with electronic transmission making counterfeit written prescriptions useless. Banks transmit information securely and inexpensively on a daily basis. Healthcare should be at least as efficient.
Inside the hospital, physicians traditionally handwrite “orders” including diet, activity, condition, diagnostic tests, therapeutic interventions, and medications for each of the patients. At NCH we are evolving into an electronic medical record facility and have had digital nurse documentation since 2001. Over the past year medication administration has also improved so that every medication, patient (with a wrist band) and nurse (with a badge) has a unique barcode. To prevent errors and complete the paperwork, every time a medication is administered all three bar codes are scanned and have to match up to confirm the right medicine is being given to the right patient at the right time. Nurses do this because it is safer for the patients. Neither time nor energy is saved but the nurses are more comfortable knowing that errors are much less likely.
During the last six months in the Operating Room, and two months in the Emergency Room, surgeons and physicians have been ordering almost all of their medications, treatments, and diagnostic tests digitally, using portable and table top computers. There is very little handwriting in these areas. Electronics do not save time for the physicians doing the ordering but, again like with medication administration, a safer environment is created for all concerned.
Changing the manner in which we work will improve safety and add value to healthcare. NCH continues to be on the forefront for in-hospital digital technology. Outpatient electronic prescribing remains a challenge.
Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.