e-Prescribing: First Impressions

A couple of weeks ago we rather unceremoniously added e-prescribing into our EMR system.  Because of my mistaken interpretation of the CMS guidelines on Medicare e-Rx incentives and penalties we rushed e-Rx a bit.  I thought each of our physicians had to do 10 Medicare e-Rx prescriptions before June 30.  It turns out you are exempt from the 1% Medicare penalty if you have a certified EMR.  The CMS guidelines are incredibly difficult to understand.  No surprise there.

My thoughts after the first 2 weeks:

1. The concept is sound and very useful. Although it only takes a second to grab a printed script off the printer and sign it, eliminating that step is refreshing and streamlines clinic operations much more than I would have thought.   We have far fewer pieces of paper to push around.  There might even be some cost savings on paper.
2. Cultural acceptance has been effortless. I wondered if patients would be unhappy without that precious paper prescription.  I should have known better.   We have been calling in scripts forever.
3. The darn thing works! I held my breath waiting for the wave of angry phone calls from patients and pharmacies.  It never came.  For the first few scripts we called the pharmacies to be sure they received the script.  There was never a problem.
4. The workflow changes will be interesting. Some changes are obvious.  We had to get the front office staff to get pharmacy information from each patient and enter it in the system.  Other implications are less clear.  Do we really need printers in every exam room now?  Do tablets become more useful over other PCs?
5. Mistakes are rare and easy to fix. This evening on call I got a message from one of my partner’s patients alleging that her prescriptions were not “called in.”  I got into the EMR from home and saw her e-scripts were created but were never signed.  This was because we took the system off line at about the same time the chart note was created.  We had to install a patch.  I signed the prescriptions and fixed the problem in a second.
6. The Surescripts HIE is WORTHLESS. This is the feature that allows the EMR to upload a patient’s medication list based on his/her recently filled prescriptions.  But the feature forces a “workflow paradox:”
   1. Uploading prescription histories takes considerable time.  The upload needs to be done in advance of the patient visit so it doesn’t impede workflow.  I don’t understand why it is so slow.
   2. The upload cannot be performed until the patient gives consent.  So you can’t do the upload until the patient arrives at the office and signs the form.

I suppose we could work around this via giving consent on the web portal; that would be very cumbersome.    Even if it worked well the feature does not improve our workflow.  The medication reconciliation step may make it worse.  The bottom line is I don’t care what is in the Surescripts database.  We ask patients what their medications are and they tell us.  Done.