Expert Panel Issues Recommendations to Improve “Electronic Prescribing”

Electronic prescribing—using computers or other handheld devices to generate prescriptions that, today, are primarily handwritten by doctors—holds promise for reducing medication errors, improving quality, and reducing costs in health care delivery. However, specific electronic prescribing systems vary widely in their features and in the methods they employ.

Recently, a RAND-sponsored panel of experts has issued a set of recommendations for comparing electronic prescribing systems and to help guide the development of electronic prescribing policy. The recommendations were detailed in a recent article published in Health Affairs.

According to the article, health care providers wanting to pursue electronic prescribing should look for systems that are integrated with patients’ computerized records, can list all medications that a patient currently takes, can transmit prescriptions according to established standards, and that disclose the results of any sponsorship from third parties such as health insurers or drug manufacturers.

Until recently, health care delivery organizations, physicians and other stakeholders had little information on which to select among the many available and emerging alternatives, which can have significant impacts on both patient outcomes and costs of care.

According to Douglas Bell, an associate natural scientist with RAND, who was lead author of the paper containing the recommendations, the results provide information that federal policymakers can use in developing standards that are likely to help promote safety, quality of care, and cost savings.

The expert panel was assembled by RAND and represented physicians, health care quality and consumer advocates, pharmacists, pharmacy benefit managers, nurses, economists, medical informatics experts, and insurers.

The panel developed 60 recommendations, rating them based on their ability to improve patient safety and health outcomes, help patients manage costs, maintain patients’ privacy, and promote physician acceptance. Fifty-two of the recommendations were rated by the experts as clearly positive for patient safety and health outcomes, and 43 were rated as achievable in the average clinician’s office within three years.

The panel recommended that electronic prescribing systems should:

• Import patient identification and demographic data from electronic medical records used by the organization;
• Provide the patient’s complete current medication list to prescribers who have care responsibility for the patient;
• Display a list of medications appropriate to the diagnosis when it is entered;
• Guard against efforts to promote specific drugs by third parties such as drug manufacturers or pharmacy benefit managers;
• Distinguish alerts based on patient safety and health outcomes from those based on formulary adherence;
• Transmit prescriptions electronically using established standards for data exchange;
• Support compliance with federal health care privacy laws and methods for checking the integrity of stored data.

For More Information

"RAND Electronic Prescribing Expert Advisory Panel. Recommendations for Comparing Electronic Prescribing Systems: Results of an Expert Consensus Process," Health Affairs, May 25 2004, Bell DS, Marken RS, Meili RC, Wang CJ, Rosen M, Brook RH

Developing Standards for Electronic Prescribing Systems (http://www.rand.org/health/eRx/)

RAND Health (http://www.rand.org/health/)

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