The days of illegible, chicken-scratch doctor writing are a step closer to becoming history. E-prescriptions will soon be mandatory in The Netherlands. Beginning in January of 2014, the National Healthcare Inspectorate will require all medications to be prescribed and submitted to pharmacists electronically.
A guideline for electronic prescribing has been established by the Dutch Medical Association and it is an expectation that every health provider will implement an e-prescribing system during 2013. The guideline has been approved by a wide range of professional and government agencies.
Several studies in the Netherlands have demonstrated high rates of preventable medication-related hospital admissions. In the HARM study (Hospital Admissions Related to Medication), 5.6% of all acute admissions to hospital were medication-related, and of these almost half were considered preventable. This was estimated to result in 19,000 preventable admissions per year at a cost of Euro 85 million. The study authors recommended improved information exchange around individual patient issues, such as kidney function and co-morbidities.
However, current e-Prescribing systems do not appear to be a panacea. A review of errors associated with computer-generated prescriptions demonstrated an overall error rate of over 10%, which is similar to the error rate with hand-written prescriptions in other studies. Notably, the error rate varied from 5% to 35% depending on the specific computerized system that was used. The ability of pharmacists to process electronic prescriptions is another potential source of error. If computer-generated prescriptions are printed or faxed then they need to be re-entered into pharmacy systems.
Recommendations for e-Prescribing systems:
- Forcing functions that prevent omitted or incomplete information.
- Drug decision support that checks dosing and frequency to identify potential errors.
- Calculators that eliminate double-entry of information (for example, calculating the quantity from the dose, frequency and duration).
- Ease of use and integration into clinical workflows without affecting productivity.
- Adherence to communication standards that allow accurate data-sharing between different electronic systems.
- High reliability and availability of electronic systems.
Exit receptblok. Croonen H. Medisch Contact 2013.
Errors associated with outpatient computerized prescribing systems. Nanji K, Rothschild J, Salzberg C, et. al. J Am Med Inform Assoc 2011;18:767-773.
HARM Study. 2006.
Richtlijn elektronisch voorschrijven. KNMG 2013.