The end of hand-written prescriptions

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.

RxA 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.

Sources:
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.