Joint Statement from Surescripts and Researchers at Massachusetts General Hospital, Harvard Medical School, Brigham and Women's Hospital, CVS/pharmacy and Partners Healthcare Regarding Recent Study Published in JAMIA
ARLINGTON, Va., and BOSTON - July 8, 2011 - The following statement was issued today by Surescripts and the authors of the study "Errors associated with outpatient computerized prescribing systems," which was published online recently by the Journal of the American Medical Informatics Association:
"For media, researchers, medical professionals and anyone who might reference the study, the use of 'e-prescribing' and associated terms ('electronic prescribing', 'electronic prescribing systems', 'electronic prescriptions', 'e-prescriptions', 'digital prescriptions', etc.) when describing the study or its implications does not accurately reflect the way the terms are used today and should be avoided.
The study examined faxed and printed prescriptions generated by a computer rather than e-prescriptions. The more common use of faxed or printed computerized prescriptions in 2008 (the year the data was gathered) has led many to equate their use with e-prescribing. By today's standards, e-prescribing refers to prescriptions that are generated using computers in practitioners' office and sent electronically in coded form to pharmacies. Therefore, the results of the study should not be generalized to e-prescribing as there are clear and significant differences between these prescription transmission methods and the terms and technologies are not interchangeable.
The federal government defines e-prescribing as the transmission, using electronic media, of prescription or prescription-related information between a prescriber, pharmacy, pharmacy benefit manager, or health plan, either directly or through an intermediary, including an e-prescribing network. Computer-generated faxed or printed prescriptions do not meet this definition and therefore do not qualify for federal government incentive programs designed to encourage adoption and meaningful use of health information technology.
When referencing the study and in general discussion it is important to make a clear distinction between prescriptions that are computer-generated and then faxed or printed as compared to e-prescriptions.
The study highlights the challenges associated with writing prescriptions on a computer and shows that the applications being used at the time the study was done had room for improvement. It made a number of recommendations about how that could be done. In addition, the study highlights several challenges and opportunities in the design and deployment of health information technology nationally.
First, it underscores the innovative role that health IT can play in healthcare quality research. Manually gathering and analyzing paper-based (i.e., faxed, printed or handwritten) prescriptions can indeed take years and rely on relatively small samples of data. Electronic prescriptions can significantly shorten the process of research while increasing its scope and statistical validity.
Second, the study also underscores how there are numerous methods of measuring and defining prescription errors. The study uses a previously published method. There are other valid approaches used by other researchers, and Surescripts employs a process based on its experience conducting clinical quality reviews on millions of de-identified e-prescriptions. Moving forward, we are issuing a call to harmonize these approaches so that researchers and health care professionals can compare results between studies - more effectively and without ambiguity. Doing so will create a more consistent and reliable record of measuring improvements in prescribing accuracy, efficiency and safety.
Last, the rapidly growing use of e-prescribing in the U.S. creates an unprecedented opportunity to not only measure and analyze quality, but continually improve it. By leveraging the existing collaboration between pharmacies, Surescripts, providers and the EHR vendor community, researchers and all participants in e-prescribing can more quickly identify opportunities for improvement and speed their implementation. We look forward to future collaborations designed to take full advantage of this capability."