Electronic Prescribing - Limitations

Limitations

Although e-prescribing has the ability to streamline workflow process and increase the system's efficiency, the appropriate tools are required in the appropriate contextual setting. As with various sectors however, change can be difficult. Previous errors may be addressed, but the adoption and implementation of new technology does not come without drawbacks.

Challenges and limitations that may hinder the widespread adoption of e-prescribing practices are addressed below:

• Financial Cost and Return on Investment (ROI) - The costs associated with purchasing, implementing, supporting and maintaining such a system may be beyond the means of most small clinical practices, and noted to be one of the greatest implementation barriers. Health care workers who are responsible for medical prescription, especially those in small practices, inner city areas, or remote rural settings, may bear more than their fair share of the cost associated with e-prescribing. This is in response to the various other stakeholders that may reap the benefits from such a system, without having to financially support it, disseminating their risk substantially. Clinical practices therefore need to invest significantly in both hardware and software, with varying costs based on system specifications (stand alone system or entire EHR system). Even clinics that receive free e-prescribing systems may face financial costs pertaining to management of the interface, customization due to flexibility, training, maintenance, and upgrades. On top of this, the clinic must also take into consideration the lost time and efficiency during the transition period of implementation. As a result large urban areas may see the greatest ROI when compared to those in rural or inner city locations.

• Change Management - Many underestimate the challenges pertaining to change management when transitioning from paper-based prescriptions to e-prescribing. This is especially true in busy practices where healthcare providers and associated staff are accustomed to their current management system, in which case change management becomes extremely important. Building on this, many staff accustomed to certain work practices may have particular aversions to technology, and therefore, may be difficult to get everyone on board when introducing such a dramatic change. Analysis is needed to understand how to change workflow around the management of prescriptions with the introduction of an electronic system, which may prove to be difficult and time consuming. The change also requires pharmacists to alter workflow and increase their awareness of new types of errors associated with e-prescribing, in order to best target their activities to reduce clinical risk. As a result, steps must be taken to ensure effective planning, training, support, and continuous quality improvement for successful transition.

• Hardware and software selection - Choosing the right hardware platform and software applications can be a rather daunting task for practices, especially in regards to small and busy settings. Many have limited access to expert information technology personnel/staff, leading them to struggle with how to get started, appropriate vendor selection, cost and function negotiations, and most importantly, long term support to ensure continuous functionality and meaningful use. Once again, initiatives must be put into place to allow for effective and strategic planning prior to adoption.

• Erroneous alerts - The inability to effectively use clinical decision support systems due to the erroneous triggering of pop-up alerts with ill-defined software is also a great limitation. Under such circumstances, many opt to turn the notifications off, disabling one of the systems great beneficial aspects.

• Integrity of data input - Accidental data entry errors such as selecting the wrong patient or clicking on the wrong choice in a menu of dosages may occur. Software vendors should continually review user feedback and follow best practices in user interface design.

• Security and Privacy - As with many eHealth solutions, privacy of patient information stored in electronic format may lead to the possibility of novel errors, such as inadvertently divulging protected health information on the internet through inadequate security practices. Instances of negligence may also arise, where employees may forward prescriptions to organizations outside its intended use. Another security issue that needs to be addressed upfront is the verification of electronic signatures, in ensuring the medical integrity of the prescriptions received by pharmacists. Therefore, Hospitals, clinics and pharmacies should be protected with firewalls, use strict computer permission settings, and remain vigilant toward signs of an intrusion.

• System Downtime - Periods of system downtime may arise, either due to network-related issues, hardware failure, or loss of electricity. The inability to use electronic prescribing when the system is not accessible is of great concern, and must be addressed with the discussion of fall-back procedures and mechanisms when such situations arise.