Electronic Prescribing Using A Community Utility: The ePrescribing Gateway

This project, part of five grants awarded by the Agency for Healthcare Research and Quality to conduct electronic prescribing (e-Prescribing) pilots, designed, developed, piloted, and studied an e-Prescribing utility called Rx Gateway.  Rx Gateway supports the transmission and renewals of prescriptions from a provider’s electronic medical record (EMR) to retail pharmacies using SureScripts Messenger Service.  The initial implementation was carried out within physician practices at Beth Israel Deaconess Medical Center.  The system was evaluated looking at data from a variety of sources, including computerized provider order entry (CPOE) applications, EMRs, RxHub, and Surescripts, comparing prescription orders to actual dispensed medications. e-Prescribing standards felt to be insufficiently mature underwent testing in a laboratory setting.  Physicians reviewed and rated suspected adverse drug events and medication errors. Time motion techniques were used to directly observe physician practices. The main objectives of the project were to:

• Test the interoperability of the initial standards with the proposed foundation standards.
• Study the effects of e-Prescribing (CPOE with electronic transmission) on patient safety.
• Study the effects of e-Prescribing on office workflow.

Most of the standards that were tested were endorsed by the project team. Several standards were noted to be insufficiently mature or unsatisfactory and were not recommended in their existing formats. The study found that e-Prescribing was well accepted by both clinicians and their office staff. The team noted that additional research will be needed in order to evaluate other e-Prescribing systems, and evaluate their impact on practice and pharmacy workflow.