OK, when I first began ePrescribing, I thought it was the greatest thing since...well, the prescription pad...then the fax. But, now it is driving me crazy.
As you know, we're not on board with an EHR yet, but our billing software has a bare bones SureScripts ePrescribing interface, so we're trying to use that to avoid the penalty for not doing so that hangs over our heads beginning Jul '11 (withhold on Medicare reimbursement for second half '11 claims beginning 1/01/12).
Our experience has been like yours. We'll submit an eRx, and the patient will call us and tell us the pharmacy never received it. We've had a local pharmacy dispense the wrong dose of an antihypertensive (of course, we're told that eRx is supposed to make such errors
impossible).
(disclaimer: I'm a liberal - Bert already knows that) Still, my sense is that the Feds just cannot turn off their bureaucracy genes and just nurture the development of medial IT that works; they just cannot get beyond the notion of loading up "protection" on data exchange interfaces to the point that they
don't work.
On the other hand, there is truth in the "anything that can go wrong, will" canard. Last year, I started Prednisone/Cytoxan on a patient with ANCA-related RPGN (rapidly progressive glomerulonephritis). I did the intitial presciptions over the phone with a pharmacist on the other end. I specified 3 50 mg cyclophosphamide tablets each morning. A month later, I received a fax refill request for 6 25 mg cyclo
sporine capsules each morning! The pharmacist "explained" that his computer interface had an automatching algorithm, so that as he typed "c...y...c...l...o..." the first match that "caught his eye" was for "cyclosporine." Seems not to have mattered that there are no cyclosporine
tablets, nor is cyclosporine available in a 25 mg size.
There was a study (I think from Boston Childrens Hospital) reported in NEJM, I think, that stuck a pin in the "notion balloon" that electronic data interchange was guaranteed to reduce errors. Does anyone else see the humor in the website "captcha" logins that attempt to verify the presence of a real human trying to log in by having the user decipher some almost illegible script?
Jim Robertson
