Summery of 1 st ten chapters of E-PRESCRIBING The Electronic Transformation of Medicine

1. Summery of 1st ten chapters of E-PRESCRIBING The Electronic Transformation of Medicine d/JACK E.FINCHAM by Nisreen Gamal Ali Atallah nes.rin`922@gmail.com

2. E-prescribing Can be defined as the use of computing devices to enter, modify ,review ,and output or communicate drug prescriptions N.B earliest application of e-prescribing in hospitals in 1970 Implemented use of health it will 1- Improve HC quality 2- Prevent medical errors 3 -Reduce HC cost 4- Decrease paper work 5- Expand access to affordable care

3. Also bring many public health benefits include 1-Early detection of infection diseases ,outbreak around the country2-Improved tracking of chronic diseases 3-Evaluation of health care

4. Issues to be considered when entering the e-prescribing-Various features and function that are apart of vendor system *Regulatory compliance *EMR solutions *H.W-Mobile -Desktop -Remote computing *Services-Training -Support -System interface -Updates*Cost –H.W -S.W -Free trials; other discounts *Functionality

5. *Functionality -Refill authorization -New prescription -E-prescribing history -User tools -Drug interaction checking -Formulary magament

6. What E-prescribing can do A) Reducing adverse drug events E-prescribing provides decision support for selection of :1-Prescribtion product 2-Information about formula , dosing ,frequency 3-Chick for allergy &drug interaction 4-Avoidence of therapeutic duplication ,maximum and minimum dose B) Ability to detect Fraudulent Patient Activity patient see numerous doctors multiple precribtion of drug of abuse , antibiotic ,antidepressent Fraud detection capability that built into every e-prescribing system

7. C) E-prescribing as means of enhance quality Bell & al suggest developing frame work when we need evaluation They points services of 14 options that e prescribing can help address: 1-patient selection or identification 2-diagnosis selection 3-medication selection 4-safty alerts : a) drug choice errors ,including allergies b) allergies drug-drug interactions c) drug disease interactions e) drug : lab (renal , hepatic junction )

8. D) Numerous Benefits of E-prescribing 1-Enhance the Accuracy of Drug Prescribing (Bell &Friedman) -Transmission of order accurately -Adhering to guidelines (EBM) -Monitoring of patient ‘s response ttt -Stay current with information on ttt protocol 2-Value Added Aspect of e-Prescribing 3-Using e-Prescribing to Monitor Patient Medication Compliance and Persistence

9. Numerous Benefits of E-prescribing 4-Cost Issues and Ramifications Decrease cost by increasing the accuracy of medication &decreasing medication errors 5-Better Control of Risky or At Risk Drugs -Controlled substance -Teratogenic drugs -More accurate dosing with chemotherapy -More control of Black Box Warning Affected drugs

10. More limitation of e-prescribing A) Increase of Self Medication &OTC drugs 1-increase locations from which to purchase OTC 2-patient comfortable of self diagnosis e self selection Of OTC drug 3-many medication switched to OTC classification B) Direct-To-Consumer Advertising (DTC) C) System cannot indicate where consumer obtain medication D) Lock Of Insurance Coverage Actual incidence of ADR is unknown and still occure despite sophisticated e-system - There isn’t a floor poof system to report ADR occurrence

11. E) Complience (patient drug taking behaviour is unclear) Intervention -patient counsling-specialized packing-varying reminder ex e-mail –tel call-other types of socialized contact F)Frank ErrorsError s in prescribing (wrong patient ,drug ,dose ,duration of action) also pharmacist can make error in dispensing and labeling N.B error will continue to be made as long as human included in HC G) Wrong diagnosis H)Tacking the place of face to face Encounters HC professionals need to interact by phone as will as interact electronically

12. What e-prescribing cannot do • Consideration of improper access and resultant impacts • Errors occurring with e-prescribing -confusing on screen laboratory results review -system usability difficulties -user training problems -suboptimal clinical safeguards • Impact on formulary adherence and generic drug utilization • Varying uptake by community pharmacy • Varying factors influencing e-prescribing -physician resistance to change -inadequate planning to incorporate e-prescribing into existing care process -cost

13. Required Data Points Ideal For e-Prescribing Accuracy *Activity reports and :patient specific information *Allergy data :drugs and other agents *Available drug listing :for prescribing drugs • Drug reactions and interactions .Drug/allergy interaction .Drug/drug interactions .Drug/food interactions .Drug/herbal supplement interactions*Drug reference • *Drug reports :patient medication history *Eligibility check : insurance eligibility *favorite prescription list -for the prescribing physician ,the most commonly prescribed drugs specific to the physician *generic medication listing *global pharmacy list :all pharmacies eligible to be used -mail order pharmacy

14. Required Data Points Ideal For e-Prescribing Accuracy *last office visit *medication history download for each patient *patient medication history *practice pharmacy list : favorite of physician or patient *patient schedule *patient sharing :other physician seeing patient can be viewed *patient demographics :age ,gender, other patient notations *pharmacy search :area specific or accessible at a specific point in time *Prescription report : all drugs the physician(s) has prescribed *rapid medication entry -a character recognition system that displays the drugs with these letters that have been typed *renewals/refills :available for each of the patient’s prescriptions *referrals: from and to the physician entering the data *user preferences :favorite dosing parameters that are physician specific can be added

15. Steps To Enable e-Prescribing 1-One-on-one training and support upon initial deployment 2-Strong marketplace sponsorship 3-vendor marketing and out reach 4-Analyzing the workload impact upon physician 5-Stimating the need for community wide approach to implementation