e-prescribing

Here we go again, forcing physicians to use technology that is not yet mature

Here we go again, forcing physicians to use technology that is not yet mature.  Texas House Bill 2743, if adopted, would require physicians in Texas to use electronic prescribing (e-prescribing) for controlled substances.   

While I agree with the goal (physician adoption of e-prescribing for controlled substances), the proposed tactic imposes requirements on the wrong stakeholder.  If e-prescribing tools and associated work flows were intuitive, effective, seamless and safe, then there would be no need to require physicians to use e-prescribing.  Physicians naturally gravitate toward technologies that are easy-to-use, safe and effective or time-saving.  I don't see many physicians writing checks now that debit cards are easy to use nearly everywhere we go.  The adoption of robotic surgery and MRI scans come to mind as well.

So to reach the desired goal, should not the state representatives instead require e-prescribing vendors to bring mature, useful products to the market?   Should we not require NCPDP, the organization that develops standards for script transmissions, to more rapidly develop standards needed to close gaps in current functionality and usefulness?  

My ER patients rarely prefer a written paper prescription.  But sometimes the patient wants a paper Rx because they just came from out-of-town, or they want to shop around for a 24-hour pharmacy in the middle of the night, or for other occasional, sometimes unusual reasons.  One of my patients preferred a written prescription because she liked how prescription paper smelled.  You might successfully guess the category of medication she received.  

It is rarely in the best interest of  my patients for me to write a prescription rather than to e-prescribe one.  Unless my e-prescribing system is down, or my patient tells me they prefer a paper prescription.  Or if I'm prescribing a narcotic, because my EHR vendor has not yet enabled my e-prescribing system to do so.  In my case it will take a major upgrade to get that done.  And I have not yet gone to a Federally-approved credential service provider (CSP) or certification authority (CA) to be "identity-proofed" so that I can obtain a two-factor authentication credential or digital certificate which is required to use e-prescribing for controlled substances.  I'll go through that hassle when my vendor enables the controlled substance e-prescribing tool.  And that upgrade will cost my organization a lot to implement.  

In the doctor's real world e-prescribing tools are not easy-to-use, intuitive or hassle-free.  Instead they are cumbersome and remain prone to some easily-preventable medication errors. In the real world of the pharmacist, it is not efficient to manually transcribe  into their own system the e-prescription information I sent.  They might have to use two screens to accomplish that task, or they might print my e-prescription and then transcribe it into their system.  That printer is likely to be in the far corner of the room.

 So in the real world Texas House Bill 2743 makes little sense.  I urge our state representatives to focus their tactics on the real problem--immature e-prescribing tools and processes.   Stop imposing unnecessary risks on physicians and patient care.  

Matt Murray, M.D.                                                                                                                                                                 cook childrens