Barriers to electronic prescribing of controlled substance, especially opioids

Amne Borghol; Fahamina Ahmed; Dana Jamero; Helen Calmes; Taylor Monthey; Stefanie Pappas; Rotieranna Scott; Joshua S. Deblieux; Melanie Ulrich; Sonia Malhotra

doi:10.5055/jom.0857

Authors

Amne Borghol, PharmD, BCPS https://orcid.org/0000-0002-0028-7174
Fahamina Ahmed, PharmD
Dana Jamero, PharmD, BCOP
Helen Calmes, PharmD, MBA
Taylor Monthey, PharmD Candidate
Stefanie Pappas, PharmD Candidate
Rotieranna Scott, PharmD Candidate
Joshua S. Deblieux, MD
Melanie Ulrich, MD
Sonia Malhotra, MD, MS, FAAP

DOI:

https://doi.org/10.5055/jom.0857

Keywords:

electronic prescribing, e-prescribing, opioids, preferences, medication safety

Abstract

Objective: Electronic prescriptions are now the standard of practice for all discharge and outpatient prescriptions. The intention is to increase patient safety, provide a more complete medication record for patients, lessen the burden on prescribers, and shorten the time it takes for medication orders to reach the pharmacy.

Design: This cross-sectional questionnaire survey study was conducted between January and August 2022 in three areas of a large urban safety net hospital. Setting: A large single academic medical center.

Participants: Emergency department, inpatient clinicians, and procedural areas. The subjects of the study were trainees, attending physicians, and advance practice providers (APPs)

Interventions: Data were collected from the participants using a self-reported questionnaire, including sociodemographic characteristics, ease of use, reliability, and preference. Additionally, the perception of the strengths and limitations associated with electronic prescribing (e-prescribing) were analyzed.

Main outcome measure: The purpose of this study was to evaluate the barriers to e-prescribing of opioids.

Results: A total of 121 prescribers completed the survey. The majority trusted that e-prescribing were transmitted successfully (62 percent), saved time (78 percent), and did not interrupt their workflow (78 percent). However, many prescribers indicated that additional improvements are needed, such as updating the patient’s preferred pharmacy in the electronic medical record during each visit (52 percent) and having a 24-hour pharmacy readily available (66 percent).

Conclusion: Prescribers value the ease of use of e-prescribing and how time efficient the process can be. Nevertheless, there is a need to improve the system’s service, design, and usefulness.

Author Biographies

Amne Borghol, PharmD, BCPS

Clinical Professor, Division of Clinical and Administrative Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, Louisiana

Fahamina Ahmed, PharmD

Clinical Associate Professor, Division of Clinical and Administrative Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, Louisiana

Dana Jamero, PharmD, BCOP

Chair and Clinical Associate Professor, Division of Clinical and Administrative Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, Louisiana

Helen Calmes, PharmD, MBA

Clinical Pharmacist, University Medical Center of New Orleans, New Orleans, Louisiana

Taylor Monthey, PharmD Candidate

Xavier University of Louisiana, College of Pharmacy, New Orleans, Louisiana

Stefanie Pappas, PharmD Candidate

Xavier University of Louisiana, College of Pharmacy, New Orleans, Louisiana

Rotieranna Scott, PharmD Candidate

Xavier University of Louisiana, College of Pharmacy, New Orleans, Louisiana

Joshua S. Deblieux, MD

PGY-3 Resident Emergency Medicine, Louisiana State University, University Medical Center of New Orleans, New Orleans, Louisiana

Melanie Ulrich, MD

Emergency Medicine and Hospice & Palliative Medicine, Louisiana State University, University Medical Center of New Orleans, New Orleans, Louisiana

Sonia Malhotra, MD, MS, FAAP

Associate Professor of Internal Medicine & Pediatrics; Director of Palliative Medicine; Associate Program Director, Internal Med-Peds Residency, Tulane University School of Medicine, New Orleans, Louisiana, and University Medical Center of New Orleans.

References

US Department of Health and Human Services: Opioid abuse in the US and HHS actions to address opioid-drug related overdoses and deaths. ASPE: Office of the Assistant Secretary for Planning and Evaluation. Available at https://aspe.hhs.gov/reports/opioid-abuse-us-hhs-actions-address-opioid-drugrelated-overdoses-deaths-0. Accessed July 7, 2023.

Balyan R, Hahn D, Huang H, et al.: Pharmacokinetic and pharmacodynamic considerations in developing a response to the opioid epidemic. Expert Opin Drug Metabol Toxicol. 2020; 16(2): 125-141.

Centers for Disease Control and Prevention: Provisional data shows US drug overdose deaths top 100,000 in 2022. Available at https://blogs.cdc.gov/nchs/2023/05/18/7365/. Accessed July 7, 2023.

Everson J, Cheng AK, Patrick SW, et al.: Association of electronic prescribing of controlled substances with opioid prescribing rates. JAMA Netw Open. 2020; 3(12): e2027951.

HHS Centers for Medicare & Medicaid Services 2020: Medicare program: Electronic prescribing of controlled substances; request for information (RFI), 85 Fed Reg. 47151 (to be codified at 42 C.F.R. pt. 423). 2020. Available at https://www.federalregister.gov/documents/2020/08/04/2020-16897/medicare-program-electronic-prescribing-of-controlledsubstances-request-for-information-rfi. Accessed July 17, 2023.

Abramson EL, Barrón Y, Quaresimo J, et al.: Electronic prescribing within an electronic health record reduces ambulatory prescribing errors. Jt Comm J Qual Patient Saf. 2011; 37(10): 470-478.

Kaushal R, Kern LM, Barrón Y, et al.: Electronic prescribing improves medication safety in community-based office practices. J Gen Intern Med. 2010; 25(6): 530-536.

Porterfield A, Engelbert K, Coustasse A: Electronic prescribing: Improving the efficiency and accuracy of prescribing in the ambulatory care setting. Perspect Health Inf Manag. 2014; 11(Spring): 1g.

Nikou G, Gallos P: Physicians’ and pharmacists’ opinions regarding the e-prescription systems. Stud Health Technol Inform. 2020; 270: 1351-1352.

Poojitha M, Bhoomadevi A: Assessing the attitude of the physicians towards e-prescribing in Chennai. Rev Gestão Inovação Tecnol. 2021; 11(4): 4489-4497.

Thomas CP, Kim M, McDonald A, et al.: Prescribers’ expectations and barriers to electronic prescribing of controlled substances. J Am Med Inform Assoc. 2011; 19: 375-381.

Almutairi BA, Potts HWW, Al-Azmi SF: Physicians’ perceptions of electronic prescribing with electronic medical records in Kuwaiti primary healthcare centres. Sultan Qaboos Univ Med J. 2019; 18(4): e476-482.

Gagnon MP, Nsangou ÉR, Payne-Gagnon J, et al.: Barriers and facilitators to implementing electronic prescription: A systematic review of user groups’ perceptions. J Am Med Inform Assoc. 2014; 21: 535-541.

Gates PJ, Hardie RA, Raban MZ, et al.: How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis. J Am Med Inform Assoc. 2021; 28(1): 167-176.

Devin J, Cleary BJ, Cullinan S: The impact of health information technology on prescribing errors in hospitals: A systematic review and behaviour change technique analysis. Syst Rev. 2020; 9(1): 275.

Mills PR, Weidmann AE, Stewart D: Hospital electronic prescribing system implementation impact on discharge information communication and prescribing errors: A before and after study. Eur J Clin Pharmacol. 2017; 73(10): 1279-1286.

Hinojosa-Amaya JM, Rodríguez-García FG, Yeverino-Castro SG, et al.: Medication errors: Electronic vs. paper-based prescribing. Experience at a tertiary care university hospital. Eval Clin Practice. 2016; 22(5): 751-754.

Walsh KE, Landrigan CP, Adams WG, et al.: Effect of computer order entry on prevention of serious medication errors in hospitalized children. Pediatrics. 2008; 121(3): e421-e427.

Franklin BD, O’Grady K, Donyai P, et al.: The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: A before-and-after study. Qual Saf Health Care. 2007; 16(4): 279-284.

Savage I, Cornford T, Klecun E, et al.: Medication errors with electronic prescribing (eP): Two views of the same picture. BMC Health Serv Res. 2010; 10: 135.

Shoji MM, Bernstein DN, Merchan N, et al.: The effect of an electronic prescribing policy for opioids on physician prescribing patterns following common upper extremity procedures. J Hand Surg Global Online. 2022; 4(2): 71-77.

Danovich D, Greenstein J, Chacko J, et al.: Effect of New York state electronic prescribing mandate on opioid prescribing patterns. J Emerg Med. 2019; 94(2): 246-254; Jawhari B, Keenan L, Zakus D, et al.: Barriers and facilitators to electronic medical record (EMR) use in an urban slum. Int J Med Inform. 2016; 246: 54.

Bright HR, Peter JV, Chandy SJ: Electronic prescribing system in a teaching hospital: User satisfaction and factors affecting successful implementation. Der Pharmacia Lettre. 2019; 11(4): 9-21.