- Financial cost and return on investment (ROI)
- Hardware and software might need to be invested for stand-alone or EHR systems
- Larger practices can achieve ROI earlier
- Change management
- Difficulty changing to a new electronic system
- Workflow
- People need to adapt to the new system
- A full EHR system will take more time
- Controlled substances
- Electronic transmission of prescriptions for controlled substances is prohibited
- State regulatory restrictions
- All states allow electronic prescribing
- Medicaid in New York require a “dispense as written (DAW)” in a handwritten form
- Hardware and software selection
- This can be a daunting task
- Limitations on e-prescribing system remote access
- No easy remote access optimal
- Cell phone gaps for digital service and limitations of broadband internet service
- Pharmacy, payer/PBM and mail order connectivity
- Not all pharmacies are connected using certified software like SureScripts-RxHub
- Do not want to pay a fee
- Medication history information is not comprehensive
- Medication history and medication reconciliation
- Confidence cannot be placed in the completeness and currency of information
- Reconciliation from multiple sources must occur
- Doctor's must consult with patients on accuracy
- Medical history information
- Not all stand-alone systems include a history which could impact a medication decision
- Prescribing from multiple office sites
- Must accommodate this because there are differing registration numbers and passwords
- Must be able to work elsewhere, but that function is not always available
- Small and rural practice challenges
- Challenges are magnified
- Lack of access to broadband and to skilled information technology professionals
- Longer to achieve ROI
- Patient acceptance and usage issues
- Patients may fee uncomfortable with e-prescriptions and demand paper prescriptions
- Frequent travelers may feel prefer a written one
A CLINICIAN’S GUIDE TO ELECTRONIC PRESCRIBING
