Europe Edging Towards Electronic Prescribing

Electronic prescribing has grown strongly in the US but its future as a European-wide approach in healthcare has been uncertain; new regulatory interest could change the playing field.
Oct 01, 2011

Nathan Jessop
With underlying technologies advancing, there has been a drive in recent years to introduce electronic prescriptions. Although electronic prescribing has gained popularity in the US and been explored by a few countries in the EU, such as Sweden, Denmark and the Netherlands, it's widespread acceptance in Europe is still pending, particularly as official backing has been unclear.

Regulatory interest

This situation looks likely to change. The EMA's Unit for Information and Communications Technology recently issued a request for expressions of interest from softwaredevelopment companies to participate in a workshop, scheduled to be held at the beginning of October, on the future of electronic prescribing in the EU (1). The outcome, once published, will provide important insight into how the agency will regulate the area of electronic prescribing. As any changes in the way prescriptions are handled will impact all stakeholders within healthcare, the EMA also extended its workshop invitation to physicians, pharmaceutical purchasers, patient representatives, health-technology-assessment bodies, specialists in the safety of medicines, experts in quality monitoring of healthcare, regulators and representatives of the pharmaceutical industry. Members of the EMA's electronic summary of product characteristics (e-SPC) project will be the main representatives from the agency's side. The e-SPC project has been examining how the information regarding authorised medicines that appears in summaries of product characteristics can be structured to better relate to available and emerging electronic media. The hope is that by understanding prescribers' information needs and providing a means to supply it electronically, the prescribing process can be better customised for individual patient needs, while also improving safety and effectiveness.

Much attention in the area of electronic prescribing inevitably centres on technologies emerging in daily life, such as faster internet connections, iPads and voice-activated control systems, that might be harnessed for the purposes of heathcare. However, focus also needs to be broader for electronic prescribing to stand any chance of success. Technology cannot just be looked at in isolation and needs to be customised to suit the situation and the people who will be using it. You can't just throw a gadget at something and hope that it solves all your problems! Thus, electronic prescribing cannot just be a simple tool that delivers prescriptions in an electronic format; it must integrate into the existing healthcare system, making it more secure and reliable as a result of the electronic decision-making database systems employed.

Electronic prescribing has several potential advantages; for example, it could provide a means to crosscheck on double medication, contra-indications and dosage at the moment of prescribing. In particular, much has been made of the potential an electronic approach offers in reducing the number of medical accidents due to prescribing errors. In a litigious country such as the US, this potential benefit is a highly topical subject and has contributed towards greater acceptance of the electronic prescribing concept. For example, one US legal firm cites figures stating that 7000 people lose their lives due to prescription mistakes annually and that more than 100000 people are affected by prescription mistakes each year (2). A 2007 report by CNN also stated that an estimated 30 million dispensing errors out of 3 billion prescriptions annually occur at outpatient pharmacies in the US (3). There is also a concern that prescription errors are increasing. This is partly due to the wide array of drugs now on the market, some of which have similar names, and a greater reliance on healthcare services taking place outside the hospital.

In Europe, it is much harder to get a picture of how widespread this problem is, but some information is available for individual countries. In the UK, a 2009 report commissioned by the General Medical Council (GMC) suggested that almost 1 in 10 prescribed items in hospitals had errors associated with them (4). The study involved hospital pharmacists in 19 hospitals in North West England. Out of 124260 medication orders checked by pharmacists within the study hospitals over a predefined period, 11077 errors were detected (6). Of these, 2% were classified as potentially lethal (4). Worryingly, errors were made by all grades of doctors, including consultants. Nearly all these errors were reportedly intercepted by pharmacists before the patients received the medicines prescribed. In a separate part of the study that examined qualitative factors in prescribing, many doctors stated that they relied heavily on pharmacists and nurses to identify and correct prescribing errors. In effect, they believed that pharmacists provided an important safety net to prevent patients receiving the wrong medication. For example, if a system links up to a patient database, it may be able to provide details about medicines that specific patients need to avoid because of interactions with other drugs. In addition, if a doctor mistakenly prescribes a medicine that could potentially interact with another, the electronic system could immediately flag up a warning.