Nathan Jessop
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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.
