Friday, April 24, 2009

E-Prescriptions: Great Advance or Big Ol' Crutch?

Computer-generated, flawlessly legible prescription for a topical steroid lotion ----
Rinse mouth twice daily.
Entered, prepared by my technician and presented to me for the final check. Of course, there's something wrong here. The doctor is called and seems flabbergasted: "But the directions just popped up like that! Can you get someone to fix that?"

Oh, no problem then... if the directions just "pop up" (which I seriously doubt) then that completely absolves you of any responsibility to actually READ what is on this prescription you are sending to the pharmacy.

Later, another e-prescription for Cefzil. Helpfully listed on one corner of the prescription are the patient's drug allergies/"adverse drug reactions": CEPHALOSPORINS.
Patient confirms this was an honest-to-goodness allergy, producing hives.
Again, the doctor wails, "Why didn't it (ie., a warning) pop up when I entered it?"

So apparently this prescriber's practice is governed by the "pop-up." I cannot convey my irritation at having to sit on the phone and track down someone, anyone, to clarify these prescriptions. COMPLETE waste of my time. I still wonder if these electronic prescriptions are worth it when prescribers don't check it for accuracy and don't know how to customize it or alter the directions so they make some kind of sense. Please, PLEASE read the thing. Just because it comes out of a computer doesn't mean it's perfect.

I really don't want to bring back those horrific hand-written prescriptions, but some days I just have to wonder.


Anonymous said...

I love the ones that print from the palm/computer to the printer most of the times. It is alot easier than trying to figure out what in the world the doc wrote for. I'm not a big fan when they seem to have directions that are more confusing that goverment tax forms. I really wish I could just take the script to them and ask what the hell where they thinking when they wrote completely non-sensical directions or really poorly worded ones that we then have to call the MD on to get straightened out. If the pharmacy staff has a hard time understanding it, do they really think the 80 y/o grandma or grandpa is going to understand it? They seem to have let common sense and actually reading the script to confirm that the script is correct before they hand it to the patient or fax it to the pharmacy.

Pharmacist Erin said...

Our store's system just started getting these last week. They're annoying as heck!! On our system, every dosage form comes up as "aerosol". And every days supply adds a zero to the end. Keflex 500mg bid #20 ...... days supply = 100. Wow isn't technology great. Ugh.

Anonymous said...

Is there some degree of 'negligence' that should be brought to bear on software companies? Seems that there is more than one 'program' available to the general public, but have no idea if one has been identified that is easier to work with. Whether or not the government needs to step in to mandate (Heaven forbid that an authoritative pharmacy body would pick up this responsibility!) a certain high level of functionality should dispel the many complaints that pharmacists have in dealing with these issues.

Anonymous said...

I was just telling my lead tech the other day that Drs are just embracing technology. They are at the stage that pharmacies were 20 years ago.

They haven't figured out that technology/computers aren't "magic boxes" yet.

It seems like magic to them. Things just "pop-up" when you put in ______ (diagnosis, drug name, etc) and they think that its a magic palm pilot, it must know.

It will be a while and probably a few deaths and/or lives/careers ruined before they realize that a human programed that computer (and more than likely not a medical professional of any kind) and a human (even if he is a high and mighty doctor of medicine) is using it, they aren't "magic" and a margin for error does exist.

The Ole' Apothecary said...

Thank you, all, for informing me as to the nature of the "new illegibility." I've been out of retail for 16 years, so I don't know what goes on. It seems as if these folks think that the computer absolves them from having to think about the things they write, so, yes, it is indeed the "new illegibility," or, perhaps, the "new illiteracy."

Shalom said...

Just got one last Thursday: Phenazopyridine powder, #6. Sig: "tid until gone".

That must have been the first instance of the word phenazopyridine that popped up, so that's what they went with. I had to call them to find out whether they wanted the 100mg tabs or the 200mg tabs.

Yet there are still some doctors that I'd take this sort of problem over their illegible handwriting any day. This screwup happens maybe once a week, whereas they can't write legibly any day of the week.

Anonymous said...

I just got one the other day for Potassium 40mg/whatever IV at a retail pharmacy that said take 2 tablets IV for 3 days. Left before that one got resolved.

Grumpy, M.D. said...

I've started using Allscripts because of the Medicare requirements, and I absolutely hate it.

It's a remarkable pain in the ass. It literally takes 10 minutes to enter a new patient, then a med, then a pharmacy. I could write out (in my neat manuscript) or call in (in my slow, non-accented English) the same script in < 1 minute.

I HATE e-prescibing, and am only using it for medicare patients. I hope other insurances don't start to require them, too.