I agree, technology has totally changed the way of pharmacy. It can provide additional safety measures, and can definately create pop-up fatigue. We have an electronic medical record, CPOE, and are now implementing bar coding at the bedside. It has been a definate improvement over receiving faxes or handwritten orders from the floors. It has also taken all of the users of our system to continually report, update, and 'fix' potential problems, errors, or concerns. I think we have done an excellent job. I personally love this new age!

As I read your editorial my mind kept substituting the words "drugs",
"medication therapy", "medicine", and "pharmacy" for the word "technology".
Especially that last paragraph. " ... it is equally important that
pharmacists and other medical professionals never lose sight of their
invaluable noncomputerized (viz physical assessment or listening) skills in
handling professional situations (viz patients)."

Here are some comments from a couple of doctors remembering the words of
their non-American professors in medical school:
---------------------------------------------------------------------------------
"I went to medical school in Mexico (for which I've been endlessly
criticized by insurance company attorneys when deposed or givin g testimony
at trial). I had a struggle there but learned medicine AND Spanish. One of
my professors told me the following, which has been a pivotal memory:

'We here of course respect the medicine you have in the U.S., and really
admire all your technology. However, we also think that you have become too
dependent on that technology [viz DRUGS]. Instead of listening to the
patient and then doing a history and physical, you order lots and lots of
tests [viz DRUGS], hoping that will make the diagnosis [viz CURE] for you.'

Patients have bought into the illusion, also. Those with back pain will often
ask me, "maybe we should get an MRI?" I tell them that these cost $1,500 and
the only purpose of doing one is to confirm a diagnosis before you have
surgery. Were broken bones not diagnosable before X-ray was invented?
Careful history and thorough physical exam will find the problem most of the
time.~ Doctor A

"I got a similar speech from a doctor from Ireland when I was in Canada."
~ Doctor B

Famous medical quotes, serving as our poetry (i.e. concentrated knowledge in
easy-to-remember modules)
"You can't make a diagnosis without thinking of it first as a
possibility."
"If you listen very, very carefully to what the patient has to say,
they will 'tell' you what the diagnosis is."
---------------------------------------------------------
Doctors and pharmacists don't just override drug interaction flags on
computers, they override/overlook/dismiss the needs of the patients who are,
literally, standing right in front of them. Writing or filling a
prescription is the "default" [read "override"] response.
THIS is why healthcare is so costly with such poor results. The Canadians, the Irish, the Mexicans, the Brits, the Cubans, the French, the WHO, even the American doctors who administer care in the Remote Area Medical Tent "hospitals" in Los Angeles all know this. ["We should be in Zimbabwe, not L.A."]

Watch this video about the RAMTs:
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&add...

As I see it, the only reason for e-prescribing is simply because DOCTORS CANNOT WRITE NEAT!!! If they could only write their prescriptions just slightly neater, billions of dollars could be saved by all without resorting to e-prescribing. As I have read from my fellow pharmacists and my own experience, they cannot type, either.

Concerning e-Prescriptions, I fully understand the utopian belief that the technology can make the world a better and error-free world. I consider myself a "gadget guy" and embrace technology as it comes across. Our store implemented e-prescription capabilities from the very beginning. But I foresee a great disturbance in the force when it concerns the push behind e-prescriptions. I have seen with my own eyes the way software companies give their sales pitch to providers and discuss how much better this capability will be opposed to the traditional way of doing things, at no additional cost to the provider. I have seen state and federal entities push these capabilities for the "betterment" of healthcare. And I have seen the aftermath of companies that have added this capability to there systems as an afterthought and the errors are piling up each and every day, and at my dime (excuse me, $0.25 per claim).

It was just yesterday that a local politician mentioned to a pharmacist in our area that he was aware of the 20% incentive that each pharmacy receives for each prescription that comes across the network. This is the miscommunication I am speaking of. As we all know, the programs that have been made available to the physicians do not affect pharmacy in the same manner. There are incentives to the providers to adopt this technology, including grants and financial helps as well as an increase to medicare reimbursements assuming a particular percentage of e-prescriptions are written. Although some states, including my own have been able to apply for grants to help for the adoption of e-prescriptions, most pharmacies are not looking at purchasing of additional hardware to facilitate these prescriptions, but instead are accruing transaction charges for each and every Rx that comes across the network, regardless of whether the prescription is meant that that pharmacy, a duplicate prescription, or full of errors. At this point, if a physician sends 15 prescriptions, it comes across as 15 separate transactions on the pharmacy side. If the physician resends that same bundle, the pharmacy will be charged for 30 transactions, regardless of how many prescriptions are actually filled. At this point, there are no filters in place that prevent redundant prescriptions from coming across the network, nor are there any provisions to prevent an MD in California from picking a wrong pharmacy that is in Tennessee and sending those prescriptions by mistake, at that pharmacies charge.

To describe to financial burden that pharmacy is facing, let's take an example. Lets say that a particular pharmacy fills 10000 prescriptions per month, and 50% are new prescriptions. That is 5000 new prescriptions per month. Assuming these are all clean claims (no errors, duplicates, or meant for a different pharmacy), at $0.25/Rx, that equates to $1250 of transaction charges in just e-prescriptions per month. Now we do not live in a perfect world, so lets factor 15%-25% in errors, etc. This will add an additional $187.50 to $312.50. We can round this up to $1500 additional dollars per month or $18000 annually. This on top of AMP, falling reimbursements, healthcare reform, fees associated with online billing transactions, pre- and post-adjudication fees, POS systems required for FSA accounts, and just the cost of operating a pharmacy, one can begin to see that a one-time grant does not necessarily affect the bottom line. And sadly, we have yet to account for the cost of the product being dispensed or the salaries of those responsible for preparing the prescription.

I have tried to reach out to each and ever person that I have come across with ideas to enhance and improve the current system, much to no avail. Although we have been capable of receiving these prescriptions for almost 5 years now, we are just now starting to see physicians utilize this service. Unfortunately, the learning curve is pretty significant. We are receiving prescriptions riddle with errors. From "take 12 tablets every 46 hours" because some system does not "know" how to handle dashes to wrong drugs altogether. The biggest gripe that I have at this time is that the local physician's system classifies medications as active or inactive. The "active" drugs do not actually represent what the patient is actively taking. Therefore each month, because the MD does not believe in refills, we receive any active drug on that patient's profile. Too many times, we have received duplication or triple utilization of the same class of medications because the "system" has not inactivated a medication when the MD changes therapy because of a insurance reason.

The sad thing is that I am actually a strong proponent of the potential that e-prescriptions can provide. This process can finally open the door to accessing information from the MD's system electronically that would assist in MTM management. This could allow for the receipt of a "clean" claim due to pre-adjudication with the insurance company's formulary, thus eliminating prior approvals. This can potentially save time, assuming that the pharmacy's system is capable to communicating with the physician's system.

I figure the only way for pharmacy to not get stuck with paying the bill for everybody else is to get this information out there. The providers of this technology are painting a picture of utopia. We are far from that scenario. But if more people take an active role in steering this initiative rather than letting it unfold before their eyes, then maybe just maybe, pharmacy can come out on top of things instead of where we normally end up.

this is excellent reading! at our place, it's the doctors that put in the prescriptions electronically via computer and then the pharmacists verify them. I'm disappointed that the pharmacy technicians don't get to do that anymore but it frees up for the techs to do the filling and everything else. I think technology is a wonderful thing but some people do not keep up with the information that it comes with, like one of our pharmacy technicians has no idea how to do certain things with our robot and after being shown numerous times over the years on how to solve the problem or whatever, she still refuses to learn anything....it drives me nuts when she refuses to learn how the technology works and so on down the line, so it's just better if I do it myself (solve the matter or whatever, rather than having to constantly explain to her).

well said. I see the new evolution of forced sure-script prescriptions as disaster just waiting to happen, we have received more prescriptions, for wrong drug, wrong patients, wrong dose, wrong sig, to the point that it is not only overwhelming the vigilance that i can muster all day. Doc are presented with computer screens with a list of drugs, look at this one, oops cursor was not on the one intended to be selected. and down the road we go. The same thing is happening with canned sigs. or they just add the sig they really want now I have a script with two sets of directions.