While ePrescribing aims to cut down on prescribing errors, fraud and patient non-compliance, it is also shifting the balance of power away from the physician's prerogative towards payer formularies and patient choice. Although threatened by these changing dynamics, the pharmaceutical industry can mitigate these losses by ensuring that no single stakeholder unduly influences the prescribing process.

One of the unfortunate truths of modern medicine is that patients need to be aware of more than just anticipated risks when seeking treatment. Injuries and death do result from errors in the prescribing, administering or taking of a medication. These are preventable medical errors and can almost always be attributed to a lack or misinterpretation of information.

For example, a physician might not be aware of the potential for a drug interaction or allergy if there is information missing from a patient's chart. In addition, patients can receive an incorrect dose or the wrong drug entirely if pharmacists and nurses misinterpretation doctor's handwriting.

Many sources of prescribing error are directly related to the fact that the prescribing process remains largely paper-based. This not only contributes to the high incidences of preventable adverse events, but also to the soaring cost of healthcare provision. Paper prescriptions also leave the prescribing process open to breaches of security and fraud because they are easily forged and difficult to trace. In addition to the risk of fraud, the inability to trace prescriptions once they leave the physician's office makes it difficult, if not impossible, to accurately assess patient adherence to the medications they have been prescribed.

Technological impact

Electronic prescribing (ePrescribing) is the use of electronic media by a physician to inform, generate, modify or transmit a drug prescription between a physician and pharmacist or payer. By increasing the reliability and speed of communication, providing access to information on patient compliance and reducing inefficiencies, ePrescribing has the potential to solve many of the problems that currently plague the traditional paper-based prescribing system.

However, adoption of ePrescribing technologies has happened much slower than originally hoped. There have been several stumbling blocks to adoption including a lack of uniform technology standards, which makes it difficult to design an ePrescribing system that is interoperable between all doctors' offices, hospitals and pharmacies.

Another barrier to widespread adoption of ePrescribing systems is that there is no formal consensus on functional standards to govern how ePrescribing is used at the point-of-care. There is great debate, for example, as to when a physician's drug choice should trigger an automatic message from the ePrescribing system. Some stakeholders believe that physicians should be alerted only when a drug interaction or other medically-relevant incident is likely to occur. Others think that ePrescribing systems should inform physicians of safer or better-tolerated alternatives to their initial drug choice.

Who stands to benefit?

Pharmaceutical manufacturers are not the only stakeholders that stand to benefit from maintaining a share-of-voice at the point-of-care. Pharmacy benefit managers (PBMs), retail pharmacies, technology companies and payers also have interests that can be seen to conflict with putting the needs of the patient first.

This is where adoption can really get stalled. The types of messaging that are allowed is going to significantly impact who has influence at the point-of-care. For instance, if a physician receives a message that the drug he intends to prescribe is not covered by the patient's insurance, it is highly likely he will seek out an alternative, such as a generic or a competing brand. Obviously drug companies are worried about the impact this will have on any of their drugs with poor formulary placement.

Pharmaceutical manufacturers are understandably concerned about the potential negative impact ePrescribing will have on their bottom line as physician-facing sales and marketing loses ground to formulary-centric decision-support tools at the point-of care. The potential opportunity to mitigate some of these losses by ensuring no one stakeholder unduly influences the prescribing process is the primary reason pharmaceutical companies should remain involved in the ePrescribing process.

Moving forward, pharmaceutical companies should focus on how the resulting changes in physician and patient behavior as a result of eHealth advances can positively affect their industry. More specifically, ePrescribing has the potential to affect pharmaceutical manufacturers through improved patient compliance, which will come about as the result of a streamlined prescribing process. Increases in patient compliance and adherence rates will have positive affects on long-term sales and potentially extend the life of key products.

Furthermore, a reduction in the rate of injury or death as the result of avoidable adverse drug events will greatly reduce the prevalence of negative industry images in the public eye.


Related research:

• eHealthInsight Series: ePrescribing - Infrastructure and Impact on the Healthcare Markets in the US and EU

• eHealth for the Pharmaceutical Industry: What companies need to know about trends in physicians and consumers' use of the Internet

• Taking CRM to the Next Level: Web-assisted relationship- and community-building for the pharmaceutical industry