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E-prescribing – nothing to write home about yet

It’s not every day – or every month, for that matter – that the Canadian Medical Association receives a public accolade from the head of Canada Health Infoway.

So it was worth noting when Richard Alvarez spoke kindly of us at the E-health 2014 conference in Vancouver in June. He acknowledged the leadership of the CMA and the Canadian Pharmacists Association (CPhA) in pushing for widespread implementation of electronic prescribing in Canada.

“The leadership that they’re showing is terrific,” Alvarez said.

While Alvarez was referring specifically to the degree of leadership shown by the two organizations, his comments touch on a tender subject. Sadly, when it comes to making electronic prescribing the norm in Canada his congratulatory statement is the only good news we can report.

Frankly, this is embarrassing. It was only two years ago that our organizations issued a joint statement predicting that by 2015 e-prescribing “will be the means by which prescriptions are generated for Canadians.” Even worse, an earlier resolution adopted by the CMA General Council in 2009 called for electronic prescribing to be in place by 2012.

The fact that we are nowhere near delivering on that goal speaks volumes about the complexities involved. Few would deny that e-prescribing can improve medical adherence, prevent fraud, increase provider collaboration and make life easier for patients; and yet, a digital solution eludes us.

Despite statistics seen from the Commonwealth Fund survey suggesting the contrary, the reality is that virtually no Canadian physician outside Quebec is yet able to electronically transmit a prescription to a pharmacist — who then fills the prescription. Data from 2012 indicating 43% of Canadian family physicians routinely use electronic prescribing probably includes many who enter prescribing information into the electronic medical record and then print the prescription out for the patient, or fax it to the pharmacist.

What are the barriers to implementing true e-prescribing? A recent survey of more than 400 CMA members identified the following top issues impairing their ability to e-prescribe:

  • not knowing of a pharmacy that accepts e-prescriptions
  • EMR usability issues

Other challenges may vary by jurisdiction, but include the following:

  • lack of government leadership
  • lack of e-prescribing functionality in some EMR systems
  • lack of interoperability between EMRs in physician practices and pharmacy management software
  • lack of a provider registry so physicians will know which pharmacies accept such scripts
  • lack of a functional drug information system
  • lack of incentives for physicians and pharmacists to e-prescribe
  • unwillingness of chain pharmacies to invest in building 10 separate pharmacy management software systems to accord with provincial practice structures and legislation
  • confusion over what is required to authenticate a physician’s signature

The picture is not universally gloomy. In Quebec, as part of the Quebec Health Record initiative, physicians in certain medical clinics and community pharmacies can view a patient’s pharmacological profile and create and receive electronic prescriptions. To date, results from this pilot project have been positive.

At the national level, the CMA remains committed to working with the CPhA and other organizations to advocate for system changes that will facilitate the implementation of e-prescribing to maximize efficiencies for physicians and pharmacists while improving the process for patients.

We are disappointed at the lack of progress on this goal, but feel it is an important issue to persevere with, in the interests of both the profession and the public.