ePrescribing

eHealth Ontario is leading the implementation of electronic prescribing (“ePrescribing”) across the province as part of its ehealth strategy to improve patient care and safety and access in support of the government’s health strategy.

eHealth Ontario is focusing its efforts over the next three years on three clinical priorities: diabetes management, medication management and wait times. These priorities are fundamental for building a comprehensive electronic health record for all Ontarians by 2015. Electronic prescribing is only one component of the overall provincial strategy to improve medication management in Ontario.

The Ontario government has explicitly placed the prevention and management of chronic diseases such as diabetes as a major health care priority and aims to prevent $300 million in hospital costs annually. eHealth Ontario’s Strategy 2009-2012 identifies diabetes management as one of its three clinical priorities.

ePrescribing Demo

Sault Ste. Marie’s The Group Health Centre, Collingwood’s Georgian Bay Family Health Team and eHealth Ontario collaborated to showcase a demonstration of ePrescribing at the Celebrating Innovations in Healthcare Expo last fall. This initiative has enhanced patient safety by reducing the possibility of medication errors due to illegible handwritten prescriptions and expanding the circle of care. Physicians at the two sites can securely send prescriptions electronically to the patient’s preferred pharmacy with just a few clicks. View the video to see how it’s done.

Benefits:

It is estimated that every year, almost 400,000 Ontarians suffer preventable, adverse events due to medications. Four thousand of them will die as a result. ePrescribing, or electronic prescribing, is the process of electronically generating, authorizing (“signing”) and transmitting prescriptions from physicians and other prescribers to pharmacists and other dispensers.

Patient benefits:

• Increased safety through the reduction of adverse drug events, hospitalization and physician visits due
  to illegible handwriting on paper prescriptions.
• Prescriptions are no longer lost and may be processed in a timelier manner at the patient’s pharmacy of choice.
• Better communication and coordination between care providers resulting in better care.
• More time for the care team, including pharmacists, to provide direct patient care.

Pharmacist benefits:

• Elimination of illegible, hand-written paper prescriptions and the time required to clarify them
  with physicians and other prescribers.
• Electronic authentication, authorization and delivery of prescriptions, reducing the potential for
  prescription fraud and diversion.
• Access to patients’ complete medication histories and clinically relevant information.
• More timely and direct communication and collaboration with physicians and other prescribers.

Progress to date

With the help and endorsement of the North East and North Simcoe Muskoka Local Health Integration Networks, eHealth Ontario launched the ePrescribing Demonstration Project, the first ePrescribing program in Canada, in April 2009:

• Two sites, which were advanced in the use of electronic medical records, were selected for the project: the Group Health Centre in Sault Ste. Marie and Georgian Bay Family Health Team in Collingwood.
• The Group Health Centre participants: 16 general practitioners, 5 specialists, 7 nurse practitioners, 23 pharmacies.
• Georgian Bay Family Health Team participants: 24 general practitioners, 4 nurse practitioners,
  19 pharmacies in the area of Collingwood, Wasaga Beach, The Blue Mountains, and
  Clearview (including Stayner, Nottawa, Duntroon and Creemore).
• Physicians and other prescribers in each site worked directly with patients who agreed to participate and explained the impact of the new process on them.
• The College of Nurses of Ontario, College of Physicians and Surgeons of Ontario and the Ontario College of Pharmacists continue to be valuable ePrescribing partners and supported the project with advice regarding regulatory issues.
• Existing electronic medical record systems owned and operated by the two sites were upgraded
  to enable participating physicians and nurse practitioners to begin ePrescribing.
• The systems allow pharmacists to verify prescriber authorization and transmission of information.
• Secure web applications provided the pharmacies with access to patients’ medication histories, including pending ePrescriptions, and a subset of clinically-relevant information; pharmacies connected to the web applications through eHealth Ontario’s Managed Private Network (Georgian Bay Family Health Team) or through a secure Citrix VPN connection (Group Health Centre).

Next steps

The ePrescribing Demonstration Project was completed in June 2009, however, participating prescribers and pharmacies at both sites will continue electronically prescribing until December 31, 2009. eHealth Ontario and the colleges are evaluating the project to determine whether new regulations, standards or guidelines will be necessary to support ePrescribing and a province-wide Drug Information System (DIS). The DIS will be connected to pharmacies across the province, enabling physicians, nurse practitioners, pharmacists and other health care professionals to ePrescribe. It will also provide prescribers and dispensers with access to comprehensive medication profiles and tools that check for allergy, drug-to-drug interactions and accurate medication dosages.

The two project sites provided valuable lessons about workflow and change management and the impact on physicians, nurse practitioners, pharmacists and patients. The project has helped to develop tools and templates for the implementation of province-wide ePrescribing and the DIS.

In the meantime, the College of Physicians and Surgeons of Ontario has advised physicians not to electronically sign prescriptions and the Ontario College of Pharmacists has advised pharmacists not to accept ePrescriptions unless they are participating in one of the two project sites.