Thursday, 24 March 2011

ePrescribing - Is "Safety Last" an option?

I had the privilege of attending an ePrescribing workshop recently. The provinces were well represented, as were pharmacies and Drug Information Systems vendors.

I particularly appreciated feedback from the physicians at the meeting who had actually used ePrescribing systems in various pilots across the country. One of these physicians gave ePrescribing in it's current form a big thumbs down. The reason? He values spending time with his patients. It takes him 12 to 14 seconds to write a paper prescription. Completing an ePrescription, on the other hand, takes him on the order of 4 minutes. He calculated that resulted in him seeing 3-4 less patients in a day.

I've heard many an eHealth idealist bemoan the dinosaur physician who refuses to get with the times, or who jealously guards his or her patient's data. But this is not the case here. This physician just wants to see his patients!

The bulk of this 4 minutes is spent responding to "Alerts" raised by the Drug Information System. The possibility of raising such alerts is the source of much excitement among eHealth proponents: drug interactions, drug allergies, adverse reactions etc could all be detected "at source". Who could say no to that?

The reality, unfortunately, is that the signal-to-noise ratio on those alerts is so bad, that by the the end of their first week, most physicians were dismissing the endless stream of useless alerts without even looking at them. All three physicians at the meeting attested to this.

It made me wonder, should we consider focusing on adoption first, and then add alerts later? There are many benefits to ePrescribing beyond alerts: prescription accuracy, minimizing call-backs, etc. Alerts will be caught by the pharmacy system DUR anyways. Perhaps "Safety Last" is actually the best way forward for ePrescribing in Canada!


  1. Ken,
    Welcome to the blogosphere! You have an "easy to read" writing style that I found quite enjoyable.

    I am huge advocate of Product Management and User Centred Design. Both are heavily influenced by the what the customer needs and count user adoption as a key success metric.

    Interesting to note that one of the most successful products in recent history, the iPhone, was launched without support for apps or "cut and paste" functionality. Yet,despite these serious shortcomings, it was a success nonetheless. It really is OK to add functionality incrementally if you can figure out what is needed to get people to use the product in the first place.

    Looking forward to your next blog post.

    Michael Martineau

  2. I beleive i am totally agree with the writer.

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