This blog is part of a series of youth authored essays on Health futures: digital first health systems for and with young people. The views expressed in this blog are of the author and not of the Lancet and Financial Times Commission on Governing Health Futures 2030: Growing up in a digital world.
One of the major proponents of Universal Health Coverage is quality of care. Several factors go into achieving optimum quality care. Pharmacotherapy highly influences the quality of care received at every level, and when drugs are used irrationally they affect the quality of care received by patients in or outside the care facility. Prescription errors can be a major cause of this. Rational drug use itemises the appropriate prescribing, dispensing, and patient use of drugs for the diagnosis, prevention, and treatment of diseases. Prescription errors can occur when the physician's handwriting is not legible, thereby leading to a scenario wherein the wrong drug is dispensed, or the right drug is dispensed but at the wrong dosage regimen.
All this leads to suboptimal treatment of the patient and may lead to a case of drug resistance, especially with antibiotics. According to the Lancet and Financial Times Commission on Governing Health Futures 2030, digital innovations could result in both tremendous long-term advantages and severe disruption in a variety of healthcare and health-related sectors. Electronic prescribing or e-prescribing typifies a major digital transformation of care provision and can abolish the occurrence of prescription error.
According to the non-profit organisation MedScape India, which leads a campaign to solve the problem, the frequency of tragic accidents caused by doctors' illegible prescriptions is rising across the globe. It noted that doctors’ illegible handwriting in medical records or medical prescriptions could put patients at risk as they may end up receiving the wrong treatment. The quality of patient care will continue to reduce if patients cannot get the optimum therapeutic intervention due to prescription errors. In more severe cases prescription errors can lead to death when drugs with low therapeutic index are prescribed beyond their correct doses or toxic effects of a drug overdose can occur.
E-prescribing is the capability for a prescriber to electronically deliver a precise, error-free, and intelligible prescription straight to a pharmacy from the point of care. A digitalised method of prescribing where a database of drugs with their correct doses tailored to the various disease conditions will no doubt eliminate errors due to something as simple as a physician's handwriting. In cases where the dose needs to be increased, physicians can always state the rationale for doing such on the script. This would also ensure better physician-pharmacist relationships to achieve better therapeutic outcomes for patients and increase the quality of care provided. E-prescribing is a crucial component in raising the standard of patient care
E-prescribing has continued to gain ground in several high income countries. For example, in Canada, PrescribeIt is currently functional in several provinces and is slowly expanding into others. In the words of Tarek Hussein, an Ontario-based pharmacist, “the transition to e-prescribing has drastically improved workflows and increased efficiency. Not only that, but the integrated, secure clinical communications tool enables us to better support the patient’s primary care team by streamlining communication”.
Low and middle-income countries are far behind in e-prescribing mostly because of the lack of appropriate technology or lack of reliable interconnectivity in the healthcare system. This may prove to be a major drawback in achieving health equity particularly in the larger context of digital health. To this effect, key stakeholders must take a mission-oriented approach to digital health innovation, one that tries to spread the advantages of these technologies in an equitable manner, make their deployment economically viable, and decentralise and democratise control over them.
Beyond eliminating errors, e-prescribing has several advantages with a major one being its ability to save time and money. When prescriptions are adequately filled, the cost of hospital revisits is reduced on the part of the patients, while on the part of the prescriber and pharmacist, time is saved due to increased prescription efficiency as multiple prescriptions can be filled in a shorter duration of time. E-prescriptions also help in the monitoring and dispensing of controlled substances which have to be accounted for.
Quality is emphasised as a crucial component of universal health coverage in the Sustainable Development Goals. When prescription errors continue to plague the first step in achieving rational drug use, the need to adopt electronic prescribing is essential, as drug therapy problems are themselves a barrier to achieving proper treatment outcomes and in some essence good healthcare quality. In conclusion, e-prescribing in addition to all areas of digital health can best be employed amidst accurate patient data within an interoperable and secure database.