Handwritten prescriptions are hell on earth, aren’t they? For patients, it’s always been about deciphering unintelligible handwriting, making back-and-forth calls with pharmacies to clarify drug availability, reading instructions, confirming insurance coverage, and getting refills. For doctors and pharmacists, it's an exhausting process of searching through piles of medical records and recalling drug information (contraindications, allergies, side effects) to advise adequate treatment. Thankfully, with electronic prescribing and electronic health records (EHRs), things got much better.
Electronic prescribing, also known as e-prescribing or eRx, was born to facilitate the traditional drug prescription process and reduce medical errors. This technology is now an essential part of the eHealth industry, working to deliver more mature, safer, and higher-quality care.
In short, eRx is a way to generate digital recipes and send them from a caregiver to a pharmacy with the help of dedicated medical prescription software. All this makes for error-free, intelligible, and accurate treatment assignments, minimizing the risks usually associated with handwritten and oral communication.
Here’s our guide to electronic prescription app development.
The moment of eRx’s glory
Though this technology is young, eRx has already gained momentum in the US, the UK, Europe, and some South American countries. Back in 2018, already, 85 percent of all prescriptions in the US were made electronically according to Statista:
E-prescribing is not yet mandatory but has been the recommended way of generating prescriptions for controlled substances in the US since 2010 according to the US Drug Enforcement Administration.
So why has e-prescribing been getting close attention recently? The answer lies in the benefits it provides.
What is eRx for?
Compared to written or faxed prescriptions, digital prescriptions solve numerous challenges for physicians, pharmacies, and patients. Below are six benefits custom eRx software offers:
Fewer prescription drug errors
Despite remarkable achievements in the healthcare industry in recent years, patient harm from medication errors is still significant. According to the World Care Organization, as many as 4 in 10 patients are harmed by errors in primary and outpatient care globally. Sadly, the gravest errors are related to misdiagnosis, taking medications incorrectly, and incorrect prescriptions.
Prescription errors usually have their roots in illegible handwriting (and thus incorrect transcriptions), poor prescription decisions, and inefficient drug administration.
eRx has the potential to eliminate errors associated with illegibility, including mixing up drug names, dosages, and forms. It also helps to minimize the number of phone calls to confirm prescriptions, formularies, and refills. All this results in a more effective workflow and greater productivity for pharmacy staff as well as increased patient satisfaction.
Having access to a patient’s insurance information, eRx allows for a more effective and quicker way to see formulary lists and choose medications that are covered by a patient’s drug benefit policy. For example, a doctor can immediately see whether brand-name drugs are available to a patient within their policy to offer better quality care.
Automated clinical decision support and faster medication reconciliation
It’s impossible to keep all drug-related information in mind. Many drugs come in numerous forms and strengths; moreover, you should be careful about drug interactions, allergies, and side effects. E-prescribing lets doctors look up drugs and read prescribing instructions. It also speeds up the process of generating and filling prescriptions thanks to drop-down lists and default SIG information (instructions for patients as to how much medication they should take, how they should take it, and when).
What’s more, by providing access to patients’ prescription histories and checking for contradictions, age, weight, allergies, and diagnoses, eRx can help to avoid the wrong or a duplicate drug from being prescribed. An eRx system can send alerts on contradictions, dangerous doses, potential adverse reactions, and duplicate therapies to caregivers while providing clear instructions on how to provide better treatment.
Increased medication adherence and fewer unfilled or lost prescriptions
Patients can forget to fill their prescriptions, lose them, or decide not to take medicine at all. As a result, around 20 percent of paper prescriptions go unfilled. E-prescribing provides an effective way to track unfilled prescriptions, allowing doctors to remind their patients about the necessity of taking medication using in-app chat or email. This helps to increase medication adherence. Doctors can also use eRx tools to track the frequency with which patients fill prescriptions for controlled substances, making it easier to detect potential drug abuse.
Simplified prescribing of controlled substances
In March 2010, the DEA proposed, in its rule on “Electronic Prescriptions for Controlled Substances,” to offer hospitals, pharmacies, and medical practitioners an advanced tool for receiving, filling, and storing electronic prescriptions for opioids and psychotropic drugs. Thanks to integration with the Prescription Drug Monitoring Program (PDMP) database, e-prescribing tools can let prescribers check a patient’s history of controlled substance use. This database also allows for more effective tracking of these types of drugs, which can help to cut the increasing rates of opioid-related addiction, abuse, and death. These measures prevent drug-seekers from altering prescriptions or doctor shopping for controlled drugs.
The safety measures included in the DEA initiative include a requirement for doctors to prove a patient’s identity (either in-person or online) and to use two-factor authentication to enter the system. This entails complex authorization involving biometrics (such as Face ID or Touch ID), a security token, or a SMS code in addition to a password.
Faster prescription refills
Physicians and clinical staff say that responding to prescription refill requests is their greatest burden. E-prescribing makes it easier for patients to get refills. It’s also easier to process urgent refills using eRx software.
How does an eRx system work?
To start, let’s figure out the structure of your eRx system and overview the process of exchanging information between an eRx app, pharmacy benefit management system, pharmacy system, and patient portal.
Based on what we’ve just learned, let’s outline the must-have features for an eRx app:
Multi-factor authentication with a password and some other form of identification, such as Touch ID or Face ID
Ability to search for patients and view their medical data and treatment history, which is possible thanks to integration with an existing EHR system via an API
Ability to create new prescriptions for each patient (indicates the drug form, dosage, and frequency and leave notes)
Drug search and discovery through integration with a drug dictionary and medication history networks
Prescription history for seeing past, regular, and pending prescriptions and refilling them
Integration with your state’s PDMP database to effectively track patients’ prescriptions for controlled substances and fight the nation’s opioid crisis
Clinical decision support, built on the basis of sophisticated algorithms and equipped with alerts, reminders, and push notifications to warn doctors of possible negative events and contraindications
Electronic pre-authorization to check a patient’s eligibility for certain drugs (through integration with a pharmacy benefit management system) and avoid surprises at the pharmacy; this feature can be triggered either by sending an eRx or by manually initiating a request
Secure in-app chat with patients and pharmacists for clarifications, additional instructions, or simply to say hello
Geo-awareness to help clinicians locate nearby pharmacies to send their prescriptions to
Digital signatures to securely verify each prescription
Ability to print prescriptions in case someone needs paper proof
Reporting functionality so clinicians and pharmacies can report to institutions in order to prove a patient’s eligibility and comply with the law
Now let’s proceed to a trickier matter – how to make your system smart, user-friendly, and secure.
What is clinical decision support and how does it make for better care?
Clinical decision support systems (that work independently or as part of an EHR or eRx system) combine health observations with doctors’ own knowledge to help doctors make more informed decisions when it comes to patient treatment. Existing clinical decision support systems (CDSSs) analyze multiple pieces of health data to provide clinical advice. There are two types of clinical decision support systems: knowledge-based and non knowledge–based.
A knowledge-based CDSS usually consists of three ingredients: a knowledge base, an inference engine, and a mechanism for communication. The knowledge base contains a set of rules and associations that work in accordance with the IF–THEN principle. For example, if your eRx system needs to check for a drug-to-drug interaction, the rule may be written as:
The inference engine then combines knowledge-based rules with a patient’s data to check for further tolerance. The communication mechanism informs a prescriber of the results of the analysis – for example, it can alert on a negative outcome for a patient – such as a dangerous contradiction with a patient’s current treatment program or a lethal drug doses for them. This technology is based on the GELLO or CQL (Clinical Quality Language) expression languages.
A non knowledge–based CDSS uses machine learning to analyze past experience in order to find common patterns in clinical data for better decision-making. These systems are often called black boxes, however, since machine learning technologies can’t explain the reasons for their conclusions. That’s why non knowledge–based systems are used for post-diagnosis to check clinicians’ hypotheses.
How can I eliminate patient privacy concerns and enable security for my eRx system?
Your eRx app is going to retrieve, modify, process, and sometimes store confidential user information – for example, patients’ treatment histories, private chats between doctors and pharmacists, and a doctor’s current geolocation. That’s why you should be aware of all security regulations and strictly follow them to protect your users’ data from fraud and breaches.
For instance, a health app for the US market should comply with the Health Insurance Portability and Accountability Act (HIPAA), while an app for the European market should follow the General Data Protection Regulation (GDPR). We suggest investigating the contents of these two measures, taking into account the specifics of your app.
Read also: HIPAA and Other Requirements for Medical Software: How to Make Sure You’re Compliant with the Law
Here’s what you can do to enable the secure exchange and processing of protected health information (PHI) in your app according to a HIPAA security checklist and our own expertise:
1) Data storage
When it comes to storing information (presumably in the cloud), we recommend choosing between Google Cloud Drive, Microsoft One Drive, Amazon Web Services, and Box, as all of these services focus on HIPAA and GDPR compliance. At Yalantis, we prefer using Amazon’s Healthcare and Life Science Segments, since it provides the most advanced cloud platform that’s fully compliant with all global industry standards.
2) Transmission security
Considering the number of stakeholders and the amount of sensitive information they exchange between their apps, you’ll need a secure system that encrypts data flows on all sides. TLS/SSL technology can help you with that.
TLS stands for Transport Layer Security, while SSL stands for Security Socket Layer. Both are cryptographic protocols that use certificates to authenticate and encrypt data between applications and servers. TLS/SSL technology lies at the heart of HTTPS (Hypertext Transfer Protocol Secure), which is used to secure connections on the web. Starting 2016, an HTTPS connection is required by Apple for iOS apps as well. As for Android mobile app development, there’s the whole section on Android Developers devoted to using TLS/SSL correctly.
There are different types of SSL certificates you can get for your app depending on the level of security you need. You can get your own SSL certificate from tried and tested services like Comodo and DigiCert.
3) Data encryption and decryption
An additional level of security can be achieved if sensitive data is additionally encrypted before sending it through HTTPS. This way, even if hackers manage to steal your data, it will look like nonsense without the decryption keys.
You can use asymmetric encryption, a modern implementation of end-to-end encryption that uses a pair of keys (public and private) to cipher and decipher secret information. You can read more about core security elements and end-to-end encryption in our blog post.
4) Access control and activity logs
For better control over PHI, enable different access levels for different types of users. For example, a pharmacy manager shouldn’t see as much patient information as a physician.
This is possible by assigning each user a unique ID that lets you identify them and track their activities in the system. After that, you should give each user privileges to either view or modify certain information.
5) Multi-factor authentication
Once roles and privileges are assigned, it’s time to define a method for verifying users who can access PHI. To make your app fsoconsider the following methods:
Biometrics (Touch ID or Face ID are great)
Physical means of identification (a key, card, or token)
Personal identification number (PIN).
The DEA requires all eRx providers to enable two-factor authentication to securely authorize prescribers within eRx systems. Two-factor authentication combines a secure password with a second method of authentication – anything from biometric data to a one-time security code received via SMS (here is where you can use Twilio's SMS Verification service, for example).
6) Expiry time and automatic logout
You should also consider setting an expiry timer on in-app conversations to ensure that older messages will be deleted, as this falls under HIPAA standards. Your eRx app has to automatically log off a user after a defined interval. This ensures that nobody will be able to use a session except for an authorized user.
How can I know that my eRx system is useful?
As we’ve discussed, medical errors are still quite common in healthcare, leading in some cases to mortality and imposing huge costs on the healthcare industry. EHR and eRx software was designed to reduce these errors and provide a higher quality of care. However, it’s not always human factors that are to blame for medical errors. Poorly implemented healthcare software – particularly in terms of its design and interface – can be the cause of harm as well.
After testing nearly 36 EHR products, Dr. James L. Madara, the Executive Vice President and CEO of AMA, claimed that most software has “cumbersome workflows and applications that do not take physician needs into account.”
Other clinicians have pointed to barely noticeable alerts in EHR products; still others have said that notifications are too intrusive, annoying, and overwhelming, such that they distract from work.
So how can you avoid usability issues and deliver a really good product that meets the needs of your users?
The Office of the National Coordinator’s (ONC) Health IT Certification Program offers one example. It requires all healthcare software developers to engage their end-users (medical staff) in thorough usability testing to ensure patient safety and improve the overall usability of products.
To prepare for this certification, it’s advisable to conduct usability testing based on test cases proposed by NIST. This will help you to address and solve the most common usability challenges before submitting your product for final approval to the ONC Health IT. This article will give you a better understanding of how to properly test your app. You can also develop your own test cases.
To wrap up
Though eRX software is mostly welcomed by physicians and clinical staff, there are still some challenges for this technology related to IT vendors who, while distributing this software, impose high installation, customization, and maintenance costs on doctors and pharmacies.
That’s why hospitals and practitioners might consider investing more modest resources into developing a customized e-prescription system as a standalone tool or as part of their existing EHR app. If you want to build a standalone eRx system or an additional module for your EHR app, Yalantis is here to answer all of your questions.