Physicians at the Group Health Centre (GHC) in Sault Ste. Marie don't want to go back to the old way of processing prescriptions following the successful conclusion of an ePrescribing pilot funded by eHealth Ontario.
The pilot links GHC physicians with 23 pharmacies in the city, allowing for the electronic transfer of prescriptions at the press of a button.
"All of the physicians who used it are so enthusiastic that we have lobbied the Ontario College of Pharmacists and the College of Physicians and Surgeons of Ontario to continue to allow the pilot to go on even though it was supposed to end last July," said Dr. Lewis O'Brien, the GHC's director of information technology.
Physicians are able to either save the prescription in the GHC's Electronic Medical Record (EMR) system or transmit it directly to the patient's pharmacy of choice. The latter is the preferred method because it allows the pharmacist to have the prescription ready before the patient arrives. It also promotes compliance because the pharmacist is able to alert the physician if the prescription isn't picked up.
If there is no pharmacy identified, the prescription is stored in the GHC's EMR and downloaded at any one of the 23 pharmacies the patient chooses to pop in on.
The pilot was funded by eHealth Ontario at two locations in the province to better understand how to go about establishing a province-wide repository for prescriptions.
"The application we're using is not a provincial solution," said Lucy Fronzi, the GHC's project manager for ePrescribing. "A provincial solution would be a repository for all of the prescriptions in Ontario, so a patent from Sault Ste. Marie can go to Toronto and fill a prescription."
The ePrescribing application at the GHC also features a secure messaging tool that allows pharmacists to question a physician about the dose or potential interactions instead of playing telephone tag.
"It's not ideal," said O'Brien. "Pharmacists still have to run two systems. They have to print out the prescription from the EMR and manually enter it in their own system, but it has been very well received."
The GHC's EMR and many other electronic medical record systems currently have the capacity to process and transmit prescriptions electronically to pharmacies, but there is no legislation permitting electronic transfer. Prior to the pilot, GHC physicians had to print out prescriptions, retrieve them from a printer in the office, sign them and hand them to the patient.
"The same process prints out a list of active medications, any notes and a legible prescription, so there are benefits, but not as many as a centralized information system," said O'Brien.
"At this point, we have an agreement between the colleges to allow the pilot to continue until such time as the project can be evaluated and legislation can be written to allow it. Hopefully, it will continue."
The GHC also served as a guinea pig for another pilot called EMRxtra that gave the same 23 pharmacies in Sault Ste. Marie access to the electronic medical records of more than 200 patients with diabetes or congestive heart failure.
Launched in August 2006 and terminated 18 months later in February 2008, EMRxtra provided pharmacists with the information needed to counsel patients more effectively. The demonstration project was funded by Canada Health Infoway to the tune of $2.5 million and was well received by patients and pharmacists.
A formal evaluation by the Courtyard Group "showed that pharmacist interactions with physicians were more clinically related" and that they felt more like part of the patient's clinical team," said O'Brien.
There was no shared access to counselling, psychiatric or OBGYN notes and patients could also elect to lock any other information they didn't want shared.
"It placed the pharmacist on the same page as the physician as to why the medication was important and how it should be taken," said O'Brien. Patients are sometimes reluctant to take a medication once the potential risks are pointed out to them, but with access to the patient's record, pharmacists were also able to explain the risks of not taking it, he added.
Participating in a pilot and then seeing it disappear has left GHC physicians somewhat frustrated.
"You do all this work and then it ends," said O'Brien. "It's hard to deal with, especially if it's a good application. It creates some reluctance going forward to sign on to other pilots."
