The electronic prescription is expected as a mechanism that exchanges prescription information electronically and helps check for duplicate medication and contraindicated combinations. However, especially at larger facilities, there are voices saying that adoption does not progress as hoped.
This article organizes the reasons adoption tends to stall at hospitals from the perspectives of mixed in-house and outside prescriptions and system integration, and explains a step-by-step way to overcome it from a practical viewpoint. Because the system and status may be revised, please assume confirmation with primary sources.
Why adoption stalls at hospitals
Compared with clinics, hospitals have complex prescription routes. In-house and outside prescriptions coexist, operations differ between outpatient and inpatient, and departmental customs remain. This complexity becomes a large wall the moment one tries to apply electronic prescriptions across the whole hospital.
Furthermore, the need to modify integration with ordering and pharmacy systems, and the difficulty of estimating cost and duration, are also reasons for hesitation. The more one aims for full adoption at once, the more coordination targets increase and decision-making tends to stall.
In addition, the burden until on-site physicians and pharmacists get used to new operations cannot be overlooked. Right after introduction, paper and electronic coexist, and there is said to be a period when effort actually increases. Without a plan that factors in this temporary burden, plans tend to stall due to field resistance.
Breaking down the complexity of system integration
The electronic prescription does not complete within the EMR alone; multiple systems are involved, including ordering, pharmacy department systems, eligibility verification, and billing. Diagramming where prescriptions are finalized and where data is passed, and identifying integration points one by one, is the starting point of the review.
- Ordering integration: confirm the timing of prescription finalization and the consistency of data items
- Pharmacy system integration: clarify the connection points with the in-house dispensing and audit flow
- Exception handling: separate the scope requiring individual handling, such as narcotics and certain special prescriptions
- Modification scope: estimate the modification cost and duration of existing systems by narrowing the target
A step-by-step way to expand the scope
Rather than aiming for hospital-wide rollout at once, it is realistic to start with a narrowed target. Beginning with a simply operated scope, identifying issues, and then gradually expanding curbs confusion and rework on-site.
For example, starting with some outpatient departments or beginning with outside prescriptions are possible ways to segment. Starting small and accumulating successes makes internal consensus-building easier. Deciding the criteria for scope expansion at the outset keeps the expansion from stalling.
When advancing stages, it is crucial to carry issues found in the previous stage into the next and resolve them before expanding. Hastily expanding the scope spreads unresolved problems hospital-wide. Setting up a review at the end of each stage and calmly judging whether to proceed is effective.
Multi-professional roles and exception handling
The electronic prescription is not just about physicians. The prescribing physician, the pharmacist involved in dispensing and auditing, and the medical affairs staff handling eligibility and billing each need to act correctly at their stage. Deciding the boundaries of roles and who judges in exceptions in advance is a condition for stable operation.
- Physician: share the criteria for judging whether to issue electronically or on paper
- Pharmacist: unify the confirmation procedure during in-house dispensing and how to record inquiries
- Medical affairs: arrange reflection into billing and the re-confirmation procedure at rejection
- Exceptions: clarify who decides to switch to paper when the system stops or communication fails
The view of operating integrated with the EMR
Adding the electronic prescription as a separate system increases screen switching and double entry, burdening the field. When it can be operated integrated with the EMR where prescriptions originate, the flow from physician input to the pharmacy department and billing connects naturally.
The EMR Sakigake Prime aims for a design that handles prescription orders, electronic prescriptions, and billing as a single flow, seeking to curb the complexity of integration modifications. In considering adoption, scope design that accounts for your hospital's ratio of in-house to outside prescriptions and the frequency of exceptions is effective.
Common failures and how to avoid them
A common failure is insisting on simultaneous hospital-wide adoption, prolonging the plan while coordination never finishes. Narrowing the scope allows an early start, and the knowledge gained can be applied to the next scope. Creating a working scope early advances things more than a perfect simultaneous rollout.
Another is postponing exception handling. Starting without settling special prescriptions and backup procedures during outages leaves the field unsure and halts operation. Including exceptions in the design scope first is the key to avoiding failure.
Regulatory considerations
The system, status, and required conditions regarding electronic prescriptions may be revised. Writing fixed assumptions into internal materials necessitates a full review at changes. It is safest to factor in the possibility of changing premises and keep operational documents easy to update.
Please confirm the latest content with primary sources such as the Ministry of Health, Labour and Welfare. Rather than relying only on vendor information, assigning a person to follow official information reduces delays in responding to revisions.
How to estimate cost and benefit
Modification cost estimates become more accurate when the target scope is narrowed. Rather than vaguely estimating a hospital-wide package, narrowing to the integration modifications of the initial scope clarifies the cost basis and eases investment decisions. Grasping additional costs per stage as the scope expands is also important.
On the benefit side, in addition to improved safety such as checks for duplicate medication and combinations, reduction of effort associated with paper exchange is expected. However, since benefits appear after operations take root, being able to explain short-term burden and mid-to-long-term benefit separately makes internal consensus easier.
Summary
Behind the stalled hospital adoption of electronic prescriptions lie mixed in-house and outside prescriptions and complex system integration. Breaking down integration points, expanding the scope step by step, and settling multi-professional roles and exception handling first are the core of overcoming it. Operate integrated with the EMR, confirm the system with primary sources as needed, and advance steadily with reasonable scope design.
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