![]() It is, however, related to an electronic prescription because it uses the same production process as an e-prescription. This is not an electronic prescription primarily because it is not transmitted to the pharmacy using a computer-to-computer electronic data interchange protocol with standard data fields. If the prescription were given to the patient to deliver to the pharmacy, then the pharmacy would still code the prescription as Prescription Origin Code 1. Once the prescription is printed on paper and manually signed, it is still a written paper prescription. Decision support can be very robust and might incorporate a number of edits, including drug-laboratory interactions, drug-age interactions, drug-allergy interactions, drug-drug interactions, drug-disease interactions, drug-formulary compliance, etc. This functionality is known as computer decision support. The software can check the prescription against a list of known allergies and against a list of the patient's other medications. Another potential advantage is that the software package of the EHR can perform a number of edits to reduce the occurrence of clinical errors. The obvious advantage here is that the printed-paper copy eliminates issues caused by poor penmanship. In the second scenario, the preparation of the prescription is carried out on a computer, typically in an electronic health record (EHR), and then printed on paper. The second scenario introduces a technical solution to address some of the issues raised in the first. Poor penmanship may lead to clinical errors. For example, look-alike drug names can cause potential problems. Then the prescription must be written in such a manner as to be legible. The prescriber must check for appropriateness of the dose, allergies and adverse reactions, drug interactions, formulary compliance, and clinical appropriateness regarding the patient's condition. In this scenario, the manual preparation of the prescription is the step where errors can be introduced. These are: 1) the process by which the prescription is produced 2) the process by which the prescription is signed and 3) the process by which the prescription is presented to the pharmacy. This simple example reveals several key processes. The pharmacist would code this as a written paper prescription (Prescription Origin Code = 1). The paper prescription is then given to the patient (or the patient's representative), who physically presents the original signed paper prescription to the pharmacy. In some cases, an agent may actually prepare the prescription and then the legally authorized prescriber will manually sign off. The practitioner writes the prescription on a blank form and then manually signs the prescription. To understand the various scenarios, it is helpful to dissect the traditional written paper prescription process. And no wonder the confusion! When one reviews TABLE 1, there are just so many options in play in the marketplace, it becomes an abyss of information. The pharmacist must understand each type of prescription in order to know how to properly apply the prescription origin code. Prescription origin codes are part of the National Council for Prescription Drug Programs (NCPDP) ambulatory code set. Also described is the Prescription Origin Code, which is required by many insurers, including Medicare, on the ambulatory pharmacy claim. To assist with this discussion, refer to TABLE 1, which outlines various types of prescribing scenarios, types of prescriptions, and some of their properties. Pharmacists should thoroughly understand how each type of prescription is generated and transmitted to the pharmacy. It is very important for pharmacists to understand the differences between true e-prescribing and other methods of generating or transmitting prescriptions, including computer-generated paper prescriptions, facsimile, and the so-called e-fax. So let's set the stage to understand what e-prescribing is and how is it different from other modalities currently in use. There is considerable confusion in the marketplace over the definition of e-prescribing, however. As pharmacists, we are seeing more and more technologies introduced to streamline patient care, and electronic prescribing, or e-prescribing, is an invaluable tool when it is utilized correctly.
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