E-scripting: why are doctors resisting?

13 July 2018

These days just about all services can be accessed electronically and one seldom finds professionals using pen and paper in their daily work. Yet the medical fraternity is slow to adopt a simple technology that can intervene in matters of life and death.

Adverse drug events (ADEs) are a reality of the medical world. In some cases there is no way of knowing that a patient would react badly to a drug. In many others, notably at pharmacy level, ADEs can be prevented by eliminating script interpretation errors through the use of technology in the form of e-scripting.

In America, where e-scripting is mandatory in many states, statistics show that dispensing errors occurred in up to 10% of scripts before e-scripting was introduced.

“I remember from my days as a pharmacist how challenging it can be to decipher not only a doctor’s handwriting, but also his or her intention with a script,” says Hannes Robberts, head of Health-Soft, one of South Africa’s leading providers of e-scripting software and part of the Med-e-Mass group. “Often times the pharmacists on duty came to a consensus decision on what the doctor wanted when they were unsure what was prescribed and couldn’t reach the doctor to confirm.”

E-scripting offers a far superior alternative.

How it works
Scripts are generated on a software platform that takes care of much of the admin associated with issuing a prescription. It is, for example, set up to include all the information a script has to have to be legal, and automatically fills in the correct ICD-10 code for medical aid claims (if the doctor and patient agree to its inclusion).

Importantly, the document’s format ensures clear instructions and no confusion regarding drugs and dosages.

An electronic data exchange interface transfers the script directly from the doctor’s PMA to the pharmacy, leaving no chance for drug seekers to alter it or for the careless to lose it. No more faxing is needed. Should the patient’s preferred pharmacy not be electronically linked to the practice, the doctor simply prints a copy of the script for the patient to take with.

“Our aim is to help doctors and pharmacies form networks based on their shared use of our e-Scripting solution,” says Hannes. “The relationship that comes from medical professionals working closely together ultimately benefits patients. It also makes life easier for everyone if the pharmacist doesn’t have to call the doctor to clarify scripts.”

The value e-scripting adds more than just an electronic script template, e-scripting software stores the patient’s history, allowing the doctor to quickly and easily refer to previous prescriptions, basic clinical notes and treatment decisions.

This functionality is particularly handy in the case of chronic conditions. Instead of having to write out a new script every time, the doctor can simply refer to the patient’s treatment plan by calling up the previous script, verify that everything is still valid, change what is needed, and render it again.

Similarly, doctors can save their preferred treatment protocols for specific conditions. The software also speeds up the issuing of sick notes, referral and personalised letters, and references for the Workman’s Compensation Association (WCA) and Road Accident Fund (RAF), freeing up more time for patient interactions.

In group practices e-scripting is extremely valuable as it allows the different partners to see each other’s prescription history for a specific patient. A patient can still receive the best care even when his or her preferred GP is not available.

E-scripting furthermore allows a practice to do away with paper and files in favour of an online system, and to be more efficient – resulting in a more professional image in the eyes of its patients.

“E-scripting is far more than a printout of a computer generated document,” says Robberts. “The intelligence behind it creates enormous value in terms of time saving, accuracy and improved patient care.”

The status of e-scripting in South Africa
In most first world countries e-scripting is a requirement because of patient safety and doctors can be penalised for not using it.

South Africa is not there yet.

E-scripting is still a choice and, sadly, many doctors are reluctant to embrace technology in their practices. While Health-Soft, for instance, has signed up around 2 000 doctors to use its e-Scripting software, not all of them are active users. And the system does not cost them anything – installation, support and licencing are subsidised and therefore free.

“Some doctors think that using technology will slow them down, and for others it’s a case of being comfortable with how things have always been done,” says Robberts. “But we are working hard to change their mindsets by proving the benefits of e-Scripting.”

The large-scale rollout of the e-scripting function that allows scripts to be sent directly to pharmacies, has also been held back by the question of what constitutes an electronic signature on a script. Previously a grey area in South African legislation, regulations published by the Department of Health in August last year have now clarified it. The requirements for an advanced electronic signature are, however, onerous to implement and companies like Med-e-Mass had to carefully consider the best way to conform.

“I am pleased to say that we are now ready to comply, and in a position to allow medical practices and pharmacies to be compliant in the near future,” says Robberts.