The widespread availability of prescription information comes as a surprise to many. Physicians wonder how drug representatives know so much about their prescribing habits. Patients are denied coverage by insurers based on medications that have been dispensed even if they are not taken. Electronic prescribing (e-prescribing) promises to further increase the availability of information for secondary uses.

Methods:

A task analysis of the e-prescribing process was conducted to identify the locations or tasks that make primary information available for potential secondary usage. A diverse set of literature is drawn upon for this analysis, including medical informatics, pharmacy, and medical privacy sources.

Results:

An unintended consequence of e-prescribing is the change in role relationships and availability of information. In manual prescribing, a patient makes a post-prescribing decision to fill the prescription. The patient controls the time that outside parties may have access to prescription information. A patient might pay cash for psychiatric medications to avoid exposing this information to employers. Outpatient e-prescribing in the US pushes the e-script directly from a prescriber at the point of prescribing and adjudicated by the designated pharmacy. While the patient may choose not to pick up the e-script, the prescription information is already entered and thus available to outside parties. The patient has lost control. E-prescribing also has no mechanism for informed consent before a patient's record is disclosed and no means for a patient to correct errors in the record.

While not a direct outcome of e-prescribing, data integrity becomes more of an issue with the prescribing and dispensing of medications. The prescribed medications can now be tracked, but they may not be filled. The dispensed medications paid for by a payer could be tracked previously but that does not mean that they are taken. This means that secondary usage of data beyond a population has many limitations that could be problematic for an individual.

Conclusion:

E-prescribing has many benefits but reduces the control over prescription information that patients have had in the past. Appropriate safeguards are necessary to encourage patients to adopt e-prescribing.

Acknowledgments:

The work was supported by a grant from the IBM Center for the Business of Government and the American University of Beirut Junior Faculty Leave Program.