An article in the May issue of AAP News described how weight and allergy lists were not required fields that electronic medical record (EMR) vendors needed to build into e-prescribing (http://www.aappublications.org/news/2016/05/20/HIT052016). In pediatrics, where weight-based dosing is essential for many medications, this information is critical for safety checks to prevent prescribing errors.
Some of the challenges in changing the standards around e-prescribing involve bringing EMR vendors and pharmacies together to agree on who is responsible for maintaining and finding clinical information like weight and what actions are needed to ensure patient safety when it is missing. In addition, the ability to send an electronic prescription requires certain standard data to be sent from the EMR to the receiving pharmacy. This requires a standard data agreement that applies to all EMRs and pharmacies, and must be designed with multiple technologies in mind.
Since the article was published, progress has been made on improving pediatric safety measures in e-prescribing thanks to the power of AAP advocacy.
In April 2015, the Academy sent a letter to Surescripts, the company that connects e-prescribing for physicians and pharmacies, requesting that a patient’s weight be a standard feature of an e-prescription.
Upon receiving the letter, co-authored by the AAP Council on Clinical Information Technology (COCIT) and the Child Health Informatics Center (CHIC), Surescripts partnered with the Academy to further this patient safety initiative.
Over the next 12 months, the Academy and Surescripts developed a proposal for the National Council for Prescription Drug Program (NCPDP), which sets standards to govern how Surescripts and EMRs exchange information. After much collaboration among the three groups, the AAP proposal was approved by the NCPDP at its national meeting in August.
COCIT Vice Chair Emily C. Webber, M.D., FAAP, spoke to more than 200 NCPDP members about the necessity of this standard. During the session, NCPDP members also spoke about the difficulties pharmacies face and the expectation that comes with receiving additional information, including the fact that some pharmacies may not have the electronic systems that provide decision support around patient weight.
However, the majority of NCPDP members, particularly those who spoke from the floor of the meeting, saw their chance to provide better medication safety for children even in the face of these difficulties. The passage of the new standard was met with a standing ovation.
“It was an incredibly moving experience to see the dedication of the group and their willingness to partner with EMR vendors and pharmacies to address this important medication safety effort,” Dr. Webber said. “Being able to tell our patients’ stories and relating it to our mission as pediatricians and AAP members was very powerful.”
The passage of the AAP proposal means the new NCPDP SCRIPT standard for e-prescriptions will include the most recent height and weight for patients under 18 years. In addition, there will be a time and date stamp. This will allow pediatricians and pharmacists to share this information and provide safe weight-based dosing. There is still much work ahead to ensure this standard is put in place in EMRs and pharmacies, but AAP members remain committed to seeing it through.
“Talking about EMR standards can get ‘techy’ very quickly,” Dr. Webber said, “but as AAP members, we can be a voice for our patients when we work with groups like Surescripts and the NCPDP.”
Dr. Chen is a member of the AAP Council on Clinical Information Technology.
