E-prescribing System Research Articles

The PrescIT platform: An interoperable Clinical Decision Support System for ePrescription to Prevent Adverse Drug Reactions and Drug-Drug Interactions.

Preventable medication errors have been proven to cause significant public health burden, and ePrescription is a key part of the process where medication errors and adverse effects could be prevented. Information systems and "intelligent" computational approaches could provide a valuable tool to prevent such errors with profound impact in clinical practice. The PrescIT platform is a Clinical Decision Support System (CDSS) that aims to facilitate the prevention of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in the phase of ePrescription in Greece. The proposed platform could be relatively easily localized for use in other contexts too. The PrescIT platform is based on the use of Knowledge Engineering (ΚΕ) approaches, i.e., the use of Ontologies and Knowledge Graphs (KGs) developed upon openly available data sources. Open standards (i.e., RDF, OWL, SPARQL) are used for the development of the platform enabling the integration with already existing IT systems or for standalone use. The main KG is based on the use of DrugBank, MedDRA, SemMedDB and OpenPVSignal. In addition, the Business Process Management Notation (BPMN) has been used to model long-term therapeutic protocols used during the ePrescription process. Finally, the produced software has been pilot tested in three hospitals by 18 clinical professionals via in-person think-aloud sessions. The PrescIT platform has been successfully integrated in a transparent fashion in a proprietary Hospital Information System (HIS), and it has also been used as a standalone application. Furthermore, it has been successfully integrated with the Greek National ePrescription system. During the pilot phase, one psychiatric therapeutic protocol was used as a testbed to collect end-users' feedback. Summarizing the feedback from the end-users, they have generally acknowledged the usefulness of such a system while also identifying some challenges in terms of usability and the overall user experience. The PrescIT platform has been successfully deployed and piloted in real-world environments to evaluate its ability to support safer medication prescriptions.

Strengths, weaknesses, opportunities, and threats (SWOT) of the electronic prescribing systems executed in Iran from the physician’s viewpoint: a qualitative study

BackgroundElectronic prescribing (e-prescribing) is an essential technology in the modern health system. This technology has made many changes in the prescription process, which have advantages and disadvantages and have created opportunities for transforming the health system. This study aimed to investigate the strengths, weaknesses, opportunities, and threats of the e-prescribing system implemented in Iran from the physician’s viewpoint.MethodsThis phenomenological qualitative study was conducted in 2022. The participants were 15 Iranian specialist physicians working at Urmia University of Medical Sciences, selected purposively and deliberately. Data was collected through in-depth semi-structured interviews using an interview guide comprising 16 questions. Interviews were conducted until data saturation was reached. The audio data was transcribed into text and analyzed using the thematic analysis. To ensure the validity and reliability of the findings, the criteria introduced by Lincoln and Guba were employed.ResultsThe results of this study showed that the e-prescribing system executed in Iran has diverse and multidimensional strengths, weaknesses, opportunities, and threats. In the strengths section, the analysis of the interviews led to the extraction of semantic units in the categories of prescription process, prescriber, patient, technical, economic, communication, and insurance. Also, the weaknesses in the three categories of the prescriber, patient, and technical were debatable. The opportunities extracted from the narratives of the interviewees were placed in four categories including technical, national macro policies, Ministry of Health macro-policies, and socio-cultural issues. Finally, the discussed threats are classified into two technical and macro policies of the Ministry of Health categories. On the other hand, technical issues played an effective role in all aspects of the SWOT model.ConclusionThe e-prescribing system in Iran has strengths, weaknesses, opportunities, and threats. An overarching factor across all aspects of the SWOT model was technical infrastructure. A robust technical infrastructure is considered a strength and an opportunity for the growth of the electronic prescribing system in Iran. Conversely, any shortcomings in these systems are viewed as weaknesses and pose a threat to the system’s sustainability.

A Preliminary Scoping Review of the Impact of e-Prescribing on Pharmacists in Community Pharmacies.

This scoping review aims to map the available literature and provide an overview of the published articles discussing the impact of electronic prescribing on medication errors and pharmacy workflow. The literature search was conducted using PubMed®, Web of Science®, and the Cochrane Database of Systematic Reviews®, as well as grey literature reports, using the search terms and related components of "pharmacists", "electronic prescribing", "medication errors", and "efficiency". The search included all articles that were published from January 2011 to September 2023. Twenty-two relevant articles were identified and fully reviewed, ten of which were included in this review. Electronic prescribing (e-prescribing) provides a solution for some of the challenges that are associated with handwritten and paper prescriptions. However, the implementation of e-prescribing systems has been recognized as a source of new unforeseen medication errors in all the reviewed articles. Productivity in community pharmacies has been affected with receiving electronic prescriptions (e-prescriptions) and having to deal with the issues that arise from them. The pharmacists' interventions were not eliminated with e-prescriptions compared to other prescription formats. The most frequently reported reason for intervention was related to incomplete instructions in the field of directions of use. Other common challenges with e-prescriptions were related to missing information, quantity, inappropriate dose, dosage form, and drug. This review demonstrates the scarcity of research about the impact of electronic prescribing on medication error and efficiency in community pharmacies. In the literature, most of the studies had mainly focused on hospital pharmacies. The literature search demonstrated that there are still some barriers to overcome with e-prescribing systems and that medication errors were not fully eliminated with e-prescriptions. New errors have been identified with e-prescriptions, all of which caused delays in processing, which affected the productivity of the pharmacy staff, and could have negatively impacted patients' safety if not properly resolved. e-Prescribing solved some of the challenges associated with illegibility of handwritten prescriptions. However, more time is required to allow e-prescribing systems to mature. Further training for prescribers and pharmacists is also recommended before and after the implementation.

Cyber Security Risk Assessment Methods for Smart Healthcare

The perverseness of the Internet of Things (IoT) has reached the healthcare sector, where interconnected medical devices are transforming how we deliver and manage health. These devices, linked wirelessly, create a vast network known as Internet of Medical Things (IoMT), that integrates seamlessly with the broader healthcare system. This interconnected infrastructure facilitates the exchange of massive amounts of patient data, paving the way for a more distributed and data-driven approach to healthcare. In healthcare’s ICT environment rely heavily on electronic health records (EHR), e-prescribing systems and other systems. Protecting this sensitive data necessitates robust cybersecurity measures. Even though data security is an indirect cost, it is crucial for healthcare systems. In general, patient trust in a healthcare system depends on the infrastructure’s ability to protect data from security and privacy threats. A critical component of this strategy is security risk assessment. A risk is an indirect cost borne by those designing these systems. The risk assessment process identifies, evaluates, and prioritizes potential threats to the organization’s assets including hardware and software. By assessing risks before acting, healthcare organizations can effectively allocate resources to mitigate the most critical vulnerabilities. While broadly applicable cyber risk assessment frameworks like NIST, ISO, and OCTAVE exist, they may lack a strong risk between assets, threats and impacts, and controls. Therefore, they do not provide a comprehensive picture for healthcare specifically. A more thorough examination is required to establish a strong association between protected systems, potential threats, and the resulting risks. This paper critically reviews these frameworks and their methodologies and limitations for healthcare cybersecurity. Even though data security is an indirect cost, it is crucial for healthcare systems.

Challenges and advantages of electronic prescribing system: a survey study and thematic analysis

IntroductionElectronic prescribing (e-prescribing) systems can bring many advantages and challenges. This system has been launched in Iran for more than two years. This study aimed to investigate the challenges and advantages of the e-prescribing system from the point of view of physicians.MethodsIn this survey study and thematic analysis, which was conducted in 2023, a researcher-made questionnaire was created based on the literature review and opinions of the research team members and provided to the physician. Quantitative data were analyzed using SPSS software, and qualitative data were analyzed using ATLAS.ti software. Rank and point biserial, Kendall’s tau b, and Phi were used to investigate the correlation between variables.ResultsEighty-four physicians participated in this study, and 71.4% preferred to use paper-based prescribing. According to the results, 53.6%, 38.1%, and 8.3% of physicians had low, medium, and high overall satisfaction with this system, respectively. There was a statistically significant correlation between the sex and overall satisfaction with the e-prescribing system (p-value = 0.009) and the computer skill level and the prescribing methods (P-value = 0.042). Physicians face many challenges with this system, which can be divided into five main categories: technical, patient-related, healthcare providers-related, human resources, and architectural and design issues. Also, the main advantages of the e-prescribing system were process improvement, economic efficiency, and enhanced prescribing accuracy.ConclusionThe custodian and service provider organizations should upgrade the necessary information technology infrastructures, including hardware, software, and network infrastructures. Furthermore, it would be beneficial to incorporate the perspectives of end users in the system design process.

Electronic prescription systems in Greece: a large-scale survey of healthcare professionals’ perceptions

BackgroundThe national e-prescription system in Greece is one of the most important achievements in the e-health sector. Healthcare professionals’ feedback is essential to ensure the introduced system tends to their needs and reduces their everyday workload. The number of surveys collecting the users’ views is limited, while the existing studies include only a small number of participants.MethodsIn this study, healthcare professionals’ perceptions on e-prescription are explored. For this, a questionnaire was distributed online, containing closed- and open-ended questions aiming to address strengths and identify drawbacks in e-prescription. Answers were collected from primary health care physicians, specialized medical doctors and pharmacists.ResultsIn total, 430 answers were collected (129 from primary health care physicians, 164 responses from specialized medical doctors and 137 pharmacists). Analysis of the collected answers reveals that the views of the three groups of healthcare professionals mostly converge. The positive impact e-prescribing systems have on the overall prescribing procedure in preventing errors and providing automation is commented. Among gaps identified and proposed improvements, health care professionals note the need for access to information on adverse drug reactions, side effects, drug-to-drug interactions and allergies. Flexible interaction with Therapeutic Prescription Protocols is desired to ameliorate monitoring and decision-making, while drug dosing features, and simplified procedures for copying, repeating, canceling a prescription, are perceived as useful to incorporate.ConclusionsCollecting healthcare professionals’ feedback is important, as their views can be transcribed to system requirements, to further promote e-prescribing and improve the provided health care services by facilitating decision making through safer and more efficient e-prescription. Introduction of the identified improvements can simplify the everyday workflow of healthcare professionals. To the best of our knowledge, a survey with more than 400 answered questionnaires on the use of e-prescription systems by healthcare professionals has never been conducted in Greece before.

Physicians' Perspectives with the E-prescribing System in Five Teaching Hospitals.

Despite the evidence suggesting the potential of electronic prescribing (e-prescribing), this system also faces challenges that can lead to inefficiency and even failure. This study aimed to evaluate physicians' perspectives on the efficiency, effectiveness, opportunities, and challenges associated with the e-prescribing system. In 2023, a descriptive analytics cross-sectional study was carried out. Due to the finite population size, all the physicians from five studied hospitals who agreed to participate in the study were included through the census method (n = 195). Data collection was conducted using a validated questionnaire. Data were analyzed using descriptive (mean, standard deviation, and frequency) and analytical (Pearson's correlation coefficient, two-sample t-test, one-way analysis of variance (ANOVA), and linear multiple regression model) statistics. The mean scores of efficiency and effectiveness were 47.47 ± 14.46 and 36.09 ± 10.67 out of 95 and 65, respectively. Removing the illegibility of the prescriptions (n = 22) was the most frequent opportunity and internet connectivity problem (n = 37) was the most frequent challenge associated with the e-prescribing system. There was a strong positive significant correlation between efficiency and effectiveness (r = 0.850, p < 0.01). Moreover, age was found to have a significant negative correlation with efficiency (B = -7.261, p = 0.004) and effectiveness (B = - 5.784, p = 0.002). Physicians believe that e-prescribing enhances the efficiency and effectiveness of their work. There are many opportunity and challenges to the use of e-prescription. Assessing the needs of physicians, actively participating and training them in the stages of design and implementation, and conducting regular evaluations of the e-prescribing system are crucial to overcome the challenges. Our finding offers insightful information about how doctors see the e-prescribing system at teaching hospitals and provide a basis for managers and policy makers at the local and national levels to support the implementation of this system and plan for improvement of its shortcomings.

Electronic health records and e-prescribing in Australia: An exploration of technological utilisation in Australian community pharmacies

ObjectiveThis study aimed to assess the utilisation, benefits, and challenges associated with Electronic Health Records (EHR) and e-prescribing systems in Australian Community Pharmacies, focusing on their integration into daily practice and the impacts on operational efficiency, while also gathering qualitative insights from community pharmacists. MethodsA mixed-methods online survey was carried out among community pharmacists throughout Australia to assess the utilisation of EHR and e-prescribing systems, including the benefits and challenges associated with their use. Data was analysed based on pharmacists' age, gender, and practice location (metropolitan vs. regional). The chi-square test was applied to examine the relationship between these demographic factors and the utilisation and operational challenges of EHR and e-prescribing systems. ResultsThe survey engaged 120 Australian community pharmacists. Of the participants, 67 % reported usability and efficiency issues with EHR systems. Regarding e-prescribing, 58 % of pharmacists faced delays due to slow software performance, while 42 % encountered errors in data transmission. Despite these challenges, the benefits of e-prescribing were evident, with 79 % of respondents noting the elimination of illegible prescriptions and 40 % observing a reduction in their workload. Issues with prescription quantity discrepancies and the reprinting process were highlighted, indicating areas for improvement in workflow and system usability. The analysis revealed no significant statistical relationship between the utilisation and challenges of EHR and e-prescribing systems with the demographic variables of age, gender and location (p > 0.05), emphasising the necessity for healthcare solutions that address the needs of all pharmacists regardless of specific demographic segments. ConclusionIn Australian community pharmacies, EHR and e-prescribing may enhance patient care but come with challenges such as data completeness, technical issues, and usability concerns. Implementing successful integration relies on user-centric design, standardised practices, and robust infrastructure. While demanding for pharmacists, the digital transition improves efficiency and quality of care. Ensuring user-friendly tools is crucial for the smooth utilisation of digital health.

Statins use amidst the pandemic: prescribing, dispensing, adherence, persistence, and correlation with COVID-19 statistics in nationwide real-world data from Poland.

Adherence to medications presents a significant challenge in healthcare. Statins, used in primary and secondary prevention of cardiovascular disease, are of particular importance for public health. The outbreak of the COVID-19 pandemic resulted in additional healthcare system-related barriers impeding the execution of therapies. This study aimed to assess the use of as well as adherence and persistence to statins in a national cohort of 38 million of Polish citizens during pandemic. A retrospective analysis of prescription and dispensation data for all statins users from the national payer organization covering the years 2020-2022 was conducted. Medication adherence was assessed using the Medication Possession Ratio, for persistence the 30-day cut-off was accepted. National data on COVID-19 cases and COVID-19 related deaths were obtained from ECDC. The analysis identified 7,189,716 Polish citizens (approximately 19% of Polish population) who were dispensed at least 1 pack of statins within the study period. Over that time, there was a continuous significant increasing trend in prescribing and dispensing of statins. Despite a total increase of 18.9% in the number of prescribed tablets, the percentage of tablets dispensed remained similar, averaging 86%. Overall percentage of adherent patients was 48.2%. For a random sample of 100,000 patients, the mean period of continuous therapy in 2022 was 6.2+/- 5.3months. During the lockdown period, the mean number of prescribed and dispensed tablets was lower by 6.8% and 5.9%, respectively (p < 0.05). However, fluctuations in the number of COVID-19 cases or COVID-19-related deaths per week had no major impact on the prescribing and dispensing of statins. Over the time of pandemic, there was a continuous increase in the number of statin tablets prescribed and dispensed in Poland. This suggests that, despite the potential limitations posed by COVID-19, access to statins remained easy, which may be attributed to the mass-scale implementation of the national e-prescription system. However, it is crucial to realise that approximately 1/7 of prescribed statin doses were never dispensed, and the overall levels of adherence and persistence were low. This underscores the necessity for concerted efforts to change this scenario in Poland.

Differences in prescribing errors between electronic prescribing and traditional prescribing among medical students: A randomized pilot study.

This randomized controlled pilot study aimed to assess the differences in the frequency, type and severity of prescribing errors made by medical students when assessed in an electronic (e-)prescribing system compared to a traditional prescribing method (e.g., typing out a prescription). Fourth year medical students in the period of 1 November to 31 July 2023, were asked to participate in this single-centre prospective, randomized, controlled intervention study. Participants performed a prescribing assessment in either an e-prescribing system (intervention group) or in a more traditional prescribing platform (control group). The prescriptions were checked for errors, graded and categorized. Differences in prescribing errors, error categories and severity were analysed. Out of 334 students, 84 participated in the study. Nearly all participants (98.8%) made 1 or more prescribing errors, primarily involving inadequate information errors. In the intervention group, more participants made prescribing errors involving the prescribed amount (71.4 vs. 19.0%; P< .01), but fewer involving administrative errors (2.4 vs. 19.0%; P= .03). Prescribing-method-specific errors were identified in 4.8 and 40.5% of the intervention and control group, respectively, with significant differences in overlapping errors as well. This pilot study shows the importance of training e-prescribing competencies in medical curricula, in addition to traditional prescribing methods. It identifies prescribing-method-specific prescribing errors and emphasizes the need for further research to define e-prescribing competencies. Additionally, the need for an accessible real-life-like e-prescribing environment tailored to educators and students is essential for effective learning and incorporation of e-prescribing into medical curricula.

Patients’ perceptions, experiences, and satisfaction with e-prescribing system: A cross-sectional study

IntroductionElectronic prescribing (e-prescribing) systems have the potential to increase the quality of care and reduce costs. Officially, since 22 December 2021, e-prescribing has been mandated in Iran. This study aimed to investigate the patients' perceptions about the e-prescribing system. MethodsA descriptive-analytic cross-sectional study was conducted in 2023. The study sample comprised 394 patients who were referred to the pharmacies of five teaching hospitals. The sample size was estimated using Cochran's formula. Data collection was performed using a researcher-made questionnaire. The data were analyzed using descriptive (mean, standard deviation, frequency, and percentage) and analytic (Pearson and Spearman correlation, One-way ANOVA, and two-sample t-test) statistics. ResultsAbout 85 % of the patients were aware of the e-prescribing system, and 70 % of them preferred the e-prescribing. Almost 57 % of the patients believed that e-prescribing did not impact their medication adherence. The mean score of patients’ satisfaction with e-prescribing, patients’ attitude toward e-prescribing, and the impact of e-prescribing on patient care was 3.91 ± 0.046, 3.45 ± 0.028, and 3.10 ± 0.050 out of 5, respectively. There was a significant fair correlation between the impact of e-prescribing on patient care and patients' attitude towards e-prescribing. Additionally, there was a significant but poor correlation between patient satisfaction with the impact of e-prescribing on patient care and patients' attitude toward e-prescribing (P < 0.05). ConclusionThe majority of the patients demonstrated awareness of the e-prescribing system and expressed a preference for electronic prescribing. Patients reported overall positive satisfaction, as well as relatively positive perceptions and experiences with the evaluated e-prescribing system. From the patients' perspective, receiving the e-prescribing tracking code through SMS was the most popular method for tracking their prescriptions. A greater focus on patient engagement and considering their requirements and needs in the system are crucial to improve the delivery of patient-centered care.

Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands

BackgroundInvestment in the implementation of hospital ePrescribing systems has been a priority in many economically-developed countries in order to modernise the delivery of healthcare. However, maximum gains in the safety, quality and efficiency of care are unlikely to be fully realised unless ePrescribing systems are further optimised in a local context. Typical barriers to optimal use are often encountered in relation to a lack of systemic capacity and preparedness to meet various levels of interoperability requirements, including at the data, systems and services levels. This lack of systemic interoperability may in turn limit the opportunities and benefits potentially arising from implementing novel digital heath systems.MethodsWe undertook n = 54 qualitative interviews with key stakeholders at nine digitally advanced hospital sites across the UK, US, Norway and the Netherlands. We included hospitals featuring ‘standalone, best of breed’ systems, which were interfaced locally, and multi-component and integrated electronic health record enterprise systems. We analysed the data inductively, looking at strategies and constraints for ePrescribing interoperability within and beyond hospital systems.ResultsOur thematic analysis identified 4 main drivers for increasing ePrescribing systems interoperability: (1) improving patient safety (2) improving integration & continuity of care (3) optimising care pathways and providing tailored decision support to meet local and contextualised care priorities and (4) to enable full patient care services interoperability in a variety of settings and contexts. These 4 interoperability dimensions were not always pursued equally at each implementation site, and these were often dependent on the specific national, policy, organisational or technical contexts of the ePrescribing implementations. Safety and efficiency objectives drove optimisation targeted at infrastructure and governance at all levels. Constraints to interoperability came from factors such as legacy systems, but barriers to interoperability of processes came from system capability, hospital policy and staff culture.ConclusionsAchieving interoperability is key in making ePrescribing systems both safe and useable. Data resources exist at macro, meso and micro levels, as do the governance interventions necessary to achieve system interoperability. Strategic objectives, most notably improved safety, often motivated hospitals to push for evolution across the entire data architecture of which they formed a part. However, hospitals negotiated this terrain with varying degrees of centralised coordination. Hospitals were heavily reliant on staff buy-in to ensure that systems interoperability was built upon to achieve effective data sharing and use. Positive outcomes were founded on a culture of agreement about the usefulness of access by stakeholders, including prescribers, policymakers, vendors and lab technicians, which was reflected in an alignment of governance goals with system design.

Perceptions of Community Pharmacists toward the National E-Prescribing Service (Wasfaty) and Exploring the Benefits and Challenges of the Service: A Descriptive Study from Qassim Region, Saudi Arabia.

Electronic prescribing systems (e-prescription) for medications have many benefits, including patient safety, increase in patient satisfaction, efficiency of pharmacy work, and quality of patient care. However, few studies have been conducted to evaluate the national e-prescription system "Wasfaty" service in Saudi Arabia, which was recently adopted. The aims of this study were to explore the benefits observed through the use of the system and most frequent challenges experienced by community pharmacists in the Qassim region of Saudi Arabia. This study was conducted using a descriptive survey on a web-based platform. The target population of the study included community pharmacists in the Qassim region of Saudi Arabia who worked in pharmacy chains utilizing the e-prescription service between September 2022 and November 2022. Descriptive statistics along with multiple ordinal regression were used for data analysis. The study population consisted of 124 pharmacists, of which 62.9% (78/124) were males and 37.1% (46/124) were females. Most of the participants had a positive perception of the e-prescription system with regard to medication safety, with 68.6% (85/124) indicating that e-prescriptions reduce the risk of dispensing errors. However, 81.5% (101/124) did not agree that the e-prescription system resulted in a reduction in workload, and 70.2% (87/124) disagreed that the service increased patient satisfaction. The results of this study indicated that the national e-prescription system has many benefits to healthcare employees and improves their work, particularly for patient safety, reducing medication errors, and improving the management of patient medications. The participants believe that there is a need to improve communication with prescribers, showing concern about the unavailability of some medications; thus, it is important for policymakers to encourage other pharmacy chains and suppliers to join the service to increase patient access to medications.

Description of Incompleteness of Prescription Writing at Surabaya Islamic Hospital A. Yani

Introduction: Medication error is an event that harms patients due to incorrect use of drugs during the treatment of health workers. Medication error can lead to increased mortality or mortality, increased duration of hospitalization, and increased cost of treatment. Objective: This study aims to provide an overview of efforts to reduce the incompleteness of prescription writing at Surabaya Islamic Hospital A. Yani in each of its parts, namely inscription, invocation, precriptio, subcribtio, and pro. Method: The type of research used is qualitative case studies and secondary data analysis of patient safety incompleteness of prescription filling at Surabaya A. Yani Islamic Hospital. Data collection by observation and interview. Result and Discussion: The results showed that efforts to reduce the incompleteness of prescriptions carried out by Surabaya A. Yani Islamic Hospital using the E-prescription system. It is hoped that the existence of E-prescription can reduce the occurrence of human error and make it easier for doctors and pharmacists to provide services. Conclusion: The conclusion of this study is that the doctor's identity and the date of writing the prescription in the inscription section, the dose of the drug in the precriptio section, the doctor's paraphrase in the subcriptio section and the patient's weight in the pro section. E-prescriptions are used as an upgrade system to replace manual prescriptions. Evaluation and socialization are carried out as an effort to reduce the number of incompleteness of writing recipes

Finding the ‘sweet spot’ between customisation and workflows when optimising ePrescribing systems: a multisite qualitative study

ObjectivesThe introduction of ePrescribing systems offers the potential to improve the safety, quality and efficiency of prescribing, medication management decisions and patient care. However, an ePrescribing system will require some...

The impact of the war on maintenance of long-term therapies in Ukraine.

Due to the Russian invasion, which started on 24 February 2022, the Ukrainian healthcare system is facing multiple challenges. A great number of healthcare facilities have been destroyed, while availability of other ones is often limited due to a lack of qualified medical staff. Certain services, e.g. cancer therapies, have been seriously disrupted. Moreover, millions of Ukrainians with chronic conditions are also suffering as due to war-related problems with execution of their long-term therapies. Availability of drugs is particularly limited in the occupied regions. According to the national statistics, as of 18 August 2022, about 505 pharmacies were damaged in Eastern Ukraine and 47 completely ruined. Moreover, the invaders have been blocking humanitarian aid provided to these territories by the Ukrainian government or other countries. Fortunately, in the areas controlled by the Government of Ukraine, the acute shortage of medicines, observed at the beginning of the war, has already been eliminated. Nevertheless, not all drugs are now fully available, even in the areas where no military attacks occur. The economic availability of drugs is also profoundly influenced by the significant increase in the cost of medications and the fall in average salaries. The Government of Ukraine is trying to minimise the impact of these war-related challenges by adopting a new legislation. This includes, among others, simplification of procedures for licensing, quality control and import of medicinal products to Ukraine. Other measures involve securing displaced people with the option of benefiting from local healthcare facilities, broadening the scope of the ePrescription system, authorizing primary care doctors to issue prescriptions to refugees, increasing the number of drugs reimbursed for long-term therapies, etc. These solutions, however, cannot balance all the harmful consequences the war in Ukraine brings in terms of maintenance of long-term therapies. Therefore, in order to minimise this negative impact, Ukraine still needs urgent international support in this area.

Transition to ePrescribing for systemic anti-cancer therapy - Perceptions of a multidisciplinary haematology/oncology team in a large teaching hospital.

A National Cancer Information System is planned for phased implementation in Irish cancer centres to enable electronic prescribing (ePrescribing) of systemic anti-cancer therapy. This study aimed to capture the opinions of healthcare professionals in a hospital setting relating to the current paper-based workflow for systemic anti-cancer therapy prescribing and their attitudes and expectations of the new ePrescribing system to develop recommendations, which assist in the planning and implementation of future ePrescribing systems. A mixed methods study of concurrent design was conducted. Interviews with healthcare professionals primarily aimed to evaluate processes and identify areas requiring improvement within the current paper-based workflow for systemic anti-cancer therapy prescribing. An online questionnaire adapted from the Information Systems Expectations and Experiences tool primarily aimed to capture expectations of the new ePrescribing system and attitudes towards the transition. Twelve healthcare professionals were interviewed, and 50 healthcare professionals responded to the online questionnaire (response rate: 33.3%). Eight major themes emerged from interview transcripts relating to opinions on the paper-based workflow. Questionnaire respondents reported positive attitudes towards ePrescribing implementation and had high expectations for workflow improvements and functionalities of the new system. Seven recommendations for ePrescribing implementation were developed: (1) prioritise specific processes; (2) plan for changes in communication; (3) repeat research in the post-implementation setting; (4) ensure good information technology infrastructure and system support; (5) ensure optimum training; (6) outline limitations of clinical decision support; (7) provide clear instructions on local configurability. This study identifies potential challenges in transitioning to ePrescribing and provides recommendations, which assist stakeholders in ensuring safe and effective transitions, thus informing future ePrescribing systems' implementation in haematology/oncology settings.

Electronic prescribing systems in hospitals to improve medication safety: a multimethods research programme

Electronic prescribing systems in hospitals to improve medication safety: a multimethods research programme

Users’ Views Regarding Electronic Prescribing Implementation: A Qualitative Case Study in A Private Hospital of Magelang City, Indonesia

The use of the Internet and digital system in a hospital named the Hospital Information System (HIS) has grown rapidly and remarkably, including in Indonesia. One of the HIS components is electronic prescribing (e-prescribing). Although the Indonesian government has mandated HIS in hospitals since 2011, successful implementation is not without challenges. Therefore, this study aimed to explore users' views regarding e-prescribing implementation through a case study in a private hospital in Magelang City, Indonesia. This study applied a qualitative approach. Participants were e-prescribing users who were selected purposively. Data were gathered using interviews. The Capability, Opportunity, Motivation, and Behavior (COM-B) model was used to structure the interview guideline. Data were transcribed verbatim and analyzed using a thematic approach. Twenty participants were interviewed. Five themes emerged through the interviews: selfreflection, perceived advantages, policy, capacity building, and quality assurance. The themes express optimism in implementing eprescribing. Users are central to e-prescribing system acceptance, as is explained in the self-reflection and perceived advantages themes. Furthermore, top management plays a pivotal role in improving the capacity and ensuring system implementation quality. This study’s findings imply that the user, system, and organization play crucial roles in enhancing health care service quality through e-prescribing.

A retrospective observational study of the use of gastroprotection for patients on dual antiplatelet therapy in an acute trust in England

Abstract Introduction Dual antiplatelet therapy (DAPT), a combination of aspirin and either clopidogrel, prasugrel or ticagrelor, is recommended for secondary prevention of ischaemic events (heart attack and stroke) in people with coronary artery disease. Patients taking DAPT may be at high gastrointestinal (GI) bleed risk if other factors (including advanced age, or concomitant use of medicines that are known to increase the risk of GI bleeds) are present. Such patients should be considered for gastroprotection e.g. a proton pump inhibitor (PPI) or H2 receptor antagonist. Aim To assess whether gastroprotection was prescribed for inpatients taking DAPT in a 750-bed acute hospital in England. Methods This was a retrospective analysis of existing data. Patient episodes involving prescription of DAPT upon discharge between April 2020 and April 2021 were extracted from the e-prescribing system (WellSky). Electronic records of the identified patient episodes were searched for co-prescription of either PPI or H2 antagonist. We also ascertained if patients on DAPT should have received gastro-protection using age 71 and over, and concomitant drugs as separate risk factors. Results Over this 13-month period there were 1693 patient episodes (mean age 72 years, 63% male) when DAPT was prescribed at discharge, of which gastroprotection was also prescribed in 1210 (71%). Of the 483 episodes when gastroprotection was not prescribed, 223 (46%) met the criterion of age as a risk factor for gastroprotection. There were a further 20 episodes of patients aged under 71 years not on gastroprotection but receiving an SSRI, NSAID, prednisolone, nicorandil or an anticoagulant. Conclusion We identified that gastroprotection was potentially missing in 243 (14%) of the total DAPT patient episodes. Though there is evidence for the use of PPIs reducing the risk of GI bleeding in patients treated with DAPT after percutaneous coronary intervention or acute coronary syndrome (1), studies have reported that gastroprotection has been missed in the at risk group (2). When considering newly initiated gastroprotection, various factors are considered e.g. any possible interaction with a PPI if one of the antiplatelets is clopidogrel. In addition, PPIs have adverse effects such as low sodium / magnesium, and this may be a reason for consideration of a H2 antagonist. Further work is required to make our prescribers and pharmacy team aware of the importance of considering gastroprotection for this patient cohort. The strength of this study is the extraction of data from our electronic prescribing system for a large cohort of patients prescribed specified antiplatelet medication. Our study has some potential limitations. First, it was conducted in a single centre in England; this might restrict the generalisability of our findings. Second, the retrospective nature of this study may introduce bias or other uncertainties. Third, we did not ascertain the indication for DAPT nor if patients came in on these drugs as opposed to being started during their admission. Fourth, we did not check risk factors for gastroprotection other than age and selected concomitantly prescribed drugs. Finally, we did not check if those not prescribed gastroprotection had significant contraindications other than electrolyte abnormalities. References (1) Guo H, Ye Z, Huang R. Clinical outcomes of concomitant use of proton pump inhibitors and dual antiplatelet therapy: a systematic review and meta-analysis. Front Pharmacol. 2021 Aug 2;12:694698. (2) Sehested TSG, Carlson N, Hansen PW, Gerds TA, Charlot MG, Torp-Pedersen C, et al. Reduced risk of gastrointestinal bleeding associated with proton pump inhibitor therapy in patients treated with dual antiplatelet therapy after myocardial infarction. Eur Heart J. 2019;40(24):1963–70.