By Eric Andrew Kristof, RN, CAHIMS | Healthcare IT Professional | HIMSS Arkansas Chapter Member
About This Series: The HIMSS Word of the Day is a running blog series drawing from the HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025) — the authoritative reference for healthcare IT professionals and the primary study resource for CAHIMS and CPHIMS certification. Each post paraphrases the term in plain language, grounds it in real-world healthcare IT context, and adds a bedside nursing perspective you won’t find in a textbook.
📖 The Term: E-Prescribing (eRx)
Source: HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025)
🔍 Plain-Language Definition
E-prescribing is the electronic creation and transmission of a prescription from the prescriber’s system directly to a pharmacy, replacing handwritten, printed, faxed, and phoned-in prescriptions.
The HIMSS Dictionary describes e-prescribing as a prescriber’s ability to send a clear, accurate, readable prescription straight to the pharmacy from the point of care, and as an important lever for improving the quality of care. It notes that the Medicare Modernization Act of 2003 gave the movement early momentum, that a widely publicized 2006 Institute of Medicine report on preventing medication errors raised awareness of e-prescribing’s safety role, and that adopting e-prescribing standards became a key part of the federal push toward electronic records. In the simplest terms, it is the computer-based generation, transmission, and filling of a prescription.
In the United States, e-prescribing messages follow the NCPDP SCRIPT standard. A prescription is not one message but a conversation between prescriber and pharmacy:
| Transaction | What It Does |
|---|---|
| New Prescription | Sends the original prescription to the pharmacy |
| Renewal Request and Response | Lets the pharmacy request authorization for more refills, and the prescriber approve or deny |
| Change Request and Response | Lets the pharmacy propose a change, such as a generic or formulary alternative |
| Cancel | Lets the prescriber cancel a prescription already sent |
| Fill Status | Tells the prescriber whether the prescription was picked up |
| Medication History | Retrieves a patient’s recent dispensed medications |
| Formulary, Benefit, and Prior Authorization | Shows coverage and price information and supports electronic prior authorization |
⚠️ Exam Alert: CPOE is used for orders inside a facility; e-prescribing sends prescriptions to an outside pharmacy, usually for outpatients and discharge medications. NCPDP SCRIPT is the e-prescribing messaging standard, not HL7. EPCS (Electronic Prescribing of Controlled Substances) adds DEA requirements such as identity proofing and two-factor authentication. And know that the SUPPORT Act of 2018 requires electronic prescribing of Schedule II through V controlled substances under Medicare Part D.
🌐 Why It Matters: Real-World Healthcare IT Context
E-prescribing removes the most error-prone steps of the outpatient prescription process: illegible handwriting, ambiguous abbreviations, transcription at the pharmacy counter, and lost paper. It also lets the prescriber see drug interactions, allergy warnings, formulary status, and sometimes the patient’s cost before the prescription is sent.
Adoption did not happen on its own. The 2006 Institute of Medicine report Preventing Medication Errors called for all prescribers and pharmacies to be using electronic prescriptions by 2010. Medicare then added financial pressure: a dedicated e-prescribing incentive program under the Medicare Improvements for Patients and Providers Act of 2008 paid bonuses and later applied penalties, and Meaningful Use made e-prescribing a core measure for eligible professionals. Within roughly a decade, sending prescriptions electronically became the default for most outpatient medications.
Controlled substances followed a slower path because of diversion and fraud concerns. DEA rules allowed electronic prescribing of controlled substances only with strict identity proofing, two-factor authentication, and certified software. Then the opioid crisis made EPCS a policy priority. Section 2003 of the SUPPORT Act, enacted in October 2018, generally requires that Schedule II through V controlled substances covered under Medicare Part D be prescribed electronically. CMS’s EPCS program measures compliance using Part D claims and considers a prescriber compliant when at least 70% of those prescriptions are sent electronically.
E-prescribing also connects to prescription drug monitoring programs, letting prescribers check a patient’s controlled substance history before writing a new prescription, and to real-time benefit tools that show prescribers the patient’s out-of-pocket cost.
Common e-prescribing problems:
- Prescriptions sent to the wrong pharmacy or to a pharmacy that has since closed
- Free-text instructions that conflict with structured dose and frequency fields
- Cancel messages that never reach the pharmacy, leaving discontinued drugs active
- EPCS enrollment and token issues that delay controlled substance prescribing
- Formulary information that is outdated or incomplete
Strengths of mature e-prescribing programs:
- Structured sig fields with clear patient instructions
- Routine use of renewal, change, and cancel transactions instead of phone calls
- PDMP checks integrated into the prescribing workflow
- Accurate pharmacy directories and patient preferred pharmacy capture
- Real-time benefit and electronic prior authorization that reduce delays at the counter
🏥 The Nurse’s Perspective: Clinical, Bedside, & Workflow
E-prescribing is a prescriber tool, but nurses manage much of the work that surrounds it.
At the Bedside
At discharge, nurses confirm that prescriptions went to the right pharmacy, explain which medications are new, changed, or stopped, and make sure the patient knows how to pick them up. A prescription sent to a pharmacy the patient cannot reach is a missed dose waiting to happen, and discharge teaching is often where that problem is caught.
Nurses also see the gap between what was prescribed and what was filled. Fill status information, when available, can reveal that a patient never picked up an important medication, which is an opportunity for outreach before a readmission.
In Clinical Workflow
In ambulatory settings, nurses commonly handle renewal requests from pharmacies, prepare prescriptions for prescriber signature under protocol, respond to pharmacy change requests, and resolve prior authorization issues. Each of those tasks has an electronic transaction behind it, and using the structured transaction rather than a phone call keeps the record accurate.
Medication history retrieved through e-prescribing networks is also a nursing tool. During admission and medication reconciliation, dispensing history can reveal medications a patient forgot to mention, or show that a listed medication has not been filled in months.
In EHR Implementation (Go-Live Perspective)
During Epic implementations, e-prescribing readiness includes pharmacy directory setup, prescriber enrollment and EPCS identity proofing, two-factor authentication devices, and testing with pharmacies. Discharge prescription workflows are a common focus because they cross the inpatient and outpatient worlds.
End-user support analysts at Go-Live often see e-prescribing problems surface quickly: a prescriber who cannot sign controlled substance prescriptions because two-factor setup is incomplete, prescriptions printing instead of transmitting, or renewal requests landing in the wrong pool. Routing those issues to the right team on the first day prevents patients from leaving without their medications.
🎓 CAHIMS / CPHIMS & HIMSS Perspective
CAHIMS Exam Domain Mapping
E-prescribing appears in CAHIMS questions about medication safety, standards, and regulation:
| CAHIMS Domain | How E-Prescribing Appears |
|---|---|
| Healthcare & Technology Environments | MMA 2003 and Part D standards; SUPPORT Act EPCS requirement; DEA rules; Meaningful Use measures |
| Clinical Informatics | Medication safety; decision support at prescribing; PDMP integration; medication reconciliation |
| Healthcare Information & Systems Management | NCPDP SCRIPT transactions; e-prescribing networks; two-factor authentication; pharmacy directories |
| Management & Leadership | Prescriber adoption; compliance monitoring; workflow design for refills and prior authorization |
Key Terms to Know Alongside E-Prescribing
- CPOE (Computerized Provider Order Entry) — electronic ordering within a facility, distinct from outpatient e-prescribing
- EPCS (Electronic Prescribing of Controlled Substances) — e-prescribing of controlled substances under DEA security requirements
- NCPDP SCRIPT — the standard that defines e-prescribing transactions between prescribers and pharmacies
- PDMP (Prescription Drug Monitoring Program) — a state database of controlled substance prescriptions dispensed
- Electronic Prior Authorization (ePA) — electronic submission and approval of payer prior authorization requirements
- Medication Reconciliation — the process of comparing medication lists to identify and resolve discrepancies
HIMSS Organizational Position
HIMSS supports medication safety and standards-based prescribing through its public policy engagement on electronic prescribing, prior authorization, and opioid-related health IT. Members can find medication safety research and case studies through the HIMSS Resource Center.
🔗 Explore Further: External References
- CMS — Electronic Prescribing for Controlled Substances (EPCS) Program https://www.cms.gov/medicare/e-health/eprescribing/cms-eprescribing-for-controlled-substances-program
- NCPDP — National Council for Prescription Drug Programs https://www.ncpdp.org/
- National Academies — Preventing Medication Errors (2006) https://www.nationalacademies.org/projects/HCSX-H-04-03-A/publication/11623
- CMS — Promoting Interoperability Programs https://www.cms.gov/medicare/regulations-guidance/promoting-interoperability-programs
- AHRQ PSNet — Computerized Provider Order Entry (Primer) https://psnet.ahrq.gov/primer/computerized-provider-order-entry
- HIMSS — Resource Center https://www.himss.org/resource-center
Term source: HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025). All definitions in this series are paraphrased for editorial purposes. Readers are encouraged to consult the primary source for exact language.
Eric Andrew Kristof, RN, CAHIMS is a Healthcare IT professional and HIMSS Arkansas Chapter member based in Hot Springs Village, AR, with hands-on Epic Go-Live experience and a diverse healthcare and IT background. He writes at kristof.org at the intersection of clinical care and healthcare technology.
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