When a doctor sends an e-prescription, it’s supposed to make things safer. No more scribbled handwriting. No more guessing if that’s a 5 or a 9. But if you work in a pharmacy, you know the truth: e-prescribing hasn’t fixed everything. In fact, it’s created a whole new kind of mess.
You’ve seen it. A prescription comes in from Epic or Cerner. The sig says: "1 TAB PO DAILY." You scan it. Your system reads it as "10 TAB PO DAILY." The patient gets ten times their dose. That’s not a typo. That’s a transcription error - and it’s happening more than you think. A 2015 study in the Pharmaceutical Journal found that nearly 40% of all prescribing errors in e-prescribing systems come from these kinds of misreads. Not because someone wrote it wrong. Because the system didn’t talk to the next system properly.
Why E-Prescribing Creates New Errors
E-prescribing was meant to kill handwritten errors. And it did. Back in 2005, handwritten prescriptions had 12.3 errors per 100 prescriptions. Today, that number is down to 3.8. But the new errors? They’re sneaky. They don’t come from bad penmanship. They come from systems that don’t speak the same language.
Take the sig field - the instructions on how to take the medicine. One system might send "take one tablet by mouth once daily." Another system might translate that into "1 TAB PO QD." But your pharmacy system? It doesn’t recognize "QD." It sees "QD" and thinks it’s "10." That’s not your fault. That’s the system’s.
And it’s not just the sig. Medication names, dosages, frequencies - they all get lost in translation. A 2023 post on Reddit’s r/PharmacyTech from a pharmacist with 842 upvotes said it plainly: "27% of prescriptions from Epic show up with garbled sigs. We fix them manually every day."
The Biggest Culprits: System Fragmentation and Poor Integration
Here’s the real problem: most practices use one system. Most pharmacies use another. And they’re not built to work together.
Practices using standalone e-prescribing tools like DrFirst Rcopia have 42% fewer transcription errors than those using EHR-integrated systems. But here’s the twist - integrated systems like Epic’s Hyperspace reduce overall prescribing errors by 84%. So which do you choose? The answer isn’t simple. Integrated systems are better for safety overall, but only if they’re connected to your pharmacy’s system. If they’re not? You’re stuck with manual re-entry - the exact thing e-prescribing was supposed to eliminate.
And it’s not just about the software. It’s about the data format. The NCPDP SCRIPT Standard Version 201900 was created to fix this. It’s a set of rules that says: "This is how you send a prescription." But only 32% of U.S. pharmacies have true interoperability. The rest? They’re still doing manual work. That’s 68% of pharmacies where someone is typing in what the system should’ve sent automatically.
Six Proven Ways to Stop Transcription Errors
The Agency for Healthcare Research and Quality (AHRQ) studied this for years. They found six strategies that actually work. Not theory. Real results.
- Standardize the sig format - Instead of letting doctors type free text, force them to pick from a dropdown: "once daily," "twice daily," "every 8 hours." This cuts transcription errors by 41%.
- Use CancelRx - If a doctor changes their mind, they should cancel the old prescription electronically. No more two prescriptions for the same drug sitting in the pharmacy inbox. This reduces confusion errors by 63%.
- Share one medication list - When the pharmacy and the doctor’s system both pull from the same list of what the patient is actually taking, you stop errors from missed refills or duplicates. This cuts reconciliation errors by 52%.
- Require medication indications - If a doctor prescribes methotrexate, they must say why: "for rheumatoid arthritis," not just "for pain." This prevents wrong dosing - like giving a weekly dose daily. It reduces indication-drug mismatches by 79%.
- Connect pharmacy and prescriber systems directly - If Epic talks to QS/1 without human input, you eliminate 92% of manual re-entry errors. That’s not a guess. That’s a 2017 ISMP Canada case study result.
- Redesign how modifications work - If a prescription needs to be changed after it’s sent, the system should flag it clearly. No more "I thought the doctor meant to change it" moments. This reduces confusion errors by 67%.
What’s Holding Practices Back?
These fixes aren’t magic. They take work. And most practices don’t have the time or money.
63% of providers say their legacy systems won’t talk to modern e-prescribing tools. 72% say doctors hate typing structured data. They want to click and go. They don’t want to pick from dropdowns. They think it slows them down.
But here’s the thing: it doesn’t slow them down. It prevents errors. And errors cost more than time. A wrong dose can mean a hospital stay. A wrong drug can mean death.
Some places have made it work. A 2022 MGMA case study found that practices using fully integrated Epic-CVS systems cut transcription errors by 92%. Why? Because the system didn’t just send a prescription - it sent the full patient record, the active meds list, and the correct sig - all in one clean package.
What You Can Do Today
You don’t need to wait for a system upgrade. Start here:
- Check your pharmacy’s system - Does it support NCPDP SCRIPT 201900? If not, push for it.
- Train your staff - Teach them what to look for: "QD" vs. "1 TAB," "BID" vs. "twice daily," "PO" vs. "by mouth."
- Ask your prescribers - Do they use structured sigs? Do they cancel old prescriptions? If not, show them the data: "Your patient got 10x their dose because the system misread '1 TAB' as '10 TAB.'"
- Use the Surescripts Pharmacy Health Information Exchange - If you’re not using it, you’re missing a tool that cut errors by 88% in pilot programs.
And if you’re a provider? Start using medication indications. It’s not extra work. It’s better care. Dr. David Bates from Harvard says it clearly: "Adding the reason for the drug cuts dosing errors by 78%." That’s not a suggestion. That’s a lifesaver.
The Future: AI and FHIR Are Coming
The next big shift is coming. By 2025, the ONC will require all e-prescribing systems to use FHIR - a modern data-sharing language. And by 2026, AI tools like Epic’s DoseMeRx will start flagging dangerous prescriptions before they’re sent. One pilot showed a 65% drop in transcription errors just from AI validation.
But here’s the catch: none of this matters if systems still don’t talk to each other. FHIR won’t fix bad workflows. AI won’t fix ignored alerts. The technology is ready. The problem is the people.
Until we stop treating e-prescribing like a checkbox - "We have it, we’re done" - and start treating it like a safety system, errors will keep happening. Not because the tech is broken. Because we’re not using it right.
Final Thought: It’s Not About the System. It’s About the Process.
E-prescribing didn’t cause these errors. Poor design, poor integration, and poor training did. The system isn’t the enemy. Complacency is.
Every time you catch a wrong sig before it goes to the patient, you’re not just fixing a mistake. You’re preventing harm. And that’s why this matters. Not because it’s efficient. Not because it’s trendy. Because someone’s life depends on it.
What are transcription errors in e-prescribing?
Transcription errors in e-prescribing happen when prescription data is misread, misinterpreted, or incorrectly converted between different systems - even though it’s meant to be sent electronically. For example, "take one tablet daily" might be converted to "1 TAB PO DAILY," and a pharmacy system might misread "DAILY" as "10" and give the patient ten times the dose. These errors aren’t caused by handwriting, but by system incompatibility, poor formatting, or lack of standardized data fields.
Why are e-prescribing errors still happening if the system is digital?
Because not all systems talk to each other. A doctor’s EHR might send a prescription in one format, but the pharmacy’s system expects a different one. Even small differences - like "QD" vs. "once daily" - can trigger misreads. Standalone e-prescribing tools often have fewer errors than integrated ones, but only if they’re not connected to the pharmacy. True safety comes from full integration, which only 32% of U.S. pharmacies currently have.
What’s the most common type of transcription error?
The most common error is misreading the sig - the instructions on how to take the medication. Abbreviations like "QD," "BID," or "TID" are often misinterpreted by pharmacy systems. For instance, "1 TAB PO DAILY" can be read as "10 TAB PO DAILY" because the system confuses "D" with "10." This happens in 27% of prescriptions from major EHRs like Epic, according to pharmacy staff reports.
How can pharmacies reduce these errors?
Pharmacies can reduce errors by using the NCPDP SCRIPT 201900 standard, connecting directly to prescriber systems via Surescripts, training staff to recognize risky abbreviations, and pushing prescribers to use structured sigs and medication indications. Practices that use CancelRx and shared medication lists see up to 67% fewer errors. The key is automation - if someone has to type anything in manually, the risk goes up.
Are electronic prescriptions safer than handwritten ones?
Yes - overall. Handwritten prescriptions had 12.3 errors per 100 prescriptions. E-prescribing has dropped that to 3.8. But while e-prescribing reduces total errors, it introduces new types of errors - mostly from system miscommunication. Handwritten errors were often more severe (mean harm score of 4.6), while e-prescribing errors are usually less harmful (mean harm score of 2.2), but they’re more frequent and harder to spot because they look "correct."
What’s the role of the 21st Century Cures Act in this?
The 21st Century Cures Act, effective in 2021, bans "information blocking" - meaning healthcare systems can’t prevent data from flowing between providers and pharmacies. If a system refuses to share e-prescription data properly, it can be fined. This law is pushing vendors to adopt FHIR standards and improve interoperability. It’s not a technical fix, but a legal one - forcing the industry to make systems work together.
Will AI solve transcription errors?
AI tools like Epic’s DoseMeRx are already in pilot testing and can reduce transcription errors by up to 65% by flagging mismatched doses, incorrect frequencies, or dangerous combinations before the prescription is sent. But AI won’t fix broken systems. It can only work if the data it receives is clean and standardized. Until all systems use FHIR and structured data, AI will keep hitting walls.
What should small practices do to avoid these errors?
Small practices should choose ONC-certified e-prescribing systems that support NCPDP SCRIPT 201900 and connect directly to pharmacies via Surescripts. Avoid standalone tools unless they integrate with your pharmacy’s system. Use structured sigs and medication indications religiously. Even if your system doesn’t force you to use them, make it a rule. And if you’re using a legacy system, apply for the $15 million in ONC funding available for small practices to upgrade to FHIR-ready systems by 2025.
Ashley Durance
November 13, 2025 AT 14:47Let’s be real - the system doesn’t care if you live or die. It just sends what it’s told to send. That ‘1 TAB’ becoming ‘10 TAB’? That’s not a glitch. That’s a design choice. Someone decided abbreviations were fine. Someone decided ‘QD’ was universal. And now pharmacists are the human firewalls between algorithms and dead patients.
And don’t get me started on ‘structured sigs.’ Doctors hate them because they’re lazy. But if you’re too busy to type ‘once daily,’ you’re too busy to be prescribing.
This isn’t a tech problem. It’s a cultural one. We let providers cut corners and call it efficiency. Then we blame the pharmacy when the patient ends up in ICU.
Fix the people first. The software will follow.
Or keep doing what you’re doing. More deaths. Same paperwork.
Scott Saleska
November 14, 2025 AT 15:33Actually, the real issue is that nobody’s held the EHR vendors accountable. Epic, Cerner - they’re monopolies. They charge hospitals millions, then lock them into systems that don’t talk to each other. It’s intentional. Interoperability means less lock-in. Less lock-in means less profit.
And don’t tell me about FHIR. It’s been around since 2017. But vendors are still ‘working on it.’ Translation: they’re milking the status quo.
The 21st Century Cures Act? It’s toothless without fines. And guess what? No one’s been fined. Not one. Because politics.
Meanwhile, your grandma gets 10x her dose because a system thought ‘DAILY’ was ‘10’.
This isn’t innovation. It’s negligence dressed up as progress.