Instant Medicine

You've seen the advertisements; perhaps you've even spoken to sales reps at medical society meetings or national conferences. But with the near-daily deluge of information about technological advances to help physicians practice more efficiently, you may not have made the leap across one of the most promising frontiers of paperless medical offices: electronic prescribing.

"E-prescribing," as the technique is commonly known, is probably one of the most practical and accessible ways for physician practices to jump into the electronic age. Electronic prescribing technologies are praised by their advocates as time-savers that also reduce the risk of error and liability. One company, iScribe, even offers physicians a discount on their malpractice insurance premium after using its product for one year. An attractive offer, to be sure.

So what's the catch? There seem to be relatively few. Aside from spending some time to set up the equipment and master the learning curve, e-prescribing is virtually painless. Some companies even provide needed equipment, and most services increase productivity in exchange for a minimal investment.

Quick and easy

An e-prescribing system's greatest boon is its promise of a streamlined prescription process. Each of the estimated 2.5 billion prescriptions dispensed in the United States every year takes valuable time - especially when taking into account the physicians' time fielding pharmacist calls to confirm prescriptions, replace non-formulary drugs, and related tasks.

To e-prescribe, a physician opens the patient's electronic record, (stored on the e-prescribing device), selects a condition or medication, checks for drug interactions or allergies, confirms the medication is included on the patient's health plan formulary, enters dosage information, and sends the prescription via fax - or electronically -  to the pharmacy of the patient's choice. The whole process takes no more time than writing a conventional prescription -  and has additional safeguards built in.

"Electronic prescribing is quick and easy," says Joseph Goldberg, MD, a San Francisco physician who uses ePhysician's system. "I can easily go through a list of 10 or 12 descriptions of a drug - side effects, contraindications, potential conflicts. Avoiding the phone calls is great, too - that's very time-consuming for my staff."

Among the challenges e-prescribing helps avoid are illegible handwriting, incorrect dosages, unclear instructions, and often-dangerous errors related to confusing similarly named drugs. The long-term goal: to increase accuracy and minimize medication errors, which in 1993 were estimated to account for about 7,000 deaths - more than double the number from a decade before.

Covering all bases

Checking formulary compliance -  a time-consuming, yet crucial part of prescribing -  becomes simpler with most e-prescribing tools. Most vendors update formularies weekly or more often, based on input from health plans, pharmaceutical benefit management firms, and formulary management companies.

Users of the ePhysician service, for example, receive new formulary information when the physician "syncs" with a desktop computer. And ReadyScript's wireless system makes new formulary data available to subscribers immediately via instant connectivity. Either way, e-prescribing systems mean no more guessing or memorizing lists of drugs.

An unexpected benefit is that handheld prescription devices may bolster physicians' level of experience and caring in the eyes of some patients. One Palm-based product, ePocrates (which is free to physicians), brings a searchable PDR into the exam room.

Bruce Bagley, a family physician and board chairman of the American Association of Family Physicians, uses ePocrates -  with unexpectedly positive results. "One patient told me last month a drug was making her nauseous," he relates. "I pulled out my Palm Pilot and looked the medication up on ePocrates, then told her nausea was not a usual side effect with that medication. She looked surprised, then said, 'You really know, don't you? You're not just guessing.' Here is a tool I didn't know I needed, but have used every day since I got it. It gives me the power and support to do a better job."

Pharmacists, too, see added efficiencies by being able to quickly fill faxed or electronically submitted prescriptions. "[E-prescribing] eliminates all the communications problems," says Ken McLain, a Newport Beach, Calif.-based pharmacist. "From our viewpoint, the prescription is already prescreened and easy to read - we just type it in and fill it. So far we haven't had to call or have any questions about those prescriptions."

Choices and decisions

E-prescribing systems now offer - or soon will - everything from prescriptions to more complex applications, allowing physicians to check patient records, order lab tests and referrals, or complete an online patient "visit." To be sure that you choose the right system for your practice, ask yourself a few questions.

First, how will you handle conversion? Patient data must enter the system somehow. Practices using electronic medical records (EMR) are set to begin - as long as the e-prescribing software can work with the EMRs. ReadyScript, for example, is a medication management and prescribing system that creates an interface with a practice's existing management system to integrate its EMR. Practices can enter patient data one chart at a time, perhaps as a patient schedules an appointment. Or they may choose a start date, and enter new information from the next patient visit.

Next, consider whether you have the appropriate infrastructure. Do you have enough computers to allow other staffers to be appropriately connected? Think about how e-prescribing will affect daily workflow and whether individual responsibilities need to be modified to make the most of everyone's time with the equipment.

You'll need to decide which platform to use. Options include Palm (used in Palm and Handspring handheld units) and Windows CE (used in the Hewlett-Packard Jornada and some "mini-laptop" or tablet computers). If you will need new hardware to use an e-prescribing system, consider the cost - and be aware that some companies provide hardware. This may be an especially worthwhile perk if e-prescribing vendors undergo a likely industry consolidation, perhaps rendering current hardware unusable.

Finally, decide what you want to accomplish in the long run. For the not-so-computer-savvy, using a handheld device might be intimidating at first. But once the system becomes part of your routine, you might want to add other services. Think ahead about what sounds right for your practice: Ordering labs online? Processing online referrals? Linking to your existing EMR or practice management system? Conducting online visits with patients?

Although many products focus on prescription refills, they offer several other activities online. "We tried to design our product to fit with how a physician works," says Michael J. Lombardi, ReadyScript's executive vice president of marketing and business development.

That's good news for busy physicians who are often inundated with information about technologies that may or may not be particularly beneficial. Wherever your practice stands along the winding road of practice management technology, e-prescribing will likely prove to be worthwhile. Plan ahead, take a deep breath - and take that first step.

Susanna Donato can be reached at editor@physicianspractice.com.

This article originally appeared in the September/October 2001 issue of Physicians Practice.