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Digital Rx

February 1, 1998
by Polly Schneider
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THE AUTOMATION OF medication ordering is one of the most obvious transactions in healthcare because of the opportunities to save a great deal of time and money, now spent by physicians, their staff and pharmacists, reconciling orders over the phone. Electronic prescribing through both proprietary networks and the Internet has become widely available by many vendors and represents a large market opportunity--an estimated two billion prescriptions are filled annually. But getting physicians to use computers when they prescribe, and working through the technical glitches on the pharmacy end of the transaction continue to impede progress.

The electronic prescribing craze that started a few years back has been fraught with difficulties, but the resistance of physicians to the concept has been the greatest obstacle and caused some large vendors to pull out in 1997. "Everyone has discovered that we forgot to ask doctors if they really wanted this," says Chuck Reed, president of the American Society for Automation in Pharmacy. "It doesn’t really fit in with their workflow."

Avoiding drug events
Proponents of the technology, however, claim that with the right value-adds, physicians will be willing to change the way they work. Advanced Health Med-E Systems, Chicago, subsidiary of practice management firm Advanced Health Corp., is one of the few companies offering a product that takes advantage of the Internet. The company’s e.RX prescription writing software has a drug utilization review (DUR) engine that allows physicians, at the time of ordering, to access databases from a central server on the Internet or their intranet with drug interaction and dosing information--important in helping to prevent the growing problem of adverse drug events (ADEs). Various studies have shown the impact of ADEs on the nation’s healthcare system. One from the journal Therapie, May 1996, suggests that drug-related illnesses account for 5 percent to 23 percent of hospitalizations, 1.75 percent of ambulatory visits and one in 1,000 deaths.

Managing formularies
Yet the Byzantine problem of formulary management alone may be incentive enough for physicians to use computers for prescription ordering, according to Lyle Berkowitz, an internist with Northwestern Memorial Hospital in Chicago, and medical director for Advanced Health Med-E Systems. His patients are covered by some 30 to 40 different insurers. "If I am lucky, about once a year I get a booklet from these groups concerning their formulary, and then they may update it during the year and send me a letter. The truth is--I cannot keep track of all these formularies." Advanced Health is also incorporating formulary data into its offering, which allows physicians to screen drugs for compliance when they write the prescription--avoiding time-consuming games of phone tag with the pharmacist later.

Applications that offer immediate value to physicians--formulary and ADE checking--may be the catalyst to move prescription automation forward. "I see e.RX as a product that allows physicians to begin to experience the benefits of how computers can help them in their clinical practice," Berkowitz says. The product is available for free to physicians and is now being distributed through the Physicians’ Online network. Advanced Health has contracts pending to sell the product to HMOs.

Automating refills
The automation of refills--which accounts for the majority of prescription transactions and a substantial number of phone calls to the physician office every day--is another value-add of such systems since prescriptions are already in the system and can be approved online. "This is a huge time-saver for doctors and for the pharmacy," says Jack Guignan, president of ProxyMed, Inc., Ft. Lauderdale, Fla., a clinical database and EDI provider for healthcare. Its multiprotocol network, ProxyNet, handles claims, prescriptions and laboratory transactions. The company’s acquisition last year of IBM’s electronic prescription product Prescribe brought contracts with national chains Walgreens, Walmart and Eckert’s: ProxyMed is now generating 150,000 electronic prescription transmissions a month to 10,000 pharmacies. Guignan expects the business to double by the end of the second quarter through relationships with practice management software vendors.

Still, it all comes back to physician workflow and whether the process is as easy as using a prescription pad. "In developing this, your only competition is that piece of paper and pen," says Pat Peneer, product manager for National Data Corporation’s competing product, Prescription Network Manager. To make the system really useful, adds Berkowitz, there must be an interface to the practice management system so that the doctor can see all of the patient’s administrative data, including insurance information, and the prescription can then be stored in the medical record.

"Unfortunately, computerization of the workflow has not been done very well yet," notes Berkowitz. "Even if it is a portable device, it is still bigger than the prescription pads. So the efficiency more likely comes when they need to refill a list of medications, or when they avert an interaction which would cost them time later on."