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Major Effort Underway For Electronic Prescriptions; But Does It Beat The Phone?

from the keeping-people-healthy dept

Tue, Jan 16th 2007 5:19pm — Mike Masnick

While there's still quite a big debate over whether or not healthcare records should be made digital, it looks like prescriptions may be about to go digital in a big way. A bunch of different healthcare and technology companies have all teamed up to make it free for physicians to make use of electronic prescription capabilities (assuming they have a PDA or computer already -- so not completely free). The thinking is that many physicians haven't gone down the road of e-prescriptions because it's too costly to get the necessary software -- however, even if the software is free, there are still concerns about about training and implementation. The good side of e-prescriptions is that it makes record keeping easier and makes mistakes from unreadable doctor's scrawling significantly less likely. However, there are still some questions concerning the privacy and accessibility of the records. Also, it's not clear that this is necessarily the best system. It's becoming increasingly common for doctors to just phone in prescriptions to pharmacies, which gets rid of the problem of bad doctor handwriting, and doesn't involve setting up software and training doctors how to use it. It's nice that there's an effort underway to modernize parts of the healthcare system, but it's not clear that this is really the best way to go about it.

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Nobody Special, 16 Jan 2007 @ 7:06pm

This Is Good
I provide technical support for a large doctor group, so I feel I can speak from an informed position. This is a great step in the right direction. Most all doctor offices now have computers and internet. And data encryption for transmittal across the internet is not tough to implement. As for privacy - this is more private.

Consider when a doctor "calls the prescription in" he assigns this to a medical assistant. The assistant then calls the pharmacy and leaves a message. Then, the pharmacy will check the message is checked on some schedule. Considering that I have yet to see a very secure voice mail system, this system is bound to have better security.

This also eliminates two steps in which errors can be made. The medical assistant can't inadvertently mis-pronounce the prescription. And the pharmacy tech can't inadvertently write the wrong thing down. Further, every system I have seen will prevent the doctor from making a huge dosing mistake. After the drug is chosen, the doctor is given a range of dosages to choose from.

Add in a system to cross check for drug interactions and you have a huge benefit. While I have not had a chance to see this particular system, it is sure to get imediate compitition from some already great providers.
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PhysicsGuy, 16 Jan 2007 @ 7:20pm

am i the only one who feels unsettled that there are doctors that would require "training" to use prescription software? maybe it's the way it's mentioned in the article, as if it's some advanced, complex software that has so much depth merely looking at the window wouldn't tell you how to use (which i assume it's the exact opposite, at the least it's not like using 3d modeling software or trying to code in assembly without training).
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Patrick Mullen, 16 Jan 2007 @ 7:20pm

ePerscribing has actually been around for quite a while. There are many benefits, but in reality, there are many problems with it. When does the prescription get transmitted? A high percentage of prescriptions that doctors write are actually never picked up for multiple reasons. What happens when the patient doesn’t go to the pharmacy?

Older doctors are resistant to technology, they don’t have PDA’s or computer systems. You will see statistics that say that most doctor offices have internet access, but most don’t use the internet for business purposes. Younger doctors have grown up on PDA’s and other technologies, but still there are those that resist.

The biggest issues are around the benefits. ePerscribing benefits the insurance companies, the pharmaceutical companies, and just about everyone except those that would actually have to use it. Nothing is quicker for a doctor than whipping out their scrip pad and writing down the prescription. To get doctors to adopt any new technology, you have to do three things. Save them time, money or improve patient outcomes. Technology that does not benefit the user is rarely adopted.
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|333173|3|_||3, 16 Jan 2007 @ 11:05pm

pen and paper...
... is not only cheaper and more convienient for the doctor, it prevents format wars at the pharmacies, and means thatthe patient can choose which pharmacy to go to after he has left the surgury. HTe pharmacy's own internal computer system can check for the cheapest version of the prescribed drug.
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Nobody Special, 17 Jan 2007 @ 5:56am

am i the only one who feels unsettled that there are doctors that would require "training" to use prescription software?
The training typically consists of simply showing the doctor how to use the software and takes very little time on an individual basis. It only becomes an issue when looked at from the standpoint of reaching large numbers of doctors.
As for the comment about pen and paper -- perhaps you should learn a little more. First, there are no format wars. The format for electronic prescriptions is settled. Patients won't be required to use electronic prescriptions. And since most patients go to the same pharmacy as a matter of habit, they get the benefit of the prescription being ready quicker.
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another, 17 Jan 2007 @ 6:01am

Re: pen and paper...
Cheaer and faster than writing it out?

What could be cheaper than a doctor whipping out his scrip pad (which was given to him by a drug company) and pen (which was given to him by a drug company) and writing out the prescription?

The benefits just do not fall to the end user (the doctor) but the time does. Thats not a good solution. The only way it will really catch on is if the govt. either requires it or the insurance companies or drug companies pay the doctor to use it.
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Kate Gladstone, 17 Jan 2007 @ 10:00am

why electronic records won't eliminate the handwri
Among the hospitals that call me in to prevent medication errors (by giving handwriting classes to the doctors), a fairly high percentage claim to have "computerized everything" 1 or 2 or 5 or more years ago … yet they still have handwriting problems, because of a crucial 1% to 5% of handwritten documentation that just won't go away. Doctors in "totally computerized" hospitals still scribble Post-Its to slap onto the walls of the nurse's station, still scrawl notes on the cuffs of their scrubs during impromptu elevator/corridor conferences with colleagues … and, most of all, doctors with computer systems often have the ward clerks operate the computers, use the Net, or whatever: working, of course, from the doctors' illegible handwriting. Bad doctor handwriting, incorrectly deciphered by ward clerks using the computer for any purpose, thereby enters the computerized medical record. And what happens when disasters knock out a hospital's network? More than one hospital, during Hurricane Katrina, lost its generator, its electric power — and therefore its computer system — for the duration. Even the computer-savviest staffers in the disaster zone had to use pens. Let's hope they wrote legibly. Kate Gladstone - Handwriting Repair - http://learn.to/handwrite
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DV Henkel-Wallace, 17 Jan 2007 @ 1:24pm

Additional issue
I heard a talk from someone working on (and trying to get people to adopt) electronic prescribing. She said one big issue is that if you select a prescription from a pull-down list you can accidentally click on the wrong medication that's alphabetically adjacent to the one you want but therapeutically unrelated.

What often happens, and is part of the point of pharmacists, is that the pharmacist will catch an inconsistency (in script combination, or previous scripts, or dosage prescribed) and decipher the doc's (or phone answerer's who took down a called-in script) handwriting to figure out an alternative interpretation. With the electronic system the traces of what might have been intended never appear. Apparently, and disturbingly, this happens in an enormous number of cases -- by my memory over 10%.

Sure you could try to encode this all in an expert system but it could be painful and deadly to get the bugs out
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