April 2002 • Volume 8 • Number 4 |
e-prescribing: cure for your scribbles
If you haven't yet thought about electronic prescribing, you probably will soon. Why? For starters, patient safety. Also, federal regulations about patients' privacy may be easier to meet via the computer than the prescription pad.
A few comments from family physicians who write electronic prescriptions may help you make decisions about e-prescribing.
PROS AND CONS
"My prescriptions are legible, refills are a snap, and I always have the available doses on my handheld computer, so I cannot accidentally prescribe a strength that isn't available," says Lorne Bigley, M.D., of Eugene, Ore., who uses a personal digital assistant. "I always have the patient's medication history on my PDA -- in case I'm in the hospital or see the patient without a chart."
Bigley cautions that with a patient's first e-prescription, it takes time to input the patient's name, date of birth, sex and health plan. It also takes time to print the prescription. Then Bigley has to leave the exam room, pick up the prescription from the printer in his office and sign the prescription.
The family practice residency at the Fort Wayne (Ind.) Medical Education Program uses a system that faxes prescriptions straight to pharmacies.
However, implementing e-prescribing takes time, says Frederic Jackson, D.O., the residency director. "We have used the system about four months, but we're still in the implementation phase," says Jackson.
"Despite the slow implementation, I'm a big supporter of electronic prescribing," says Jackson. "It retains information, produces a legible prescription and does a lot of cross-checking that doctors don't always remember to do." For each prescription the system checks for drug-to-drug and drug-to-food interactions, customary duration of treatment and earlier adverse reactions the patient has had to the medicine. "If I order a drug for a month and the usual time would be 10 days, the system flags me," says Jackson. "It helps me use safe prescribing practices."
TO PAY OR NOT TO PAY?
Some FPs have received free software for electronic prescriptions, but at least one suggests the value of paying. "We have written over 28,000 prescriptions electronically," says Louis Spikol, M.D., of Allentown, Pa. "The company has performed a number of upgrades, consistently improving the product. We do pay for the system, but I think it's worth it. You can hold the company accountable for any problems."
PDA OR EMR?
One FP suggests avoiding PDAs for prescribing.
"Do your prescription writing from your EMR software and fax it from your main computer network or server," says Alan Falkoff, M.D., of Stamford, Conn. "A PDA that sends prescriptions has database problems with formularies and changes of insurance companies. The size of the database eats up the whole of your handheld computer. There are limitations on where it may work. The PDA must then be backed up to a PC file and/or printed out to keep a record of the prescriptions that have been written, for whom, what and when. Otherwise, it is potentially a medicolegal nightmare."
But Michael Cole, M.D., of Roland, Okla., says he has no problem using his PDA for prescribing. He has many Medicaid patients, knows the formulary for Medicaid and hasn't entered any formulary in his PDA.
He maintains his patients' medicinal history both in his PDA and his patients' paper charts. And at least once a year, the hardware vendor doubles the amount of memory in Cole's PDA.
LIFE SPAN OF VENDOR
One key question, says Cole, is whether the software company will be around awhile. "There's no assurance -- none, and never will be -- that the whole system I've grown to depend on so much will be available to me next week," he says.
DISCUSSION GROUP
If you'd like to join AAFP's PDA and Wireless Technology e-mail discussion group and share questions and answers with your peers, follow the directions at http://www.aafp.org/members/lyris/ (have your AAFP ID number handy).
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.