You’ve been handwriting prescriptions for years, and it’s worked pretty well for you. It takes only 10 or 20 seconds to dash off a script; nobody has sued you over anything you’ve prescribed; and you don’t have to mess with a computer while seeing patients.
Still, pharmacy calls are driving your staff crazy, and once in a while, a pharmacist notifies you about a potential drug interaction. So you wonder whether electronic prescribing might protect patients from harm, and whether it could make your office more efficient.
Studies show that e-prescribing does in fact improve patient safety. For example, in 2003, three Massachusetts health plans gave e-prescribing software licenses and PDAs to 3,400 physicians and nurses. In 2007, with the aid of computerized drug/drug and drug/allergy alerts, the collaborative’s providers wrote nearly 5 million electronic prescriptions — and changed 104,000 of them because they were potentially harmful.
The Henry Ford Medical Group in Detroit had a similar experience in early 2005, when the group started piloting a standalone e-prescribing program. By July of the next year, 600 of its 800 doctors had access to it. During that period, more than 98,000 prescriptions — including 7,300 that might have caused drug allergies — were changed or canceled as a result of automatic alerts. Three-quarters of Henry Ford’s doctors say e-prescribing improves the quality of care and makes patient care safer.
Some private practice doctors agree, too. “Patient safety is definitely increased by reducing errors in the transcribing process” at the pharmacy, says Bernd Wollschlaeger, a family physician in Miami who uses the iScribe program. Azar Korbey, a family doctor in Salem, N.H., stresses the importance of legibility and drug/allergy alerts. He says his Allscripts e-prescribing program has warned him against prescribing the wrong medication a number of times.
Solo family practitioner Allen Warrington of Wilmington, Del., has found that e-prescribing gives him more accurate medication lists, his office manager and wife, Deborah Warrington, notes. Two-way online connectivity with pharmacies — now available with most chain stores and some independent pharmacies — reveals whether patients are refilling their prescriptions, and whether it’s time to call them back into the office for a blood test.
After a year of using the DrFirst Rcopia program for free, (courtesy of Delaware Blue Cross and Blue Shield), the Warringtons have decided to subscribe. “There’s no question that it’s better, more accurate care,” Deborah Warrington says.
The cost of e-prescribing
That’s all very nice, you say, but what will it cost me, and how will I recoup that investment?
“Standalone” programs — those that aren’t part of an EMR system — are not expensive. For example, DrFirst, which hosts its Rcopia software on the Web, charges $799 per physician, per year for use of the program and a service that includes online connections to pharmacies and regularly updated formulary and drug databases.
PocketScript, made by Zix Corp., costs $600 a year (although health plans sponsor most subscriptions). ERX NOW, a Web-based program, is free. Corporate sponsors — including Microsoft, Cisco, Dell, Fujitsu, Sprint, Aetna, and Wellpoint — foot the bill. They also pay for a drug database, formulary lists, and a connection to SureScripts, the company that links physician offices online to most pharmacies.
An interface between a practice management system and an e-prescribing program typically costs about $2,000 — a pretty hefty price tag at first glance. But by avoiding dual entry of patient demographic and insurance data, the interface actually saves money in the long run, says Rosemarie Nelson, an MGMA consultant based in Syracuse, N.Y. If you still don’t want to invest in this program, she adds, your vendor can “dump” your existing demographic data into the e-prescriber for just a few hundred dollars. But here’s the caveat: Your staff will have to enter data twice on new patients.
If you choose eRX NOW , a practice management interface is either free or almost free. A number of vendors, including Allscripts, supply it gratis. If you have a practice management program that’s not made by one of those companies, you can have an interface written for $295; maintenance costs are $19.99 a month.
Many practices already have most of the computer equipment they need for e-prescribing. While standalone programs are usually designed for PDAs, they can also be used on desktops, laptops, and tablet PCs. So if you want to use the desktop that’s already in your office and write prescriptions on it at the end of visits, that’s perfectly OK.
A wireless network is essential if you’re going to prescribe on a PDA or a laptop while in the exam room. The cost of a wireless setup ranges from about $70 for a home-style system to a few hundred dollars for one designed for small businesses. Larger offices will have to spend more to deploy extra access points.
