U.S. doctors issuing e-prescriptions

It’s a good thing pharmacists can usually translate the illegible scrawl that is your family doctor’s hand-written prescription. But figures in the U.S. state the 8th leading killer of Americans is misconstrued doctors’ orders.

That possibility could be remedied by a solution put forward by Weston, Fla.-based ParkStone Medical Information Systems and IBM Global Services last October. The two companies launched ParkStone’s handheld, point-of-care application which was said to eliminate hand-written prescriptions within three years. No doubt the medical community is as regimented as it is meticulous, but ParkStone is banking on the belief its offering will prove to be more than a Band-Aid solution with health professionals everywhere.

“Just over 2,000 physicians in the U.S. have installed the system,” said Lewis Stone, chief technology officer for ParkStone. “We’re in over 15 states after completing our first pilot which began in April 1999 and we found that three-quarters of the 40 physicians in the Florida marketplace that tested the system for us said they picked up the device for all their prescribing. The device takes the place of the prescription pad.”

The effort is aimed at providing physicians across the U.S. with a mobile technology tool that will enhance patient care, streamline traditional paper-based processes, and reduce the threat of medication errors.

Dr. Emmet Kenney, the director of medical services with ParkStone, said the elimination of hand-written prescriptions inside of three years in the U.S. (or anywhere) isn’t likely. While he dismissed the bravado heaped onto the system by certain news organizations, he stated his confidence in the system is unshakeable, comparing the ParkStone handheld to that of a living, breathing medical file on any patient.

“The extent of the problem is that real, hand-written prescriptions are a safety issue,” he remarked.

Prior to a year-long pilot of the system in the U.S., Big Blue was asked to assess each physician’s technology needs and to provide on-site and Web-based training to doctors and their office staff. IBM also provided the systems integration services for ParkStone, building on a solid relationship between the two entities.

“IBM worked with ParkStone to train physicians and deploy the technology in their offices,” said Dr. Russell J. Ricci, general manager for IBM Global Health Care Industry in Boston. “As the technology expands its reach, it’ll also expand the depth of IBM’s middleware and hardware applications. The ParkStone application is very targeted and efficient and it doesn’t require a physician to enter tons of data to make use of it.”

interactive file

The ParkStone software is designed to electronically prescribe medication on insurance forms, check drug interactions, refer specialists on insurance plans, schedule patients, capture charges and order lab test results.

Armed with PDAs, doctors will be able to issue an electronic prescription on behalf of a patient and zap it to a registered pharmacy. The patient then visits that pharmacy to collect the medication without fear of their doctor’s orders being misinterpreted.

“The handheld is in synch with the database of a doctor’s local office,” Kenney said. “It receives updated information which is downloaded overnight. All prescriptions written take less than 90 seconds to process…you can then print out the prescription, sign it and hand it to the patient or fax it directly to the pharmacy.”

A wireless implementation of the ParkStone System is scheduled for the first quarter of 2001 in the U.S. As for Canada, the company is in the process of seeking partners to introduce the services here.

How it works

The ParkStone System consists of a network of palm-sized PCs (PPC) which are used by individual physicians for medication management, referral generation, formula management, diagnostic test management and hospital charge documentation.

As a formula and medication management tool, the ParkStone System is used in place of the traditional paper prescription pad. The PPC prescription pad is aware of the patients’ insurance affiliations, the formula drugs offered under each plan and the relative cost of each medication. Prescriptions are generated via infrared communication with an on-site printer or electronically transmitted to the pharmacy of the patients’ choice. Patient-related information, unique to the appropriate health plan, offers physicians the ability to generate the proper referrals and diagnostic testing. The palm-sized PCs are returned to a cradle each night to synchronize information and download software updates from the ParkStone server.

Dr. Tom Handler, a research director with the Gartner Group in Stamford, Conn., said the ParkStone system is comparable to competing solutions in the marketplace.

“It’s a pretty good system, but my problem with all the gadget manufacturers is…they need to increase functionality,” he said. “ParkStone has already done that. within a year, all care delivery organizations including physicians will find it difficult to defend themselves in a malpractice case dealing with hand-written prescriptions if they haven’t started moving towards this type of system.”

Handler also said, despite the benefits the ParkStone system may offer, it still won’t completely phase out the traditional paper-based prescribing methods inside of three years.

the canadian question

Despite the exciting possibilities this technology holds for the medical community, Dr. Jeff Poston, executive director of the Canadian Pharmacists Association in Ottawa, said the likelihood of ParkStone’s or a similar solution being fully implemented in Canada in the near future is doubtful.

“There are two main stumbling blocks to these types of technologies. One is ensuring authenticity of an electronic prescription by ways of a digital signature, the other is security-related,” Poston said. “The other side of all this is to know that electronic prescriptions aren’t legal in Canada. Pharmacies require a written or verbal instruction from a doctor.”

Poston also raised the issue of freedom of choice for the patient when choosing which pharmacy will fill the prescription.

“The consumer should have the choice of which pharmacy they want to patronize. You don’t want to get into a situation where you’re locking people into going to just one specific pharmacy,” he said. “I think once handheld wireless technology advancements and advancements in the GP3 standard, as well as the next generation of wireless devices, come along with greater access to drug databases you’ll see some implementation. We’re still waiting for a directive from Health Canada on this whole issue.”

However, Ricci insisted that Canada leads the world with regards to pharmacy information services. “There’s already projects running in Alberta and B.C. where a doctor can go to an ER and find out what prescriptions you as a patient last paid for,” he said. “For a doctor to know what you last took is important. Hand-written prescriptions kill people everyday.”