March 23, 2006



March 1, 2006

Cover Story: Airborne Prescriptions

One health insurance company is protecting patients, reducing costs and saving time with electronic prescriptions. -- By Rita Kushnir
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Iíve always been amazed by the ability of pharmacists to discern illegible handwriting and, from a couple of squiggly lines, read the name of a medication, dosage and special instructions. Itís no small feat, in fact, as approximately 7,000 people die each year from prescription errors, many of which are caused by either misread instructions on the pharmacistís end or interactions and allergies unconsidered by a physician. Although most hastily written prescriptions simply result in a callback from a pharmacist, some end in a visit to an emergency room. Which made it time for technology to step in.

CareFirst is the largest healthcare insurer in the mid-Atlantic region, with over 3.3 million members and 6,000 employees. More than 80 percent of the regionís physicians participate in at least one of CareFirstís provider networks. To eliminate the inefficiencies and inaccuracies associated with paper-based prescribing, CareFirst decided to give electronic prescribing a try. ďWe wanted to introduce more technology into the providersí offices to help them become more efficient,Ē says Peter Stoessel, tactical operations director at CareFirst. ďWe were looking for ways to improve patient care quality and to enhance the safety of our members.Ē

Weíre all familiar with the traditional process: A physician writes out a prescription or calls in the prescription directly to the pharmacy. In the case of a written prescription, the patient takes it to the pharmacy and then waits for it to be filled or makes an extra trip to pick it up. Not only is this method a waste of the patientís time, but doctors waste time that could be spent with a patient by placing follow-up calls to the pharmacist.

CareFirst selected Rcopia from DrFirst, an electronic prescribing system that was awarded top honors at the TEPR (Towards the Electronic Patient Record) Conference in both 2004 and 2005, as the best E-Prescription Management System. Rcopia allows physicians to write and send complete prescriptions to pharmacies nationwide using handheld devices. Its speed, ease of use and sophisticated features elicited immediate interest from CareFirst. Designed by physicians, its goal is to simplify and expedite the prescription process without excessive intrusion into a providerís practice, which reflects its easy-to-use interface. Rcopia is platform independent and runs on various PDAs and smartphones. A Web version is also available.

The Never-Tiring Assistant
CareFirst enrolled 500 of its physicians in a 12-month pilot program, providing each with a Palm Treo 650 with the prescribing tool installed and running on the Sprint PCS CDMA2000 1x network, enabled by Qualcomm. The key feature of Rcopia is that it provides a physician with a patientís medical history, including previous and current medications, and automatically checks for a patientís allergies and any drug-drug interactions that may occur.

ďSay Iím your doctor,Ē Stoessel explains, ďand you come in to see me. I [enter] your name and pull up your entire medical history, as well as your prescription history. It will tell me, as a physician, whether or not there is going to be an allergic reaction to a drug I want to prescribe or a drug-drug interaction. In fact, thatís been our biggest value in doing this. Over the course of 12 months, doctors canceled prescriptions nearly 2,000 times for our members alone, because of one of these warnings. The savings attached are huge for us, and a member could avoid having to go to an ER for an allergic reaction. Whatís interesting is that itís really not what we thought it would beóit turned out that the safety angle was probably the biggest benefit of this application.Ē

With Rcopia, doctors are also connected to patient charts wherever they go. A physician can receive a call from a patient while away from the office and still write a prescription, because all of the patientís medical information is in his or her pocket.

Drawing Conclusions
Over the pilot period, 210,000 digital prescriptions were processed via DrFirst, a significantly better result than most analogous programs in the country have seen, according to CareFirst, and an indication that the physicians have embraced the tool. Formulary compliance rates increased from 81 percent to 85 percent, and nearly 6,500 potential adverse drug interaction or allergy events were discovered. About 47 percent of drug-drug interaction alerts and 24 percent of drug-allergy alerts resulted in cancelled prescriptions. Adverse drug events were also avoided, and prescription costs were reduced.

CareFirstís deployment is also a step toward healthcare professionalsí adaptation to electronic tools that will inevitably replace traditional methods in the future. Some doctors did have slight problems integrating Rcopia with their practice management system, but these were quickly solved with some training and technical support.

ďI think it was incredibly successful,Ē Stoessel concludes. ďThe volume of transactions tells me that we found an application that was fast and fit seamlessly into the providerís practice pattern. What you find in technology, a lot of times, when you try to roll it out to the docs, is that if it makes them change too much, they are not going to use it. [DrFirst] was very fast, highly secure, easy to use and they saw benefits to it. They could use it in their regular process and not lose anything. They didnít have to change things. In fact, it probably made their offices much more efficient.Ē Rcopia also provides a reporting system that makes it easier for medical practices to track their prescriptions and print their records of all prescribed drugs.

The pharmacists were also affected favorably by the deployment. They donít have to waste time interpreting info from handwritten prescriptions, and they donít have to waste time on the phone confirming them. Plus, through Rcopia, they can now receive prescriptions in one of two ways. If they arenít wired, DrFirst sends the info to a clearing house, which then faxes the printout to the pharmacy. Most of the pharmacies, however, are able to receive electronic prescriptions straight into their queues.

Rita Kushnir is the former Web editor of Mobile Enterprise magazine.

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