Companies push to have doctors abandon pen for PDA
By Theresa Agovino, Associated Press, 05/24/01
NEW YORK -- Nine months ago, Dr. David Hudson took five or six calls a day from pharmacists seeking clarification on prescriptions. Now he gets bugged only three times a week.
Hudson's handwriting hasn't suddenly improved. J ust the opposite. He now uses a handheld computer to process electronic prescriptions.
A handful of companies now offer digital prescription systems for harried doctors, hoping to modernize a process that hasn't changed much since Hippocrates. Their marketing efforts -- in many cases backed by pharmaceutical companies -- have made small inroads into changing prescribing habits.
The idea isn't simply to improve efficiency but also to eliminate prescription errors -- which a 1999 Institute of Medicine study blames for killing 7,000 Americans a year.
Hudson, a family practitioner in Shreveport, La., uses iScribe for printing out what he formerly wrote by hand. Allscripts Healthcare Solutions Inc. and ePhysician Inc. have competing services.
Printed prescriptions end questions about scribbled dosages or the name of a drug.
They can also let doctors check beforehand whether a patient's health insurance plan covers a particular medicine. Doctors save time by avoiding calls from pharmacists who want to switch to a different drug when the original isn't covered.
In electronic prescribing, lists of patients and drugs are downloaded to a doctor's handheld device.
After making a diagnosis, the doctor enters the drug and dose into the personal digital assistant and transmits the information wirelessly to a printer. The result: a clear, legible prescription for the patient.
Some doctors can transmit directly to pharmacies, but that is rare now primarily because the technology is so new.
"It seems like a no brainer to say that if we automate prescription-writing we will get rid of a lot of medical errors," said Mark Bard, director of health practice at Cyber Dialogue. "But doctors have been slow to change."
Only 4 percent of the approximately 625,300 doctors in the United States use personal digital assistants to write prescriptions.
Dr. Alan Douglass tried iScribe for a few months but couldn't get comfortable writing prescriptions on it. So he reverted to paper and pen.
"I know all this writing is for the birds," said Douglass, a family practitioner in Middletown, Conn. "But (as I was learning) it was taking me three times as long to use the machine as it was to write on a piece of paper."
One reason doctors have been slow to adopt electronic prescription writing is the lack of standards for connecting handheld devices with the pharmacies, labs and health insurers that also need the information.
But earlier this year three companies that manage prescription drug benefits -- Advance PCS, Express Scripts, and Merck Medco -- formed RxHub to create software for linking their systems. RxHub should be operational next year.
There are also corporate initiatives, along with legislation that, if passed into law, may prod doctors to change habits.
Washington state now requires prescriptions to be "legible." A New York state legislator proposes to require printed prescriptions. Bills in Congress would offer hospital and nursing homes grants to purchase medical equipment such as handheld devices.
Meanwhile, General Motors has begun equipping doctors in two cities with free personal digital assistants, printers and software to write prescriptions.
Doctors who have embraced electronic prescribing don't miss their pens and pads.
But cost could be an issue.
IScribe has offered its service for free but will impose a $25 monthly charge in a few months.
"When you are a family doctor, you have to look at every penny," said Hudson, who is part of a two-person practice that has seen its revenues squeezed by reductions in insurance reimbursements.
IScribe launched its product in 15 months ago and has attracted fewer than 10,000 doctors. The company isn't profitable, though it has generated revenue by selling ads to Johnson & Johnson. The New Jersey-based drug giant also goes out and markets iScribe to doctors.
David Levison, the company's founder and chief executive, said the time has come to test physician loyalty to the product.
"If doctors don't see $25 as a real value, they simply won't really use the service in the end," Levison said.
Allscripts is in a better position because its business base is more diverse. The company's primary business is selling drugs to doctors, who in turn make a small amount of money by reselling them to patients.
So while Allscripts charges $200 a month for its electronic prescribing software, doctors make up most of that by selling drugs to patients.
Still, the company isn't profitable. While revenues doubled to $54.9 million last year, the company reported a net loss of $57.3 million, up from $13.4 million in 1999.
"For us the price is a wash," said Kenneth Cohen, a family practitioner in Pembroke Pines, Fla. "Would I pay $200 for it? I'd really have to think about it."
Dr. Douglass is waiting for an industry shakeout before committing.
"You go to medical conventions and see so many of these companies," he said. "I'm going to see who is left standing and learn to use their device."
