Tuesday, October 25, 2005

Don't Get Crucified....By Your Scripts

Woes me! Writing scripts has become the toil of medicine. Don't get me wrong, medicines do great things for people, but they also do bad things too; nevertheless, remedies are here to stay, and the nitty gritty of any day at the office may involve refilling a number of scripts for patients you don't necessarily have to see that day... All doctors do this, but let's admit, most hate having to spend minutes or hours of valuable time everyday on the phone with the pharmacies authorizing refill requests. If it's not you, it's your staff -- tying up valuable resources that could be used otherwise. If you live in a cosmopolitan city like mine, you'll also be frustrated by the global variation in accents of the pharmacists who answer the phone -- the connection is usually staticky, the person barely speaks English, and they barely understand what you're saying. No wonder there are as many as 7000 deaths per year from prescription errors, which amount to about 5 percent of the 3-4 Billion prescriptions written and filled every year in the United States.

Recently I experienced my own brand of prescription error when a pharmacist, of their own accord, decided to substitute an antibiotic eyedrop for my 1-year old with conjunctivitis, for one that contained a combination steroid and antibiotic. I caught the error when I got home and looked at the bottle. I couldn't believe it! Had I not been a doctor, I would have administered an eyedrop that was changed without the pediatrician's consent, by the pharmacist, who obviously didn't know what they were doing, potentially risking a corneal ulcer for my infant son, due to the steroid content. I'm careful about prescribing such steroid-containing eyedrops for adults without an ophthalmologist's consent. However, the point is that medication errors are a real thing, and eventually they do hit close to home.

Thus you get a great company like SureScripts that is trying to integrate electronically the communication between pharmacists and doctors, so that prescription information can be exchanged electronically while preserving efficiency, quality and safety. Let's not forget that part of those prescription errors are unrecognized drug-drug interactions. This is where an electronic prescribing database, with its built-in alarms for potential interactions that may be overlooked by today's information-overloaded and pharmaceutical honey-coated-drug-courted physicians, is a great solution for improving safety and patient outcomes, as well as controlling costs by alerting the physician to non-formulary medications and their in-formulary alternatives.

One such program is DrFirst, which won Top Honors at the 2005 TEPR AWARDS. I had a chance to demo this program online today. The nice thing about it is that it allows one to either use an online portal for sending secure scripts electronically to the pharmacy, or transmission from your cellphone, such as the handy Treo 600 smartphone. I have to say the cellphone portability of this program with its patient log and history of last-prescribed medication(s) were the bells and whistles that caught my attention. I use the Treo 600 smartphone now as my pager to avoid having to carry around another device, and enjoy receiving my pages as text messages from which I can select the number to call back the patient or doctor or pharmacy. Now with drfirst, the same phone turns into an e-prescribing solution. What a great idea! No more waiting on the phone, or trying to get the pharmacist to understand your English. It all sounds great, but DrFirst still has a ways to go on online presentation. They need to improve navigation on their website to make it more visually intuitive. All said, they deserve their TEPR top honors, and I would consider this program in a practice that is keeping costs down and not quite ready to jump to a full Electronic Medical Record solution [which is much, much costlier].

So the thing about SureScriptsis that it is not a program you buy. It is a communication network that the other applications available for purchase, whether e-prescribing solution or EMR, use to transmit the information securely to the pharmacies. SureScripts is the intermediary that communicates with the pharmacies' computers. This all sounds great, but its implementation and ease of use is going to depend on the pharmacies. During my recent visit to the pharmacy, I noticed that the computer they were using had an interface that reminded me of the old Commodore computers. Yes, ye-olde dinosaurs of the early computer age -- that is what the program the pharmacies are using looks like. So while they're trying to incorporate this great modern network, they're doing it into an ancient computer system. This is the Jetsons meets the Flintstones. I asked the pharmacist at Duane Reade if they were SureScript ready, and she said yes, but that the system has its flaws..... Surprise, surprise.... I could not have guessed by looking at those old computer monitors that I once used back in the late 80's when learning what a computer was! Anyway, the program is unable to tell the pharmacist when a new prescription request has arrived. So it's basically relying on the pharmacist to check it periodically, which this pharmacist admitted does not happen all the time. Then, to receive a soon-to-be irate patient, arriving at the pharmacy, asking where their prescription is, and the pharmacist likely telling them they haven't received it because they are looking through their faxed requests, where the surescript prescription will not be. It still does not seem to be in the psyche of the pharmacists to check the computer, unless told to do so. So, it seems, that if you plan to switch to e-prescribing for greater ease of use, make sure you contact your most frequently visited pharmacies, and make them aware, as well as tell your patients to know how to ask for their prescription in order to avoid the very well-known scenario of the frustrated, angry patient calling your office asking where their prescription is. But just think, at least you can look forward to easily transmiting prescriptions electronically without consuming more than a minute of your time, when the hair on your back rises, as you hear the patient asking on the way out in the presence of a full waiting-room, "By the way, do you think you could call these scripts in for me?"

With my recent struggles with clueless pharmacists, who seem to be trying to take as much time as possible filling any prescription, much less attending to you, it seems that we have a major implementation problem in our hands. While the doctors are being sold Rolls-Royces, the pharmacies are still driving station wagons. The concept behind SureScripts and all of the e-prescribing and EMR platforms out there that enable this is great, but someone needs to speak to the CEO's or whoever heads these national pharmacy chains about updating their computer systems and improving their store service ethic in order to create a system that works on both ends seemlessly, efficiently, and accurately.

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