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Group prescribes changes
By Cheryl Powell
Beacon Journal medical writer
The days of walking out of the doctor's office with a prescription in hand could be numbered. Rather than handing over a prescription scrawled on a piece of paper, doctors are starting to send their medication orders over secure computer connections directly to the pharmacy of the patient's choice. Electronic prescribing -- known as ``e-prescribing'' for short -- is being heralded as a way to cut down on medication errors while reducing costs and improving patient compliance with their doctor's orders. In fact, the National Institute of Medicine recently issued a recommendation that all prescriptions be written electronically by 2010 to help cut down on medication errors. This month, a group representing many of the region's largest employers is launching a program to encourage more doctors in the Akron-Canton area to adopt e-prescribing. The Employers Health Purchasing Corp. of Ohio wants to find 25 area doctors who are willing to be the first physicians in the region to use an e-prescribing tool called ``iScribe.'' The Canton-based group is made up of area employers that pay medical bills for their employees. Participating businesses -- including FirstEnergy, Diebold, the cities of Akron and Canton, Summit County, numerous school districts and others -- employ about 430,000 people. The employer group is offering the program in partnership with Caremark Rx Inc., the Nashville-based company that manages the employee pharmacy benefits for the coalition's member companies. The Canton-based group and Caremark will share the cost -- estimated at $8,000 per participating doctor -- to provide training and purchase the software, personal digital assistants and other hardware needed for iScribe. Doctors won't face any out-of-pocket costs to participate, said Christopher Goff, president and chief executive of Employers Health Purchasing. The goal is to have the system operational in the region by the end of June, he said. ``We feel it will bring a lot of convenience to our employers' employees, retirees and dependents,'' Goff said. Records computerized Caremark's iScribe program gives doctors computerized access to their patients' medication history, allergies and potential drug interactions, said Dr. Jan Berger, senior vice president and chief clinical officer with Caremark. ``We see this first and foremost as a patient safety issue,'' Goff said. Doctors also can get access to more than 4,000 formularies. Those are lists indicating which prescription drugs insurance companies will cover, as well as which medicines carry higher co-payments for patients. Armed with that information, Goff said, doctors hopefully will be more likely to order generic medicines and preferred brand-name drugs that cost the patients -- and their employers -- substantially less money. ``We think it will have a positive financial impact to employees, dependents and retirees in that if a physician writes a brand script and a generic equivalent or substitute is available, the system should prompt the physician to write that alternative,'' Goff said. ``... It will also generate that consumer discussion about what more cost-effective options are available.'' Indeed, there is some evidence that e-prescribing can drive down drug costs. Costs could drop Preliminary results from a study of four Dayton doctors who used e-prescribing found those physicians were more likely to order generics or cheaper brand-name drugs, said Marc Sweeney, past president of the Ohio Pharmacists Association and chair of pharmacy practice at the University of Findlay School of Pharmacy. ``It definitely changed prescribing patterns,'' Sweeney said. Another study by Caremark found that doctors who used the iScribe system were three times more likely to prescribe a generic treatment for an acid-related gastrointestinal problem. Practice already here A few practices throughout Northeast Ohio already have adopted e-prescribing. Last year, for example, physicians at the Cleveland Clinic wrote almost 3 million prescriptions electronically from computers in their examining rooms, according to Dr. C. Martin Harris, chief information officer. The e-prescribing tool is part of an extensive electronic medical record system the Clinic has installed to provide computerized access to personal health information for doctors and their patients. Cleveland Clinic patients who sign up for online access to their medical records can use the computer system to send medication refill requests directly to their doctor rather than having to call the office or come in for a visit, Harris said. ``It really had a dramatic impact on phone calls,'' he said. ``What it's done is allowed the telephone calls that are really needed to get through.'' Doctors at Falls Family Practice in Cuyahoga Falls also launched e-prescribing as part of a $750,000 investment in electronic medical records. ``You get legible writing, clear concise instructions and checks for drug interactions,'' said Dr. Hugh McLaughlin, a family physician with the practice who's been using e-prescribing for eight months. ``It's foolproof.'' Not necessarily, Sweeney said. Doctors still can point and click to the wrong drug or dose, creating ``a nice, legible error.'' Getting doctors to abandon their pen and prescription pad can be challenging. Initially, Sweeney said, some doctors find it more time-consuming to switch to e-prescribing. ``One of the challenges is getting physicians to adopt it,'' he said. ``The reality is, in a time-pressured environment, there's nothing faster than just writing it down on a piece of paper. ``However,'' he added, ``once they're up and running, the nice thing is that it ultimately will save time because they don't have to re-enter information.'' | 
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