The process of generating a prescription follows that of using a paper prescription pad. Prescribers may override the predetermined choices and enter personal choices for quantity, instructions, and refills. The physician then views the completed prescription information, confirms the pharmacy information, and sends it through the wireless network and the computer system to the pharmacy or prints it in the office. All products support some type of list to facilitate rapid generation of custom prescriptions. Prescriptions produced by these systems benefit from perfect legibility, fraud and error reduction, automatic drug interactions checking (except ePad), and improved formulary compliance.
Each system can connect to front office systems and move patient demographic data into the prescription writing system. A real time interface updates both applications simultaneously, so information entered in the registration system is immediately available in the prescription writing system. With a bridge program, information entered into the registration system is unavailable in the prescription-writing program until the program is run and transfers the data to the prescription writing system.
PocketScript
Reviewed by Eric Weidmann, MD
PocketScript is unique, because the user can select voice recognition, screen touch, or the keyboard to quickly compose and send prescriptions. Patients’ records may be added or edited from the hand-held PC or the physician’s server. Hand-held to server communication is fast enough to provide high-speed Internet connectivity from the examination room, which is useful for patient care, business, and personal uses. Drug-drug interactions are checked automatically when choosing a drug and before sending the prescription. Patient allergy and diagnosis fields are promised for future releases.
PocketScript does not have to be linked to the practice’s registration system. If not linked, each patient must be entered manually the first time only. Patient data (eg, weight, insurance plan, and so on) can be changed using the Patient Maintenance function on the hand-held device. A scrollable Favorites list can be created of the physician’s most commonly used drugs; it uses PocketScript’s standard instructions for the signature. There is a scrollable, pull-down menu called Macros containing the physician’s custom-named drugs with physician-generated customized instructions and quantities (eg, special creams or a corticosteroid taper). Internet access on the wireless hand-held provides references for specialized disease and interaction information. I use my hand-held to access my E-mail as I move between patients. The keyboard allows me to use the hand-held to reply easily. We also use the E-mail system as an intra-office memo system for routine discussion and reminders.
Most of our prescriptions are faxed from the hand-held through the computer in our office to local pharmacies with the graphic of our log-in signature. Printed prescriptions can be sent to the printer in our office, which we then manually sign. PocketScript can provide digital signing when that complies with a state’s board of pharmacy regulations. Internet-enabled pharmacies can receive prescription data electronically using an E-mail–like system. There is no option for chart documentation other than printing a second script.
PocketScript is our choice because of its strong physician leadership, ethics, design, and serious commitment to the prescription process. It is usable by even the most computer phobic provider and does not attempt to replace anything but the paper prescription pad, phone, and wasted time—at least for now. Also, the vendor does not sell profiles of our prescribing habits. Security of the patient data and prescription process are excellent and are maintained even if the hand-held device is stolen. PocketScript is intuitive, simple, and efficient, with no tolerance for errors.
The design of the PocketScript server-based system eliminates the need to dock hand-held devices, avoiding time-consuming and frustrating tasks for the physician. This system is ideal for physicians who do most of their work in one or a few sites in which wireless nodes can be installed. We have changed office processes for refill and pharmacy calls, saving an estimated 1 hour per day per nurse and 30 minutes per day per file clerk. Patients and pharmacists frequently praise the clarity, accuracy, and convenience of the PocketScript system. PocketScript is a serious medical care partner and the perfect first step into e-medicine for our group practice.
ePhysician ePad
Reviewed by Daniel E. Diamond, MD
The ePhysician system uses a wireless wide area network (WAN) rather than a wireless local area network in the physician’s office. Prescriptions can be transmitted directly to the vendor’s server through an OmniSky (or equivalent) wireless cellular-WAN modem. The physicians who do not want to use the wireless interface can use the docking cradle attached to a computer in the office for synchronization. The prescription is then securely sent through the Internet to the vendor’s computer (using the cradle takes approximately 30 seconds per synchronization). The wireless method is more efficient and allows the physician to write and send the prescription without leaving the examination room. It also allows the physician to write and send prescriptions when away from the office.