Hand-Held Electronic Prescribing

Do any of the following situations sound familiar?

1. You want to prescribe 25 mg of a drug but are uncertain whether the drug is supplied as a 25-mg or 50-mg tablet.
2. An elderly patient comes in for an update on her multiple problems. At the end of a long visit, she asks to have all 17 of her prescriptions refilled.
3. You need to determine whether there is a possible drug interaction between existing medications and an upcoming medicine.
4. You would like to be able to generate a list of all your patients taking a recently recalled drug.

Now imagine a hand-held prescribing device the size of a prescription pad that turns on instantly, knows the date, and through a connection to your computer, knows your patient list for the day. Using this device you could quickly select the patient’s name from a drop-down list and see his or her insurance plan, age, and other demographic information. You could select medications from an alphabetic scrolling list that includes information specific to the patient’s insurance plan. You could check allergies and drug interactions against the patient’s list of previously prescribed drugs and known medication allergies, alerting you only if a clinically significant problem is detected. After selecting the medication, you could choose from a list of available dosages and specify the quantity to be dispensed Figure 1, and the prescription could be digitally signed and sent electronically to the patient’s pharmacy or to your printer. Chart documentation could be produced concurrently on a sticky-backed label that can be affixed to the patient’s medical record. The prescription would be saved for generating rapid renewals in the future. Drug information and insurance formularies would be updated regularly from central computers, and new drugs and dosage forms could appear on the hand-held devices before they show up on the pharmacists’ shelves.

Does all this sound far-fetched? It’s not. This type of technology is currently available. Systems range from simple prescription writers—a hand-held device with initial manual entry of patient data and prescription printing from an infrared-equipped printer—to full electronic medical records systems. Prospective users have to decide which features provide sufficient benefit to merit the investment of time necessary to learn them. In this article, 3 systems (PocketScript, ePhysician ePad, and AllScripts;)Table 1, Table 1a are reviewed by physicians who have successfully incorporated electronic prescribing into their practices.

A system that does nothing other than produce legible prescriptions in the same time it would take to write one by hand can benefit many physicians. One that provides an accurate record of previous prescriptions that allows the rapid renewal of multiple prescriptions is even more valuable. Another important potential benefit of an electronic prescribing system is fewer errors, including those caused by illegible handwriting, incorrect dosage selections, drug-drug or drug-disease interactions, and drug allergies.

These systems still have some limitations, however. Most do not automatically suggest a dosage adjustment for age, renal function, hepatic function, and alcohol and tobacco use (although drug monographs may be available on the hand-held device itself). Similarly, weight-based pediatric prescription information may be available in monographs on the hand-held device but is not built into the prescribing process. Some states allow electronic transmission of prescriptions, some do not, and some have made no ruling; specific rules vary. Fortunately, each of the vendors reviewed in this article made certain that their system is installed in a way that conforms to state laws.

Most primary care physicians have not made the leap to electronic medical records; package delivery services and supermarket checkouts use more technology at the point of service than the average physician does. These devices may change that by providing a relatively low-cost low-risk improvement with less impact on work processes than a full electronic medical record.

Common Features

Each of the systems we reviewed is “wired” somewhat differently Figure 2. PocketScript and AllScripts use a wireless local area network in the physician’s office to move information from the hand-held device to a desktop computer server in the physician’s office. This server is in turn connected to the vendor’s computer through a modem or other high-speed access device to get drug information updates. The office computer also sends prescriptions directly to pharmacies either as an electronic message or by fax.

A system using ePhysician includes a personal computer in the physician’s office to load patient demographic information onto the hand-held using a docking cradle. Prescriptions can be sent directly from the hand-held device to a central computer server at the vendor’s offices using a wireless modem. Alternately, they physician can dock the hand-held device in a cradle attached to the computer, which is connected by a modem to the vendor’s central computer. The vendor’s computer server then sends prescriptions to the selected pharmacy, either electronically or by fax. All systems use sophisticated encryption to protect the confidentiality of data as it is sent between computers.

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.

ePad has several other unique features. Because patient demographics are entered into the physician’s existing practice management system and transmitted to the hand-held when it is docked, the physician does not have to enter any patient data. To write a prescription for a patient who has not previously been entered into the system, the user docks the hand-held in the cradle for synchronization. Also, all prescriptions are transmitted from the vendor’s central computer servers either electronically or by fax to any pharmacy in the United States. Users can also print from the hand-held to a local printer. To generate chart documentation, the user can configure ePad to automatically print a copy of the prescription on the local computer when it transmits to the pharmacy. ePad currently comes bundled with ePhysician Superbill for charge capture and is integrated with Drug Facts and Comparisons. It also includes a Web interface that allows my staff to efficiently process prescription renewals, and a scheduling module that makes it possible to schedule patients on the computer. This schedule is viewable on the hand-held device.

ePad by ePhysician with the OmniSky wireless service is simple, efficient, and powerful. Its interface was designed with a focus on the physician user. Although there is a subscription charge for ePad, the fee pales in comparison with the cost of lost physician productivity due to the inefficient technology of printing prescriptions locally (or writing them by hand). Using the ePad system in our office has resulted in very positive patient feedback and increased efficiency and job satisfaction among staff.

AllScripts
Reviewed by Azar A. Korbey, MD

At the installation stage, AllScripts’ on-site team realizes that the use of these systems require change. They take the time to train the staff and make them part of the process. AllScripts differs from the other systems, because after the selection of the patient name, users select their most frequently coded diseases listed by common name and International Classification of Diseases-ninth revision code. This list is prescriber-specific, not patient-specific. Users can also access the patient’s prescription and diagnosis histories, and the AllScripts system automatically checks for previous adverse drug reactions. Next, AllScripts shows the medicines that the user most frequently prescribes for a disease. AllScripts learns each user’s prescribing preferences, so users do not need to enter their favorite prescriptions. The list also shows preferred instructions for any given medication, and if AllScripts’ office dispensing system is used, it will tell users whether they have the drug in inventory. To produce a prescription, the prescriber may modify a prescription from a frequently used list or choose from any other drug in AllScripts’ database.

Users have access to all patients in the practice through the network, regardless of provider or schedule. Patients not registered with the practice can be manually added into the hand-held device or desktop computer server. Unlike the other systems, AllScripts automatically produces a mailing address-sized label for chart documentation that includes all details of the prescription. The vendor also sells a turnkey pharmacy service (FirstFill) for in-office dispensing. It is only for common medications, and is similar to providing samples. The local wireless network is fast; high-speed access to the Internet is proving very useful.

AllScripts is complete and does what it promises. It is a well-funded, publicly traded company that is adding applications and acquiring additional companies that will allow dictation and charge-capture systems to be added. I have had long-term experience with the product and its exemplary phone support, and I believe they will both be around in the future. They are even willing to come on site immediately, if required. I strongly recommend this system.

Editor’s Note: We had hoped to include the iScribe 3000 system (www.iscribe.com) in this review but could not obtain the product and complete the review in time for publication. We plan to publish a software review of iScribe in a future issue of JFP.

Do any of the following situations sound familiar?

1. You want to prescribe 25 mg of a drug but are uncertain whether the drug is supplied as a 25-mg or 50-mg tablet.
2. An elderly patient comes in for an update on her multiple problems. At the end of a long visit, she asks to have all 17 of her prescriptions refilled.
3. You need to determine whether there is a possible drug interaction between existing medications and an upcoming medicine.
4. You would like to be able to generate a list of all your patients taking a recently recalled drug.

Now imagine a hand-held prescribing device the size of a prescription pad that turns on instantly, knows the date, and through a connection to your computer, knows your patient list for the day. Using this device you could quickly select the patient’s name from a drop-down list and see his or her insurance plan, age, and other demographic information. You could select medications from an alphabetic scrolling list that includes information specific to the patient’s insurance plan. You could check allergies and drug interactions against the patient’s list of previously prescribed drugs and known medication allergies, alerting you only if a clinically significant problem is detected. After selecting the medication, you could choose from a list of available dosages and specify the quantity to be dispensed Figure 1, and the prescription could be digitally signed and sent electronically to the patient’s pharmacy or to your printer. Chart documentation could be produced concurrently on a sticky-backed label that can be affixed to the patient’s medical record. The prescription would be saved for generating rapid renewals in the future. Drug information and insurance formularies would be updated regularly from central computers, and new drugs and dosage forms could appear on the hand-held devices before they show up on the pharmacists’ shelves.

Does all this sound far-fetched? It’s not. This type of technology is currently available. Systems range from simple prescription writers—a hand-held device with initial manual entry of patient data and prescription printing from an infrared-equipped printer—to full electronic medical records systems. Prospective users have to decide which features provide sufficient benefit to merit the investment of time necessary to learn them. In this article, 3 systems (PocketScript, ePhysician ePad, and AllScripts;)Table 1, Table 1a are reviewed by physicians who have successfully incorporated electronic prescribing into their practices.

A system that does nothing other than produce legible prescriptions in the same time it would take to write one by hand can benefit many physicians. One that provides an accurate record of previous prescriptions that allows the rapid renewal of multiple prescriptions is even more valuable. Another important potential benefit of an electronic prescribing system is fewer errors, including those caused by illegible handwriting, incorrect dosage selections, drug-drug or drug-disease interactions, and drug allergies.

These systems still have some limitations, however. Most do not automatically suggest a dosage adjustment for age, renal function, hepatic function, and alcohol and tobacco use (although drug monographs may be available on the hand-held device itself). Similarly, weight-based pediatric prescription information may be available in monographs on the hand-held device but is not built into the prescribing process. Some states allow electronic transmission of prescriptions, some do not, and some have made no ruling; specific rules vary. Fortunately, each of the vendors reviewed in this article made certain that their system is installed in a way that conforms to state laws.

Most primary care physicians have not made the leap to electronic medical records; package delivery services and supermarket checkouts use more technology at the point of service than the average physician does. These devices may change that by providing a relatively low-cost low-risk improvement with less impact on work processes than a full electronic medical record.

Common Features

Each of the systems we reviewed is “wired” somewhat differently Figure 2. PocketScript and AllScripts use a wireless local area network in the physician’s office to move information from the hand-held device to a desktop computer server in the physician’s office. This server is in turn connected to the vendor’s computer through a modem or other high-speed access device to get drug information updates. The office computer also sends prescriptions directly to pharmacies either as an electronic message or by fax.

A system using ePhysician includes a personal computer in the physician’s office to load patient demographic information onto the hand-held using a docking cradle. Prescriptions can be sent directly from the hand-held device to a central computer server at the vendor’s offices using a wireless modem. Alternately, they physician can dock the hand-held device in a cradle attached to the computer, which is connected by a modem to the vendor’s central computer. The vendor’s computer server then sends prescriptions to the selected pharmacy, either electronically or by fax. All systems use sophisticated encryption to protect the confidentiality of data as it is sent between computers.

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.

ePad has several other unique features. Because patient demographics are entered into the physician’s existing practice management system and transmitted to the hand-held when it is docked, the physician does not have to enter any patient data. To write a prescription for a patient who has not previously been entered into the system, the user docks the hand-held in the cradle for synchronization. Also, all prescriptions are transmitted from the vendor’s central computer servers either electronically or by fax to any pharmacy in the United States. Users can also print from the hand-held to a local printer. To generate chart documentation, the user can configure ePad to automatically print a copy of the prescription on the local computer when it transmits to the pharmacy. ePad currently comes bundled with ePhysician Superbill for charge capture and is integrated with Drug Facts and Comparisons. It also includes a Web interface that allows my staff to efficiently process prescription renewals, and a scheduling module that makes it possible to schedule patients on the computer. This schedule is viewable on the hand-held device.

ePad by ePhysician with the OmniSky wireless service is simple, efficient, and powerful. Its interface was designed with a focus on the physician user. Although there is a subscription charge for ePad, the fee pales in comparison with the cost of lost physician productivity due to the inefficient technology of printing prescriptions locally (or writing them by hand). Using the ePad system in our office has resulted in very positive patient feedback and increased efficiency and job satisfaction among staff.

AllScripts
Reviewed by Azar A. Korbey, MD

At the installation stage, AllScripts’ on-site team realizes that the use of these systems require change. They take the time to train the staff and make them part of the process. AllScripts differs from the other systems, because after the selection of the patient name, users select their most frequently coded diseases listed by common name and International Classification of Diseases-ninth revision code. This list is prescriber-specific, not patient-specific. Users can also access the patient’s prescription and diagnosis histories, and the AllScripts system automatically checks for previous adverse drug reactions. Next, AllScripts shows the medicines that the user most frequently prescribes for a disease. AllScripts learns each user’s prescribing preferences, so users do not need to enter their favorite prescriptions. The list also shows preferred instructions for any given medication, and if AllScripts’ office dispensing system is used, it will tell users whether they have the drug in inventory. To produce a prescription, the prescriber may modify a prescription from a frequently used list or choose from any other drug in AllScripts’ database.

Users have access to all patients in the practice through the network, regardless of provider or schedule. Patients not registered with the practice can be manually added into the hand-held device or desktop computer server. Unlike the other systems, AllScripts automatically produces a mailing address-sized label for chart documentation that includes all details of the prescription. The vendor also sells a turnkey pharmacy service (FirstFill) for in-office dispensing. It is only for common medications, and is similar to providing samples. The local wireless network is fast; high-speed access to the Internet is proving very useful.

AllScripts is complete and does what it promises. It is a well-funded, publicly traded company that is adding applications and acquiring additional companies that will allow dictation and charge-capture systems to be added. I have had long-term experience with the product and its exemplary phone support, and I believe they will both be around in the future. They are even willing to come on site immediately, if required. I strongly recommend this system.

Editor’s Note: We had hoped to include the iScribe 3000 system (www.iscribe.com) in this review but could not obtain the product and complete the review in time for publication. We plan to publish a software review of iScribe in a future issue of JFP.

Do any of the following situations sound familiar?

1. You want to prescribe 25 mg of a drug but are uncertain whether the drug is supplied as a 25-mg or 50-mg tablet.
2. An elderly patient comes in for an update on her multiple problems. At the end of a long visit, she asks to have all 17 of her prescriptions refilled.
3. You need to determine whether there is a possible drug interaction between existing medications and an upcoming medicine.
4. You would like to be able to generate a list of all your patients taking a recently recalled drug.

Now imagine a hand-held prescribing device the size of a prescription pad that turns on instantly, knows the date, and through a connection to your computer, knows your patient list for the day. Using this device you could quickly select the patient’s name from a drop-down list and see his or her insurance plan, age, and other demographic information. You could select medications from an alphabetic scrolling list that includes information specific to the patient’s insurance plan. You could check allergies and drug interactions against the patient’s list of previously prescribed drugs and known medication allergies, alerting you only if a clinically significant problem is detected. After selecting the medication, you could choose from a list of available dosages and specify the quantity to be dispensed Figure 1, and the prescription could be digitally signed and sent electronically to the patient’s pharmacy or to your printer. Chart documentation could be produced concurrently on a sticky-backed label that can be affixed to the patient’s medical record. The prescription would be saved for generating rapid renewals in the future. Drug information and insurance formularies would be updated regularly from central computers, and new drugs and dosage forms could appear on the hand-held devices before they show up on the pharmacists’ shelves.

Does all this sound far-fetched? It’s not. This type of technology is currently available. Systems range from simple prescription writers—a hand-held device with initial manual entry of patient data and prescription printing from an infrared-equipped printer—to full electronic medical records systems. Prospective users have to decide which features provide sufficient benefit to merit the investment of time necessary to learn them. In this article, 3 systems (PocketScript, ePhysician ePad, and AllScripts;)Table 1, Table 1a are reviewed by physicians who have successfully incorporated electronic prescribing into their practices.

A system that does nothing other than produce legible prescriptions in the same time it would take to write one by hand can benefit many physicians. One that provides an accurate record of previous prescriptions that allows the rapid renewal of multiple prescriptions is even more valuable. Another important potential benefit of an electronic prescribing system is fewer errors, including those caused by illegible handwriting, incorrect dosage selections, drug-drug or drug-disease interactions, and drug allergies.

These systems still have some limitations, however. Most do not automatically suggest a dosage adjustment for age, renal function, hepatic function, and alcohol and tobacco use (although drug monographs may be available on the hand-held device itself). Similarly, weight-based pediatric prescription information may be available in monographs on the hand-held device but is not built into the prescribing process. Some states allow electronic transmission of prescriptions, some do not, and some have made no ruling; specific rules vary. Fortunately, each of the vendors reviewed in this article made certain that their system is installed in a way that conforms to state laws.

Most primary care physicians have not made the leap to electronic medical records; package delivery services and supermarket checkouts use more technology at the point of service than the average physician does. These devices may change that by providing a relatively low-cost low-risk improvement with less impact on work processes than a full electronic medical record.

Common Features

Each of the systems we reviewed is “wired” somewhat differently Figure 2. PocketScript and AllScripts use a wireless local area network in the physician’s office to move information from the hand-held device to a desktop computer server in the physician’s office. This server is in turn connected to the vendor’s computer through a modem or other high-speed access device to get drug information updates. The office computer also sends prescriptions directly to pharmacies either as an electronic message or by fax.

A system using ePhysician includes a personal computer in the physician’s office to load patient demographic information onto the hand-held using a docking cradle. Prescriptions can be sent directly from the hand-held device to a central computer server at the vendor’s offices using a wireless modem. Alternately, they physician can dock the hand-held device in a cradle attached to the computer, which is connected by a modem to the vendor’s central computer. The vendor’s computer server then sends prescriptions to the selected pharmacy, either electronically or by fax. All systems use sophisticated encryption to protect the confidentiality of data as it is sent between computers.

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.

ePad has several other unique features. Because patient demographics are entered into the physician’s existing practice management system and transmitted to the hand-held when it is docked, the physician does not have to enter any patient data. To write a prescription for a patient who has not previously been entered into the system, the user docks the hand-held in the cradle for synchronization. Also, all prescriptions are transmitted from the vendor’s central computer servers either electronically or by fax to any pharmacy in the United States. Users can also print from the hand-held to a local printer. To generate chart documentation, the user can configure ePad to automatically print a copy of the prescription on the local computer when it transmits to the pharmacy. ePad currently comes bundled with ePhysician Superbill for charge capture and is integrated with Drug Facts and Comparisons. It also includes a Web interface that allows my staff to efficiently process prescription renewals, and a scheduling module that makes it possible to schedule patients on the computer. This schedule is viewable on the hand-held device.

ePad by ePhysician with the OmniSky wireless service is simple, efficient, and powerful. Its interface was designed with a focus on the physician user. Although there is a subscription charge for ePad, the fee pales in comparison with the cost of lost physician productivity due to the inefficient technology of printing prescriptions locally (or writing them by hand). Using the ePad system in our office has resulted in very positive patient feedback and increased efficiency and job satisfaction among staff.

AllScripts
Reviewed by Azar A. Korbey, MD

At the installation stage, AllScripts’ on-site team realizes that the use of these systems require change. They take the time to train the staff and make them part of the process. AllScripts differs from the other systems, because after the selection of the patient name, users select their most frequently coded diseases listed by common name and International Classification of Diseases-ninth revision code. This list is prescriber-specific, not patient-specific. Users can also access the patient’s prescription and diagnosis histories, and the AllScripts system automatically checks for previous adverse drug reactions. Next, AllScripts shows the medicines that the user most frequently prescribes for a disease. AllScripts learns each user’s prescribing preferences, so users do not need to enter their favorite prescriptions. The list also shows preferred instructions for any given medication, and if AllScripts’ office dispensing system is used, it will tell users whether they have the drug in inventory. To produce a prescription, the prescriber may modify a prescription from a frequently used list or choose from any other drug in AllScripts’ database.

Users have access to all patients in the practice through the network, regardless of provider or schedule. Patients not registered with the practice can be manually added into the hand-held device or desktop computer server. Unlike the other systems, AllScripts automatically produces a mailing address-sized label for chart documentation that includes all details of the prescription. The vendor also sells a turnkey pharmacy service (FirstFill) for in-office dispensing. It is only for common medications, and is similar to providing samples. The local wireless network is fast; high-speed access to the Internet is proving very useful.

AllScripts is complete and does what it promises. It is a well-funded, publicly traded company that is adding applications and acquiring additional companies that will allow dictation and charge-capture systems to be added. I have had long-term experience with the product and its exemplary phone support, and I believe they will both be around in the future. They are even willing to come on site immediately, if required. I strongly recommend this system.

Editor’s Note: We had hoped to include the iScribe 3000 system (www.iscribe.com) in this review but could not obtain the product and complete the review in time for publication. We plan to publish a software review of iScribe in a future issue of JFP.