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E-Mail Cure for Doctor’s Writing

November 12, 1999

WASHINGTON (AP) _ Dr. Victor Plavner is throwing away his prescription pad in favor of a little electronic gizmo _ it looks like a wireless miniature computer, a bit larger than a PalmPilot _ that slides into the Maryland physician’s coat pocket as he examines patients.

This is a handheld electronic prescription pad. No longer will pharmacists squint at Plavner’s acknowledged messy handwriting.

No longer must Plavner rely on memory to know if a new drug interacts dangerously with his patient’s 10 other medicines, or fumble through paper charts to check for allergies _ the machine will flash a warning.

With a few clicks, he e-mails the prescription straight to a drugstore _ no more lost little pieces of paper.

And no annoying phone call when the pharmacist discovers Patient X’s insurance doesn’t cover Drug Y. Different insurance formularies are programmed right into Plavner’s TouchScript Personal Prescriber, so he can choose up front whether to fight an insurer’s coverage decision or pick an alternative drug.

Paperless prescriptions are still a fledgling trend, but drug experts say the new technology promises to increase medication safety, and make prescribing easier.

``Heck yes, I want one,″ said Dr. Walter Donnelly of Cincinnati, who tried a competing electronic prescription pad, PocketScript, in a pilot test by manufacturer Way Over the Line. ``This is a step where, with very little change in the way we work, we can make a difference in our patients’ lives.″

If ``e-prescribing″ sounds like just the latest gimmick, consider this: Two million Americans are hospitalized annually from drug side effects, and 100,000 die. Many are caused by preventible medication errors _ when the wrong drug or wrong dose is prescribed, pharmacists misread an illegible prescription, doctors or pharmacists mix up drugs with similar names, or a drug interacts dangerously with a patient’s other medication.

Then there’s the Texas jury that last month ordered a doctor, drugstore and pharmacist to pay $450,000 to the family of a man who died after the pharmacist misread the doctor’s handwritten prescription.

E-prescribing can’t help all errors, but ``it will reduce the problems with handwriting,″ said Susan Proulx of the Institute for Safe Medication Practices. Plus, ``it offers some warning system that will make the physician or prescriber stop and think, ’Do I really want to prescribe this medicine for this patient?‴

Electronic prescribing started in hospitals, where doctors leave a patient’s bedside to go type in prescriptions on special computers at nursing stations. The Journal of the American Medical Association reported last year that such computerized prescriptions cut by more than half the rate of serious medication errors at one hospital.

Still, only a small percentage of hospitals have computerized prescriptions, and they seldom spread to private doctors’ offices.

Now manufacturers hope handheld, wireless versions that each doctor would carry around like an old-fashioned prescription pad will increase e-prescribing.

The technology is fledgling _ Allscripts has 1,500 doctors using its TouchScript so far, but about a dozen competitors are gearing up their own versions.

How does it work?

Say you have a sinus infection. Plavner pulls up your name and punches in his diagnosis. He can type in any drug, but has programmed his device to flash ones he most commonly prescribes for sinus infections _ the antibiotic Augmentin and decongestant Entex. The device spots no allergies or other problematic medicines in your record. But wait _ it flashes that Augmentin isn’t on your insurer’s approved medicines list. Plavner decides to choose an equally good alternative.

Scribbling a prescription is a little faster, Plavner says, and not all insurers or drugstores yet accept e-prescriptions.

Also, computers are only as good as the data programmed into them. Allscripts addresses that by dialing into doctors’ main computers nightly to provide drug safety updates.

E-prescribing can be costly _ TouchScript is about $250 per month. And while such systems use high-security software programs, advocates note to those worried about hackers that paper prescription pads today are frequently stolen and forged.

Ultimately, Donnelly says, ``this is the way medicine’s going to be done in the very near future by almost everyone.″

___

EDITOR’S NOTE _ Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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