IE 11 Not Supported

For optimal browsing, we recommend Chrome, Firefox or Safari browsers.

What the Doctors Ordered

Wireless PDAs help physicians reduce Medicaid hassles and costs.

Skyrocketing costs and alarming amounts of avoidable errors have health-care professionals searching for answers to problems that have plagued the medical world for years. Some state health-care administrators hope the use of wireless PDAs can help them do both.

Medical groups have pushed for computerized physician order-entry software that would convert the drug prescription process from paper to computer, theoretically increasing efficiency and accuracy. In reality, creating frustrating results.

Cedars-Sinai Medical Center, the largest private hospital in the West, recently suspended use of its multimillion-dollar computerized ordering system after hundreds of doctors complained it required too much work. Instead of noting information on a chart, the doctors entered the information into a laptop or a computer station. The doctors found writing paper prescriptions easier and quicker.

Another electronic method -- writing prescriptions from handheld PDAs -- was unpopular because the PDA's system had to be integrated with a retail pharmacy or mail order pharmacy. Since the doctor needed a wireless connection, he had to pay a monthly fee. A good number of companies that offered that type of service have gone bankrupt, leaving a handful still offering prescription writing solutions via PDAs, including Allscripts, ePocrates, PocketScript and Wellinx.

Learning from these past failures, several states are investigating more promising uses of wireless technology. One firm, ePocrates, has developed a wireless program that Washington, Oregon, California, Vermont and Michigan hope will reduce errors, save physicians time and save state Medicaid programs money by giving doctors on-the-spot information on cheaper drugs preferred by Medicaid programs. The system also gives physicians immediate access to information on drug interactions, possible allergic reactions and dosages.


More Information
About a thousand doctors in Washington use their own PDAs and download information from the ePocrates software system, which allows them to access formularies (required drug lists) of insurance providers and state Medicaid programs. The cost to the Medical Assistance Administration (MAA), part of the Department of Social Services in Washington, to have the Medicaid information available on ePocrates software was $30,000.

"It just means when you're in the exam room or in a hospital or taking calls in the field somewhere you can access all the information that you need," said Carol Cordy, a Seattle physician.

Two subscriptions are available to the physician, the most basic of which is free and includes preferred drug lists. The premium subscription costs $49.99 a year and includes other information, including alternative medicines, such as herbal remedies and anti-microbial treatments.

The doctor, before beginning a shift, plugs the handheld into a computer, dials up the ePocrates Web site and downloads the needed information. Some information available through the subscription is also available in the Physicians Desk Reference (PDR), but would require that the doctor leave the point of care and take time to thumb through the PDR. Some information, however, is new and not in the PDR.

So far, the software has been a hit in Washington and has eliminated some consternation felt by physicians prior to its implementation last fall. In addition, the system could be an avenue toward cutting what has become unsustainable growth in most Medicaid programs around the country.

Virtually all states are facing increases of 10 percent to 20 percent in Medicaid costs, according to the National Governors Association. Much of that increase can be attributed to prescription costs -- in Washington, the MAA spends more than $1 billion every two years for prescription drugs. The MAA has set a savings target of approximately $60 million, which it plans to meet by using less expensive drugs. The hope is the ePocrates system will contribute to that savings by providing physicians immediate access to preferred drug lists.

"We do expect it to save money," said Jim Stevenson, communications director for the MAA. "It's an annual subscription fee to us, and that's a relatively modest $30,000 per year. The savings we expect from our drug preferences are going to be on a much different scale -- millions of dollars in savings."

Doctors aren't always aware of less expensive drugs preferred by Medicaid and often prescribe more expensive drugs that have been heavily advertised by pharmaceutical companies. "In some cases, the drug companies are such good advertisers you don't know that the generic drugs are available," Cordy said.

The difference in cost is staggering. Makers of the anti-depressant Prozac recently advanced a generic Prozac, which costs just 5 cents per pill compared to $2 to $3 for the original. "You look at that and say, 'Why would you prescribe a drug that's $3 when you can prescribe the same thing for 5 cents?'" Cordy said.

A 20 mg tablet might be as expensive as a 40 mg tablet -- information useful to a physician and not necessarily available without the software, Cordy said. "If it's in a tablet that can be cut in half and the 40 mg tablet is the same as the 20 mg, I'm going to prescribe the 40 and tell them to cut it in half," she said. "It will save the system money."

Without the software, the doctor doesn't know which drugs are on the preferred list and often prescribes a drug for which the patient is not qualified, in which case he'll receive a phone call from the pharmacist who'll ask for another prescription. "It saves tons of time, and you're not having to prescribe a drug that's not covered and go through all that hassle of playing phone tag with the pharmacist," Cordy said.

Medicaid programs have tried to establish required formularies, but have been sued by the pharmaceutical companies. So they compile "preferred" drug lists to aim physicians toward less expensive drugs.

Any drugs not on the preferred list must be preapproved. "We're trying to use ePocrates to highlight those [preferred] drugs," said Doug Porter, assistant secretary for MAA. "Our hope is they won't prescribe that [expensive] drug, or at least they'll have a warning that they'll have to get prior approval if they do. It gets us closer to how the commercial world operates."

The doctors are pleased with the developments, Porter said. "Their reaction is, 'At least we know what the rules are, and we don't have to keep getting surprised and have to sit there on hold trying to talk to the pharmacist.'"


Safety Benefits
The doctors also like the safety benefits of immediately downloading information on various drugs. "[The doctors] are motivated by an attempt to increase safety, so it's a clinical rather than a financial issue for them," said Lydia Green, director of Corporate Communications for ePocrates.

An estimated 98,000 patients die annually in hospitals from avoidable medical errors, and the hope is this kind of system will help to reduce that number. "We expect this to be a quality improvement because it gives doctors more prescribing information than they had in the past," said the MAA's Stevenson.

A study published by the Journal of the American Medical Informatics Association that surveyed doctors using the ePocrates system reported that the software could help prevent one or two errors per week by helping doctors keep track of the barrage of new drugs and changing treatment guidelines.

"What's unique about this is, it's a lot of individuals taking collective action," Green said. "They are having an impact that governments or health systems haven't had by trying to force people to change."