In an effort to propel the trend to handheld electronic prescribing, one malpractice insurer is offering reduced premiums to physicians who use iScribe's e-prescribing technology gratis for one year.
Karen Weinstein, M.D., internist and co-owner of an Oak Park, Ill., practice, has prescribed electronically for three months via a handheld personal digital assistant (PDA) provided by iScribe. "It saves time and money and effort," she says. "There's no downside to using it, except for the learning curve, and it took us literally three or four days to learn it. The secondary benefit is the patients think it's really cool and innovative that they have a doctor who has the latest technology."
The market for handheld electronic prescribing has exploded in recent months, with more than 30 handheld products now available, says Rachel Terrace, health analyst for the Internet research and advisory group Jupiter Communications.
"There's so much competition in this space. There are too many players. They're all very new. They're all offering different, varying levels of functionality within their devices."
Each seeks to reduce the mounds of paperwork confronting doctors and ensure better accuracy.
The iScribe system recommends dosages, defines unacceptable formularies, flags drug interactions, remotely transmits prescriptions to a printer and creates adhesive labels for charts. Weinstein says benefits of the technology include legible prescriptions clarifying which of similar drugs--such as Prilosec and Prozac--is specified, a dip in pharmacy callbacks and boosted accuracy. "I definitely think it cuts down on errors, primarily dosing errors."
Error reduction was the primary motivation for The Doctor's Company to partner with San Mateo, Calif.-based iScribe, says Richard Anderson, M.D., medical oncologist and board chairperson of the Napa, Calif.-based malpractice insurer. "It's also a rather dramatic demonstration that the market is way ahead of the legislative and judicial efforts to curb medical errors."
TDC, the nation's largest physician-owned malpractice insurer, is incrementally extending the offer to its 18,000 policyholders nationwide, says project director Hans Bruhn. Physicians who prescribe more--pediatricians, psychiatrists, dermatologists, family practitioners and internists--will receive iScribe equipment first, Bruhn says. "Geographically, our heaviest push is on the West Coast."
Pediatrician Steve Pregulman, M.D., iScribe's director of product development, trumpets e-prescribing to doctors across the country. "I tell them just put down the paper and pen because that's where the danger is. I'd rather they use a competitor's product than stick with the paper and pen."
ePhysician CEO Stuart Weisman, M.D., says his company is mailing those with verified prescribing privileges a free ePad kit--Palm Pilot, synching device and CD--requested over the Web. Quickly installed on any network, the kit enables users to send encrypted prescriptions to pharmacies over the Internet for a $20 monthly subscription fee, he says.
Tom Lee, M.D., director of product development for ePocrates, says 85,000 visitors have downloaded clinical drug information into handheld devices at no charge from the company's Web site for easy point-of-care reference. Also offered free to doctors are ePocrates-branded Palms preloaded with customized applications, such as content from online clinical information providers MD Consult and Up To Date, through the sponsorship of a pharmaceutical company and pharmacy benefit manager.
A publicly traded forerunner in e-prescribing, Allscripts is flush with $135 million cash and carrying no debt, says CMO Peter Geerlofs, M.D. "Other companies are trying other ways to penetrate the market, often by giving product away, and they are frequently subsidized by pharmaceutical companies. We don't need to do that."
More than 3,000 physicians are paying Allscripts up to $250 per month for services including electronic prescriptions transmitted from a touch screen or a Windows CE-based PDA through a local server to pharmacies, Geerlofs says.
Allscripts is bolstering distribution by acquiring organizations with products already in use by doctors. Examples are MasterChart, which records and transmits digital dictation from a handheld Windows PDA over the Internet for transcription, and ChannelHealth, which provides Web-based tools such as lab results, task scheduling and charge capture.
Terrace says that PocketScript is able to download entire patient records, ePocrates enjoys significant market penetration and iScribe boasts a seasoned management team.
Terrace says functionality runs the gamut--e-prescribing, charge capture, referral, labs, coding, scheduling and drug information.
Determining what functionality each player currently offers--and what they intend to offer--is difficult, Terrace says. "It's very confusing. They have these big dreams about what their product can do, but who knows if they can really execute on that?"
Which vendors are left standing at the end pivots on five factors, according to Terrace. She says the winning vendors will offer products that are free to doctors; wireless; platform-agnostic, operating on Palm or Windows systems; target high-prescribing physicians and medical students; and offer intuitive functionality that saves time.
The fragmented market has solidified since March, with deals in the works across the healthcare continuum, says iScribe CEO David Levison. "There is increased activity between and among all the key constituents--handheld, point-of-care vendors; retail pharmacies; managed care; pharmaceutical firms; pharmacy benefit managers. What was a moderate interest turned into a substantial interest."
Levison predicts the industry will settle on a standard within six months and adopt widespread wireless transactions by next year. "Fortunately, it's an enormous opportunity, so there will be lots of winners here."
Linda Boone Hunt is a Prescott, Ariz.-based investigative reporter and feature writer.