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Early experiences in e-prescribing: the state of Florida deploys handhelds and prescription management software to Medicaid physicians, to drive down the cost of medications and to provide point-of-care decision.

E-prescription tools and medication management databases are gaining acceptance among physicians not because of an attraction to the hightech wizardry of zapping prescriptions from bedside to pharmacy, but because of the need to enhance patient safety, along with the concerns about saving dollars.

Both the U.S. House of Representatives and the Senate have worked on Medicare reform bills that incorporate mandates for electronic prescribing. Now, state Medicaid programs also are aggressively moving toward e-prescription solutions as a means to improve efficiencies in their prescription drug benefit programs and to improve medication outcomes.

Gold Standard Multimedia (GSM) has teamed up with Microsoft, Sprint Communications and Florida Medicaid in an innovative program to help the state of Florida improve healthcare delivery through a wirelessly enabled point-of-care medication management solution. The program centers around a patient care system called eMPOWERx that provides point-of-care, patient-specific medication history and comprehensive drug information and interaction reports, seamlessly integrated with Medicaid's Preferred Drug List.

The information is delivered to physicians using a Sprint Communications Toshiba 2032 Pocket PC running Microsoft Windows Mobile software for Pocket PC Phone Edition. The Pocket PC serves as both a PDA and wireless phone, with voice and data supported using Sprint Communications' CDMA network.

Florida Medicaid recognizes that the use of information technology affords a unique opportunity to minimize medication interactions, improve health outcomes, reduce instances of suboptimal therapeutic selection and provide better communication with providers about preferred drug alternatives. The system also helps reduce fraud and drug abuse by providing clinicians with real-time prescribing histories for Medicaid beneficiaries.

Bringing Power to Providers

We launched our project with Florida Medicaid in June 2003, and in a few short months, we have experienced remarkable adoption from Florida Medicaid providers.

At the outset, Florida Medicaid identified for participation in the initial program 1,000 physicians who were in the top tier for writing the most Medicaid prescriptions. Fully funded by Florida Medicaid, the program arms each physician with a Pocket PC, the eMPOWERx drug information application and Sprint connectivity at no cost to the provider.

The eMPOWERx system includes a continuously updated, patient-specific, 60-day history of all Medicaid drugs dispensed. This ensures continuity of care, because a physician can see all medications the patient is taking, updated daily, regardless of who prescribed them. This helps the general practitioner who refers patients to specialty care, since he or she no longer needs to rely on those patients to report back which medications were prescribed.

The system also makes it easier to identify patients who attempt to fraudulently obtain the same prescription from multiple sources by mimicking symptoms that could result in a narcotic or other abused drugs being prescribed. Specific instances of "doctor shopping" have already been uncovered, and these patients have been reported to Florida Medicaid for additional investigation.

The Right Handheld

In terms of device selection, we needed a device that provided wireless Internet connectivity, security and the ability to work with the CDMA wireless standard. We chose the Pocket PC because it is small enough to be carried everywhere, yet has enough screen size to deliver rich content. The small size and wireless connectivity of the Pocket PC make it significantly easier for a physician to integrate the device into the way he or she practices medicine.

Another plus is that the Pocket PC includes a built-in phone. This allowed us to include a speed dial connection to the Florida Medicaid help desk. When a physician needs to prescribe medication that is not on the preferred drug list, he or she can immediately call for a permission code that allows the prescription to be filled. This real-time verification makes life easier for patient, physician and pharmacist.

A key element of the program is that each day the database is updated with the Medicaid patient manifest, which shows all Medicaid-covered pharmacy transactions from the previous day. This constantly renewing 60-day database is continuously available to physicians via their wireless devices, so they can instantly see all medications a Medicaid patient is taking, including specific prescribing details (date, days supplied, pharmacy), regardless of how many healthcare providers the patient may be seeing.

Physicians no longer depend on a patient's memory to collect historical data. The system automatically incorporates the historical data for evaluating interactions for potential new drugs, and it also flags existing concerns. A physician preparing to see a new patient can know of an interaction before the patient walks into the office. As the physician enters the patient's name, the system uses the 60-day historical record to search for interactions. If an interaction is detected, a message is posted to the screen of the Pocket PC, providing decision support to the physician during the patient visit.

Encouraging Physician Adoption

Ease of use is essential to wide acceptance of electronic solutions. With forethought to the domain in which pharmacological data is being utilized, software can anticipate what a physician needs to know. Avoiding interactions is so basic to protecting patient safety that we wanted to make the process as easy as possible. This is why we created a one-click function for checking a proposed medication against all of the drugs a patient is currently taking. If an interaction is found, another click triggers an automated search for an equivalent medication that does not interact with other drugs the patient is taking.

There are so many demands on a physician's time and attention. If a decision support tool isn't intuitive, effective and beneficial, then even "free" is too expensive. To be valuable to a busy physician, technology must be easy to adopt and extremely beneficial for physicians to use with patients. Florida Medicaid was wise to underwrite the capital investment required to implement the program. The anticipated benefits to patient safety, cost reduction and overall better healthcare for Medicaid beneficiaries justify the state's investment in this program.

Pushing change can cause resistance, so our program has worked to create a sense of pull. We want physicians to hear about our wireless patient care solution and pull it into their practices. This is working very well. We are now more than halfway to our goal of getting 1,000 Medicaid physicians deployed in the program, and we are finding that the more devices we make available, the more demand we receive.

As physicians start to show their colleagues how the handheld devices work, we're getting calls requesting devices for everyone in a practice. Physicians will literally see this solution while meeting a colleague and call us to ask to participate in the program.

We're confident that Florida Medicaid will enlarge the program, perhaps offering devices to a larger group of providers. The good news is that physicians in the field are asking for the devices because they see a benefit to their patients and practice. Once a device is deployed to a physician, it is integrated into that physician's daily workflow.

In summary, Florida Medicaid is providing an excellent model for how to bring about positive change without pushing additional regulations onto physicians. By offering physicians a powerful and portable medication management solution that provides significant value for them and their patients, the state is creating a solution that healthcare providers will pull into their daily practice. The results will be dramatic in terms of better healthcare outcomes, as well as a lower cost for providing the Medicaid description benefit program through increased use of the preferred drug list and reduction of fraud and drug abuse.

David Medvedeff, Pharm.D., is the vice president of government business development for Gold Standard Multimedia, Tampa, Fla. Contact him at medvedeff.d@

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Title Annotation:PDAs & Handhelds
Author:Medvedeff, David
Publication:Health Management Technology
Date:Dec 1, 2003
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