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Philadelphia Physicians Go Digital

Kate Traynor

Electronic physician order entry, a standard practice for nearly a dozen years at Temple University Health System’s inpatient facilities, is getting under way at the health plan’s physicians' offices.

Unlike Temple’s hospitals, which have terminal-based systems, the physicians' offices are using hand-held prescription-writing devices provided by Allscripts Healthcare Solutions of Libertyville, Ill. The health system tested the devices in a pilot program that started in July 2000, made some refinements, and expanded the system this past April.

"Since the pilot," says Steven R. Carson, M.H.A., assistant vice president for the Philadelphia-based health system, "we’ve moved this device into 10 physician practices and we have well over a hundred docs utilizing it."

An obvious benefit to using the hand-held devices is that they produce legible prescriptions. But the devices also contain current information about Temple’s drug formularies, including products for which a preferred generic equivalent exists. Carson hopes that the devices will cut Temple’s drug costs by prompting physicians to prescribe more generic products for Temple’s 58,000 managed care patients.

"About 52 percent of our overall prescriptions that are written are generics," Carson says. "Our goal is to increase that generic utilization to at least 70 percent, if possible."

Gary E. Slosky, Pharm.D., director of pharmacy services at Temple, points out the benefit to the pharmacy when formulary checking is done at the point of prescribing. "There is less of a problem of a prescription coming into a pharmacy that’s not covered, or…adjudication problems…because a lot of that is screened out right in the physicians’ offices," he says. "As far as time savings, I think that is pretty valuable to any pharmacist."

Because the hand-held devices communicate with the health system’s electronic medical records, Sloskey says the system also produces clinical benefits. "We’re building one database in which the patients’ information is all in one place," he says. "If a patient…walks into the emergency room, the folks in the emergency room will have information about the patient as far as drug history."

Medical information gets into the database when a patient visits a physician in Temple’s network of community-based providers. "We use the physician billing system at the registration point—the IDX system—when the patient is registered in the office," Carson says. "That information automatically passes over to the Allscripts system and prepopulates the physician’s hand-held device."

Carson describes the physicians’ acceptance of the devices as mixed. "You have people who are barely using it, and then you have physicians who absolutely love it and are using it a lot," he says.

"We’re struggling with a little bit of change within the organization," Carson notes. "If there’s any obstacle out there, it’s the actual change of…prescriptive habits."

Some of the local pharmacies that receive these prescriptions have noticed the change in prescription formats. "Those pharmacies who have not been accustomed to an electronic signature have called me up…to find out more about what we’re doing here," Carson says.

According to Carson, the decision to use the hand-held devices did not involve a big cash outlay. "You pay X dollars per physician per month," he says. "With that, you get software and all the hardware required to use the device." The health system paid, he says, for the installation of data-transmission lines to integrate the Allscripts system with Temple’s IDX billing system.

Temple’s deal with Allscripts also includes technical support. "Allscripts does all the training and education for the staff," Carson says. "They have folks here every day, going from practice to practice, managing problems, trying to work with the physicians to make them feel more comfortable."

So far, Carson says, the new system has had few glitches. "Early on, we did have some minor little bugs that we worked out," he says. "For the last eight weeks, we haven’t had any problems."