E-Prescribe – What does it take to make it Patient-Centric

I’m starting a series of posts on what does it take to make healthcare IT really patient-centric. If we started with the requirements, gathered from a patient, how would you build it.

It all started from a series of posts on Google+ Communities in which people mention that various applications are patient-centric. Maybe people do not realize what patient-centric really means… because I have trouble finding anything in our healthcare system that is really patient-centric.

I will try to address this from my point of view as  an IT savvy, healthcare obsessed e-patient and I will try to also think how it should be for a person that would check email once a day, but is scared of computers, technology, phones and wants the doctor to just tell her what to do.

How about e-prescribe – get the medicine prescriptions through a computer. Here’s what happens from a patient’s perspective right now!

– On the intake, the nurse or medical assistant asks me what is my preferred pharmacy. The options are that I know it quite well and she has it in her list. After a few fumblings with the pharmacy list, we can settle on the right pharmacy. The other option is that I don’t remember an address or even a name: that pharmacy that starts with Wal… One can easily see how the prescription can end up in the wrong place.

– The consultation goes on and my doctor settles on a medication to prescribe. If I am lucky and my doctor is open, I can look over her shoulder and visually check that this is the  medication I want, with the number of refills that I expect. We usually confirm my pharmacy one more time. If this is a new medication, I might not even understand the name, or maybe the doctor is using the generic name when I know the brand name or the other way around. Again, unless I look over her shoulder, it’s very easy to completely misunderstand what medication you got until you get that filled in at the pharmacy. Yes, one might ask a lot of questions from the doctor and the pharmacist, but this will not make it efficient.

– If I get a visit summary, I probably could see the medication prescribed and potentially remember to pick it up. I did not yet get any of those summaries, so i don’t know what information they contain.

– Assuming all is well and I don’t forget to pick up my prescription, I need to go to the pharmacy, tell the pharmacist my name and what I want refilled and 15 minutes later, I get it. As far as I know, there is no feedback to the physician – the doctor doesn’t know that I picked up my prescription or how many times I refilled.

I’m glad e-prescribe exists. But let’s accept it: it doesn’t fix much! It is a beginning, a good beginning, but it has ways to go! As Brian Pollack -a doctor – on the Google+ discussion mentioned: this is in its infancy!

So how should it be?

For a chronic patient that might have a few meds that work and he knows how to use them, I would give the patient a tool to

– Select the medicine and the amount (number of pills, bottles, etc.)

– Check prices at various pharmacies (there should be an app for that)

– Message the doctor asking for approval – doc should have at least a one year history of all the meds that patient is taking based on prescriptions filled in, Glow Caps or some other tool. Doc approves refills (maybe offline, in advance, with rules)

– Patient messages desired pharmacy and gets meds

For a new condition, doctor suggests a prescription for the e-patient:

– E-patient asks for options

– E-patient goes home and researches side-effects, how it works for others, etc.

– E-patient can message back and forth with doctor if he finds an option that seems better for him. Doctor can change the medications prescribed

– E-patient decides on an option

– E-patient checks prices and availability at various pharmacies (with information on copay from insurance company)

– E-patient messages pharmacy, pharmacy matches it with prescription from doctor

– E-patient gets the med she wants where she wants it

– Doc gets a message and note in EHR about the med and time of picking up the med.

New condition, patient is sick and wants a solution now, no time for research:

– Patient picks closest pharmacy

– Doctor sends prescription

– Medical assistant or nurse helps set up the patient’s pharmacy with the prescription

– Patient gets an email/text right away with all the info (can be visit summary)

– Medical assistant or nurse gets a note if med was not filled and calls patient the next day.

How does this sound?

 

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Posted on January 5, 2013, in Uncategorized and tagged . Bookmark the permalink. 6 Comments.

  1. We do about 75% of this today but there are things in this blog (like being able to compare prices) that we physicians want as well. We constantly pick what we think is a great medication from the huge number of drugs available in the ePrescribe list only to find out when the patient goes to pick it up that:
    1) their specific plan doesn’t cover it
    2) the pharmacy doesn’t have it or it’s no longer on the market – this happens a lot for routine multidrug remedies that are over-the-counter but the patient wants a prescription so they can use their HSA or HRA funds
    3) the plan covers it but it’s a tier 2 drug (it may be a tier 1 on another plan or another patient)

    When I check with our local pharmacists they don’t know the answers to these questions until they run the script through against the patient’s insurance plan as it may vary all over the board for various plans.

    Generic Lipitor, atorvastatin, is a good example. The cost may vary from $4 to $158 a month and their’s almost no way we know in advance what the cost is going to be.

  2. I just did a quick medicine price comparison, and found the generic version still ranged in price from $10 to $50. This is not easy, and with such variations, it is easy for the patient to wonder if the $10 medicine is really the same as the $50–maybe the $50 version is really better, not made in some suspect location, etc.

    Next, the patient may also find that Pharmacy A can supply one medication at a great rate, but the second medication may not be well-priced. If the patient sees several doctors, and gets several medications from several locations, there is little likelihood that the potential for adverse drug interactions can be prevented–unless the patient has access to all of this, and learns/is taught to check for potential problems. A reminder that the patient can be the only constant in the mix of variables most times.

  3. Very interesting post, thank you for writing it.

    I wonder about being able to e-prescribe in a non pharmacy-specific way. With paper prescriptions, we give to the patient and they get to decide what pharmacy. What if we did that electronically, so the e-rx goes to the patient (perhaps in portal? or personal health record?), patient can research prices (agree that there really should be apps/websites for this), and then patient sends to pharmacy of choice. Prescriber should get automatically notified when it was filled.

    This wouldn’t address all your concerns, but might be somewhat helpful.

    • Leslie,

      That’s exactly the kind of environment that I imagine – having the e-prescription not associated with the physician – at least in the sense of not tied to the physician’s system.

      Actually, if insurance companies would want to really help and be patient-centric, they should implement this. I don’t quite like the idea of even more control in their hand, but they do have all the info about the doctor, the patient, their formularies, how much is copay, etc.

  1. Pingback: Definitions of patient-centric HIT and design thinking questions « The Unconditional Patient

  2. Pingback: Patient-Centric Health IT | Epatient Connections Blog

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