Cybercare
A Digital Solution
Technology lends a hand in curbing prescription errors.
By Richard Hom, O.D., F.A.A.O.

In 1999, there were more than 50,000 instances of near fatal or fatal consequences from practitioner error in writing prescriptions. These errors were mainly incorrect dosing and failure to recognize drug interactions.

Needless to say, we're all aware of the importance of drug reference guides. For many years, my Physicians' Desk Reference (PDR) was the standby reference for drug indications, adverse reactions and interactions. But during my years in full-time practice, I steadily relied more on my memory than on the PDR to help me write prescriptions accurately because the PDR just wasn't convenient enough.

I also found that it frequently didn't answer my most common questions about cost or packaging.

Digital is better

Now there are two programs written specifically for the popular handheld computers called personal digital assistants (PDAs). The most popular PDA is the Palm Pilot. PDAs are about the size of your open hand and less than 1 inch thick, so you can carry them in your pocket.

These devices store phone numbers, addresses and short notes. Use a plastic stylus (a pointer in the shape of a pen) to navigate among the different programs and write information into the PDA.

A leading attraction of the Palm/Visor PDA is the keyboardless approach to navigation. It's as natural as writing a prescription on a pad in the palm of your hand -- and it looks modern.

PDA software

Companies such as ePocrates and iScribe take different approaches to resolving the prescription writing dilemma.

• ePocrates. In early 2000, this company launched QRx, a drug information database for the Palm Pilot (it presently works only on the Palm or Visor PDAs).
  You can get QRx, which is free to practitioners, by logging onto ePocrates' Web site and downloading it to your personal computer (PC). Then, simply connect your Palm Pilot to your PC to transfer the program.
  Rather than waiting for the next edition of the PDR, you can check the ePocrates Web site for new drug data and download it according to your own schedule.
• iScribe. This company's product is called the iScribe 5000 and is also a Palm/Visor-based product. It contains a drug database and a program to assist you in writing the actual paper copy of the prescription.
  With the iScribe 5000, you can transfer the information to a PC and fax it to a pharmacy for fulfillment. Or, you can print multiple copies at your office for your patients and for their medical charts. In the future, you'll also be able to use it to cross- check health plan formularies.

Get technical

If you write more than one prescription per day or if you agree that the PDR isn't convenient to use, you're ready for a personal digital assistant. With the use of this powerful tool, you'll never have to worry about the interactions between topical beta blockers and asthma or heart medications.

If all you need is a PDR-like approach to search and find drug information immediately, then the ePocrates product is ideal for you. However, if you're interested in maintaining patient medication histories, hard copy prescriptions and interaction with practice management software, then the iScribe product might be more appropriate.

Either way, as optometrists integrate further into the medical model and the traditional health care delivery system, we must leverage new and existing technology to ensure the safety of our patients.

Dr. Hom has a rich background in e-commerce. He practiced optometry in a variety of settings and currently practices part-time in San Francisco, exclusively caring for complicated contact lens patients. He is a partner and business development manager for Network Appliance in Sunnyvale, Calif.