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Media Backgrounder on Electronic Prescriptions

With the proliferation of the Internet and development of usable handheld computers, interest in electronic prescribing by physicians is again on the rise. Dozens of new companies are springing up, hoping to emerge as the leader in providing electronic connections between physicians and pharmacies. The keys to winning this race are: 1. Getting buy-in from physicians; 2. Signing up a large base of pharmacies to which physicians can send prescriptions; and most importantly, 3. Developing systems that can process refills electronically both in the pharmacy and the doctor’s office, like the system used today in Walgreen pharmacies. Walgreens offers a unique perspective on this market, having invented electronic prescribing in 1992.

Although electronic prescribing is only used for a fraction of all prescriptions written today, Walgreens use of Pre-Scribe software demonstrates the most advanced method. Pre-Scribe and Walgreens proprietary Intercom Plus pharmacy system provide a full electronic link between doctors and pharmacies for both new and refill prescriptions. Walgreens is able to receive this data in real time at any of its 3,100 stores nationwide. And only Walgreens can integrate the information directly into its pharmacy computer and workflow system, eliminating the need to re-type the prescription into the computer system.

The Birth of Electronic Prescriptions
Simply stated, Walgreens invented the electronic prescription in 1992, when it wrote the original Pre-Scribe software for IBM-compatible computers. From its original version, Pre-Scribe was much more than a glorified fax machine. The software created an electronic link that allowed doctors to dial into a central Walgreen database, which would route the prescription information to a specific Walgreen pharmacy.

With a doctor online via Pre-Scribe, refills could be authorized and new prescriptions transmitted instantly. Walgreens developed the system to save time and phone calls for physicians, pharmacists and patients. Another benefit was improved accuracy; errors resulting from misinterpreted handwriting are eliminated.

In 1993, Walgreen pharmacies in Milwaukee, Tucson, Phoenix, St. Louis and Memphis were using Pre-Scribe. And by the end of 1994, more than a dozen Walgreen markets across the country were using the system with local doctors.

But Pre-Scribe proved ahead of its time. Updating the software was difficult – because it wasn’t Internet-based, floppy disks needed to be sent to each doctor, who then had to install the new program on his or her computer. Also, other retail pharmacies were reluctant to use a system developed by Walgreens. This limited the number of pharmacies with which a doctor could use Pre-Scribe.

Growing Pains
In 1995, Walgreens decided to sell Pre-Scribe to Integrated Systems Solutions Corp. (ISSC), a unit of IBM, whom Walgreens believed would be better able to market and sell the software. Walgreens isn’t in the software business, and the company believed Pre-Scribe stood a better chance of becoming an industry standard if the Walgreen name wasn’t attached to it.

Two years later, ISSC decided to exit the electronic prescription market. Walgreens reacquired the Pre-Scribe software in order to sell it to ProxyMed, Inc., a healthcare information technology company that also operates a secure, national healthcare data network called ProxyNet.

Under ProxyMed, Pre-Scribe has spread to more than 2,700 doctors. ProxyMed also has signed up other pharmacy chains to use the system. Today, Walgreens receives more than 70,000 new and refill prescription orders each month through Pre-Scribe.

Total Integration
Since 1997, Pre-Scribe has been completely integrated into Intercom Plus, Walgreens new pharmacy computer system. When doctors send a prescription via Pre-Scribe to a Walgreens pharmacy, the prescription is delivered in real time directly into the Intercom Plus work queue without any human intervention. Once in the work queue, the prescription looks like any other entered prescription that was delivered to the pharmacy either in person, over the phone or via fax, with the doctor, patient and drug information in the system and waiting for the pharmacist. The prescription is filled like any other and can be ready for the patient when he or she arrives.

This integration is what sets apart Walgreens use of Pre-Scribe from other electronic prescription systems. Some electronic prescription systems are only truly electronic on the doctor side – the doctor writes the prescription using a computer, but the prescription is still sent via fax to the pharmacy, just like a written prescription that needs to be re-typed by the pharmacy staff.

Other systems may send the prescription directly to the pharmacy’s computer, but the computer only lists the prescription as a message rather than integrating it directly into the pharmacy’s workflow. Also, the message may be sent overnight as a data dump to the pharmacy, rather than going to the pharmacy in real time the way Walgreens system works.

Market Hurdles
So why isn’t every doctor and pharmacy communicating via computer? While writing a new prescription on a handheld computer and faxing it from a server is nice, the greatest payback for doctors and pharmacists is handling refill requests electronically, which most current electronic prescribing systems can’t do. These refill requests typically originate at the pharmacy, requiring the pharmacy computer to be linked with the doctor’s computer. That hasn’t happened on a large scale because of the difficulty in writing a program that will integrate with the different pharmacy computer systems used by various drugstores.

If refills could be handled electronically, it would eliminate the pharmacy calling the doctor for authorization, then waiting for the doctor to call back with the OK. Multiply this by the dozens of refill requests a doctor might receive each day, and it’s clear that handling refills electronically provides computer prescribing with the biggest opportunity for saving time.

With Pre-Scribe and its proprietary Intercom Plus system, Walgreens can send and receive refill requests and authorizations electronically and is experiencing the benefits of computer prescribing, though on a small scale.

Finally, a central switching service is needed to connect doctors with the different pharmacies in their area. A doctor won’t want his computer to call into six different pharmacies to send six different prescriptions. Rather, the doctor would send all his or her prescriptions to one switching company. That company would then send the prescription to the appropriate pharmacy.

Once a central switching service (or a few services) can establish itself as a full electronic link between a variety of pharmacies and doctors for both new and refill prescription requests, electronic prescribing could grow quickly in popularity.

For more information, or to arrange interviews with doctors or Walgreen pharmacists using Pre-Scribe, contact Michael Polzin, Walgreens manager of media relations, 847-914-2925, or Carol Hively, Walgreens media relations specialist, 847-914-2923.

Walgreen Co. is the nation’s largest drugstore chain with expected fiscal 2000 sales of $21 billion. The company operates 3,079 stores in 42 states and Puerto Rico and plans to operate 6,000 stores by 2010.

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