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.
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
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.
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
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.
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.
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.
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.
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.
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
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
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.