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Medical Forum / General / Pharmacy / October 2005

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electronic prescriptions

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Paul Trusten, R.Ph. - 30 Sep 2005 15:12 GMT
For the last three to five years, pharmacy trade journals have been touting
the arrival of retail pharmay electronic prescribing. In April, the
technical security rules for HIPAA were finalized, and it would seem that,
once those rules are satisfied, that electronic prescribing in retail
pharmacy would be implemented. But I don't hear anything from trade
journals, or pharmacy workers, or people getting prescriptions filled,
about it being implemented. Is it being implemented, and if so, can anyone
on this list tell us how it's going? Thanks.
Menno - 01 Oct 2005 09:38 GMT
> For the last three to five years, pharmacy trade journals have been
> touting the arrival of retail pharmay electronic prescribing. In April,
[quoted text clipped - 4 lines]
> about it being implemented. Is it being implemented, and if so, can anyone
> on this list tell us how it's going? Thanks.

We've been doing it for years, but I am working in Europe. So before I start
typing a full report: still interested to hear more about it?

Menno
Pumbaa - 01 Oct 2005 14:20 GMT
> > For the last three to five years, pharmacy trade journals have been
> > touting the arrival of retail pharmay electronic prescribing. In April,
[quoted text clipped - 9 lines]
>
> Menno

You know us Americans!  Will  it save us money or does it allow Rxs to be
filled with less personnel costs?
Bob G. - 01 Oct 2005 14:40 GMT
>You know us Americans!  Will  it save us money or does it allow Rxs to be
>filled with less personnel costs?

Lol...It sure will not save you any money...the ONLY good thing I can
see is that I CAN READ THE DAMN THINGS...no running over to the tech
and asking if they "think" this letter is a G or a Q then going over
to another Pharmacist to get a 3rd opinion then while muttering under
my breath picking up the phone and dialing the Doctors off then
listening carefully to punch in the correct on their NEW Phone
Menu....

Honestly I retired in 1998 ...but still work one evening a week behind
the counter since I happen to like 6 day weekends better then 7 day
ones Plus that one evening makes me realize why the heck I retired...

But gosh we now receive Rx's in so many different formats I honestly
have to look at each 8x10 Printout and determine IF it is in fact an
Rx or is it a faxed request to refill an exsisting Rx or is it some
other 8x10 inch sheet of paper thet can be tossed in the trash with
all the other tear offs from the 8x20 inch Rx label, receipt,
warnings, etc that spits out of the printer with every Rx that I have
to rip apart initial some sections, trash others, stuff the bag with
another, slap another section on the back of the original Rx, ...you
get the idea...

20 years ago I knew that an Rx looked like...today I have no idea...
and when Rx start showing up on my computer screen ...

Oh well... Pharmacy has changed...at least I do still get to chat with
my customers and ask them how little Sally is etc...of course I can
not mention names ...BUT SCREW THAT Mrs Smith is always going to be
MRS SMITH to me and some dumb a.s number ...

Bob Griffiths
.
Paul Trusten, R.Ph. - 02 Oct 2005 00:58 GMT
Yes, Where in Europe do you work?

> > For the last three to five years, pharmacy trade journals have been
> > touting the arrival of retail pharmay electronic prescribing. In April,
[quoted text clipped - 9 lines]
>
> Menno
P T - 02 Oct 2005 06:10 GMT
Please define "electronic prescriptions."
Paul Trusten, R.Ph. - 02 Oct 2005 15:42 GMT
My definition in this context would be a prescription whose text is
transmitted over a secure computer network, i.e., not as a fax or an e-mail.

> Please define "electronic prescriptions."
Menno - 02 Oct 2005 16:15 GMT
> Yes, Where in Europe do you work?

I work in The Netherlands.

Menno
Paul Trusten, R.Ph. - 04 Oct 2005 16:33 GMT
Menno, yes, please tell us about your work experience in the Netherlands
with electronic prescriptions. BTW, when you say years, how many years?

> > For the last three to five years, pharmacy trade journals have been
> > touting the arrival of retail pharmay electronic prescribing. In April,
[quoted text clipped - 9 lines]
>
> Menno
Paul Trusten, R.Ph. - 04 Oct 2005 16:34 GMT
Menno, yes, please tell us about your work experience in the Netherlands
with electronic prescriptions. BTW, when you say years, how many years?

> > For the last three to five years, pharmacy trade journals have been
> > touting the arrival of retail pharmay electronic prescribing. In April,
[quoted text clipped - 9 lines]
>
> Menno
Menno - 05 Oct 2005 00:06 GMT
> Menno, yes, please tell us about your work experience in the Netherlands
> with electronic prescriptions. BTW, when you say years, how many years?

I'd say at least for five or six years (I am working 4,5 yrs as a pharmacist
now), probably longer.
Well, this is how it works in my pharmacy (and in most pharmacies):
The prescriptions arrive on our server via a VPN over ADSL.
(It used to be a direct, leased line, but that's been superseded by newer
technology). The script is both physically printed on paper and digitally
stored in a buffer. The technician takes the print and uses the number on
the prescription to call the prescription from the buffer. She checks it
and can finalise it by one push of the button: there is no need to retype
it from the printout. Doctors who use the same software as we do even get
feedback. For instance, when Furabid (100 mg bid) is on backorder once
again, the doctor can see in their patientrecord that we subsituted it for
nitrofurantoin 50 mg qid. (that is not a substitution we have to call them
for)
The doctor has to make a print as well, that one has to be signed manually
and these are periodically collected and brought to the pharmacy, where we
have to store them for six years. These are requirements by law.
Sometimes this goes wrong however, when the doctor gives the manually signed
script to the patient and they try to get a fill on that one as well. We
have to be alert at that and explain carefully to the patient that they
already had their medicine on that script.
Well, I think I have covered most there is to it, but if you have anymore
questions, feel free to ask.

Menno
Paul Trusten, R.Ph. - 07 Oct 2005 13:29 GMT
Menno,

Does the digitally stored prescription consist of data, or is it a scanned
image? Sounds like it would be data, since it can be finalized with one push
of a button.

As I mentioned, e-prescribing has been touted in the U.S. for several years,
but I have yet to hear reports on its implementation here. The
implementation may be imminent, because the security rules surrounding our
new privacy law went into effect in April, and, from reading those rules, it
sounds as if that should clear the way for e-prescribing to proceed.

I am told by a New Zealander friend that all pharmacies in that country are
online together, i.e., if I get a prescription filled for something in
Auckland, it will show up on the screen of another pharmacy in Christchurch.
Are Netherlands pharmacies connected that way? In fact, are pharmacies
connected throughout the EU?

Thanks,

Paul

> > Menno, yes, please tell us about your work experience in the Netherlands
> > with electronic prescriptions. BTW, when you say years, how many years?
[quoted text clipped - 24 lines]
>
> Menno
Menno - 08 Oct 2005 00:13 GMT
> Does the digitally stored prescription consist of data, or is it a scanned
> image? Sounds like it would be data, since it can be finalized with one
> push of a button.

Indeed it is just data, I believe it is some kind of implementation of EDI
(Electronic Data Interchange, if I recall correctly). It consists of name,
address and date of birth, and a code for the medicine, so that if the doc
choose e.g. diazepam manufactured by generic producer A, it will be entered
in our system as diazepam by generic producer B, because generic producer B
is what we have in stock. And of course a code for the use, e.g. 2d1t for 1
tablet bid and the amount to fill. If it was a scanned image (of a written
prescription) it would still be susceptible to failures in recognition of
handwriting. With a prescription as data you take away a point of failure.

> I am told by a New Zealander friend that all pharmacies in that country
> are online together, i.e., if I get a prescription filled for something in
> Auckland, it will show up on the screen of another pharmacy in
> Christchurch. Are Netherlands pharmacies connected that way? In fact, are
> pharmacies connected throughout the EU?

No, as a rule they are not. However, this may be the case on a local level.
For instance in the town where I live, this is implemented. My clients can
go to any other pharmacy in town and those pharmacies will be able to see
their insurance number and their medication history, so it is safe to get
your prescriptions in another pharmacy in town. For weekends and nights
people can go to the "night-pharmacy", there we have a network that
connects the region (part of the province, about 150.000 people. Remember,
The Netherlands is a small country)

Menno
Paul Trusten, R.Ph. - 08 Oct 2005 17:20 GMT
I visited Germany for the first time this summer. In some respects,
community pharmacy is practiced there the way it was practiced in the U.S.
50 years ago, which is good. There are many independent pharmacies, and each
one seems to provide personal service. The latter is usually not the case in
America any more, as chain drug stores dominate the landscape. Pharmacy
business hours are better here now, though, with many pharmacies open all
the time. This is not so in Germany, where pharmacies usually close at
18:00.

> > Does the digitally stored prescription consist of data, or is it a scanned
> > image? Sounds like it would be data, since it can be finalized with one
[quoted text clipped - 26 lines]
>
> Menno
 
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