DrFirst brings to market third generation e-Prescribing service

Rockville 23 July 2002DrFirst has deployed Rcopia 3.0, the third generation e-prescribing and medication ordering service. This release of DrFirst's medication ordering management system is the first to span the continuum of care, combining inpatient Computerized Physician Order Entry (CPOE) medication ordering with outpatient e-prescribing functionality that extends to the physician office. The result is the most advanced tool available for improving patient safety by reducing medication errors while addressing the three critical obstacles to adoption: usability, integration, and cost.


DrFirst's Rcopia 3.0 takes a physician-centric approach to solving the medication ordering problem. This approach recognises that physicians order medications in the office, home, hospital, and points in between, and that they need a system that can operate in all of these multiple locations. To more fully meet the physician's needs, the enhanced system also includes Charge Capture functionality.

DrFirst has recently worked with Doylestown Hospital on both its in-patient and outpatient medication ordering initiatives. Doylestown Hospital's desire is to provide physicians access to patient, medication, allergy and problem lists on mobile, handheld devices, truly addressing the continuum of care.

"Doylestown Hospital has been impressed with the scope of Rcopia 3.0 as it relates to our CPOE initiatives. Rcopia provides a comprehensive solution that is not limited to the physician's setting. We pride ourselves in being at the forefront of healthcare technology and our relationship with DrFirst allows us to maintain this position", stated Brad Block, Chief Information Officer of Doylestown Hospital in Pennsylvania.

Rcopia 3.0 provides the most advanced functionality for writing and transmitting prescriptions anywhere, any time, on any device, including inpatient medication ordering. Patient demographic information, including medication and allergy lists, can now be shared in all settings. Rcopia 3.0 is a substantial improvement on the first generation of e-prescribing technology, which allowed physicians to write prescriptions on one type of device and print the prescription locally for the patient to bring to the pharmacy; and the second generation technology, which provided limited means to transmit prescriptions to pharmacies. The result is the most significant step yet in the movement to use technology to reduce preventable medication errors.

Medication errors stem from problems such as illegible handwriting, unrecognised adverse medication interactions or allergies, and the failure to have accurate patient information. The Institute of Medicine released a report in 1999 entitled "To Err is Human: Building a Safer Health System" which discussed the impact of medication errors on patient safety. The IOM report included estimates that approximately 7000 deaths occurred in 1993 due to medication errors and cited studies which found that almost two percent of all hospital admissions experience preventable adverse drug events. Such errors also have a tremendous economic impact on the health care system. Studies have shown that these preventable adverse drug events result in average increased hospital costs of $4700 per hospital admission.

While the health care community universally recognises the need to solve the problem of preventable medication errors, attempts to use technology in this endeavour have been largely unsuccessful. Past attempts have been unable to overcome the three greatest obstacles to adoption: usability for the physician; integration with legacy systems and provider work flow; and cost, particularly for hospitals and health systems. Rcopia 3.0 is the first system to solve these three critical problems.

The act of writing a prescription on a piece of paper is easy. To convince a physician to replace this process, the alternative must be as simple and also contain value beyond this simple act. Since physicians practise medicine differently and are increasingly mobile, the system must be extremely flexible. Rcopia 3.0 is that system. DrFirst recognises that physicians practise medicine everywhere and that critical patient information is needed outside of the hospital or office environment.

Rcopia 3.0 is accessible on both Palm OS and Pocket PC devices and can be used in both on-line and off-line modes. It also contains roles-based access, allowing staff to enter the prescription information with the physician merely needing to approve the prescription on-line. It can be used for prescribing medications in the physician office or ordering medications at the hospital. Most significantly, the tool can be used in both settings.

Rcopia 3.0's functionality includes the following:

  • Legibility: a legible prescription eliminates any question about the medication.
  • Maintenance of patient medication and allergy history for availability at any time.
  • Medication and allergy interaction checking. Utilising FirstDatabank's NDDF Plus drug knowledge base, Rcopia checks drug-drug interaction checking and drug-allergy alerts to reduce the incidence of medication errors and adverse drug events. The result is shorter hospital stays, lower medical costs, and improved patient care.
  • Roles-based access provides the ability to give staff assigned privileges, allowing physicians to quickly and easily sign and approve prescriptions written by staff members or residents.
  • Remembering previous ways medications were prescribed. These so-called "sticky" features further enable the physician to quickly create and refill prescriptions.
  • Device and connectivity independence. The system is accessible on desktop computers, using Internet Web browsers, and on handheld devices, including both Palm OS and Pocket PC devices. The system also can be used in both on-line (wireless LAN or wireless WAN) or off-line modes. With Rcopia Sync, DrFirst's proprietary syncing technology, users are not tied to one computer for syncing, but rather can use multiple computers and docking stations. Users can also send prescriptions using the computer's IR port or wireless technologies.
  • Inpatient medication ordering. This functionality includes the ability to order intravenous and injectable medications and compound medications. It also links with the hospital formulary to allow formulary medications to be suggested and can direct auto-substitutions where appropriate.
  • Integration: the system is integrated with major hospital information systems as well as various physician systems for data such as patient demographics and hospital information.
  • Insurance formularies. The ability to access payer formularies allows staff greater efficiency in processing the bills, including the creation of superbills.
  • Accessibility to problem lists. The integration with Charge Capture provides physician access to problem lists and ICD-9 and CPT codes, allowing quick and efficient patient billing in addition to ubiquitous access to important patient information.
  • HIPAA and security. Rcopia 3.0's security system is built on DrFirst's secure backbone, providing non-repudiation, authentication, and data integrity, whether physicians access patient information in a mobile, wireless environment or on a traditional desktop. Data is encrypted on the PDA using state-of-the-art 3-DES encryption, providing a secure medium for the storage and transferal of patient information.
  • Rcopia 3.0 is a comprehensive solution for the physician, allowing both prescriptions and charges to be captured at the point of care.

Rcopia 3.0 was created and developed by Brandon Brylawski, a board-certified internist with 12 years of experience in computer software development. He was the primary developer for the PubMed project at the National Library of Medicine and designed and developed the software for Online Mendelian Inheritance in Man (OMIM), the comprehensive compendium of human genetics from Johns Hopkins University. His experience in both medicine and software development make him uniquely qualified to create such a sophisticated product for the health care community.

One of the major problems with previous medication ordering systems is their failure to integrate, both in terms of integrating within physician work flow and existing legacy systems. No matter how powerful it is, a system will not be used unless it fits into and improves physician work flow. Rcopia 3.0's accessiblility on multiple devices and multiple operating systems, roles-based access, and "sticky" features are just three examples of how the DrFirst system accomplishes this goal.

The system must also be able to share information with already existing systems. Using the latest in HL-7 technology and deep technological expertise, Rcopia 3.0 bridges that gap. The application is integrated with hospital information systems to include real time patient look-up, using current in-house activity for the physician or practice. Integration in both the in-patient and out-patient settings provides hospital formulary information which ensures integrity of e-prescribing medication order entry.

CPOE is clearly a focus of the industry right now, but is widely misunderstood and misrepresented. It is perceived as nothing short of fundamental cultural and work process change. In addition, while hospitals and health systems recognise the need to implement such a system, the cost, both in terms of capital and human resources, has been prohibitive. Successful implementation of an alternative to the current system is both costly and difficult to integrate into the hospital setting, and many hospitals and other medical facilities are reluctant to embrace these changes.

Rcopia 3.0, however, offers a low-cost solution to solving the most basic facet of CPOE, producing medication orders that are legible and checked for medication interactions, allergies, and medication formularies. With the flexible licensing arrangements available for Rcopia 3.0, hospitals can implement a small number of users, lowering the costs and posing a less radical change to existing processes. Rcopia 3.0's integration into the hospital's information system also allows the hospital to leverage its current information system, avoiding a costly overhaul of its system.

Rcopia 3.0 is available to all IPAs, PHOs, large clinics, and community hospitals, as well as other technology companies who would like to license the product on an OEM basis. It is the most advanced product today in the market, providing the solution to the needs of the mobile physician, addressing the continuum of care, and enabling application and data sharing for both inpatient and outpatient care.

Utilising the latest advancements in Internet, security, wireless, and Personal Digital Assistant (PDA) technology, DrFirst provides a suite of integrated, affordable, intuitive, and easily implemented products and services to the health care community. These comprehensive solutions solve critical communication, business productivity, and clinical needs of physicians, clinics, hospitals, and health systems. DrFirst delivers its products on both an Application Service Provider (ASP) and Distributive Solutions Provider (DSP) basis to provide the maximum flexibility to fulfil the diverse needs of health care providers.

The backbone of DrFirst's products and services is its Secure Messaging Exchange (SMX) network, which permits secure messaging and transfer of information between users. Through this platform, DrFirst offers a practice management solution which includes automated billing, electronic claims submission and scheduling; a state-of-the-art electronic medical records application; and a complementary suite of integrated products that includes fully integrated Web and PDA-based electronic prescription writing, charge capture, and secure e-mail. More news on DrFirst is available in the VMW February 2002 article DrFirst expands hospital and physician customer base offering e-prescribing and practice management tools.

Leslie Versweyveld

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