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Articles RxRite, RIM to target MDs
Deal aims to move doctors to electronic prescriptions By Robert Thompson If RxRite Inc. has its way, we should soon witness the end of the era when pharmacists eyed badly written prescriptions from doctors in an attempt to figure out what was written. The company announced a deal yesterday with wireless communications company Research in Motion Ltd. that will allow physicians to transmit prescriptions through an Internet-based service. "We believe we can provide a compelling model that doesn't require doctors to spend thousands on computers," said Rodney Dobson, president and chief executive of RxRite. "You don't even have to have an Internet service." Physicians, who have typically been slow to embrace computer technology, are now moving towards more sophisticated pagers such as RIM's BlackBerry handheld device. The most recent version of the BlackBerry includes a small keyboard that allows users to answer or send e-mail. The move should also increase RIM's penetration in the medical market, says David Werezak, vice-president of marketing at Waterloo, Ont.-based RIM. "I think it's that we're looking to appeal to the medical segment," he said. "But it's also a very interesting mobile commerce application." When RxRite launched in 1999, the company was developing a browser-based model, but that changed in 2000 when the company realized it would be too difficult to sell to doctors, Mr. Dobson said. The new concept will be based around a revenue model in which pharmacists would pay between $0.10 and $0.50 per transaction. A three-month pilot program is expected in Canada during the fall involving around 100 doctors, with the service becoming available at the start of 2001. But overcoming Canadian regulatory issues may still prove problematic for the company. Each province is regulated by a different college of pharmacists, though it is expected the federal government will issue legislation legalizing electronic prescriptions in the coming months. Currently only written and faxed prescriptions are legal in Canada. Most pharmacies have direct connections in order to file health insurance claims, but may not be hooked to the Internet. Connecting pharmacies to the Net is not expected to be a large hurdle, but security is still a concern. Currently RxRite uses 132-bit encryption, which is standard to the Internet, and requires each doctor be identified by a digital certificate. "We will always support anything that makes sure prescriptions are very clear," said Della Croteau, deputy registrar with the Ontario College of Pharmacists. "But we've got to be looking at a system that's secure. One where the pharmacist can verify [the prescription]."  Firm aims to rewrite prescriptions RxRite struggles to woo doctors and pharmacies to the Web By Tyler Hamilton 03/16/2000 Rodney Dobson has created a service that lets doctors send electronic prescriptions to pharmacies over the Internet. It's efficient, accurate and secure - yet it's proving to be a hard pill to swallow for the medical community. For a complete version of this article, please contact RxRite (416-410-3855) or media@rxrite.com eBusiness Journal March 2000, Vol. 2. No. 3 Filling prescriptions securely online looks like a no-brainer. So why is there such resistance to the concept in Canada? By Robert Thompson When he casually glanced the prescription pad sitting on a table in his Toronto home, Rodney Dobson never thought it would lead him to start a new business. What did strike him was that there was something amiss with the pad of paper, which his wife, a doctor, had brought home. "How would you know if anyone took some of these?" he asked. The pad, which enables patients to obtain powerful medication that can only be prescribed by a physician, was lacking in any security features. Unlike a cheque book, the prescription pad wasn't even numbered. There was no way of telling which of the slips of paper had been used to fill medication requirements for patients and which had been thrown in the garbage when it was determined another type of drug could be used to treat a specific ailment. On top of that, more than 250 million prescriptions were being issued to Canadian patients every year, leaving an antiquated system open to abuse and fraud. Before he'd even considered the issue of the notorious bad hand writing that tends to come with a physician's job, Dobson had thought through a business model that would effectively fix a number of the problems that exist between doctors and pharmacists. Fast-forward slightly more than a year. Dobson was in the process of raising his second round of financing for his new Internet-based prescription venture, Rx-Rite.com. Once the company's electronic prescription service that links doctors to pharmacies across the province of Ontario is up and running (it's in beta testing now), the next step will be working it into the rest of Canada and the U.S. Certainly the idea sounds simple and feasible - provide a secure Internet connection that allows doctors to transfer a patient's pharmaceutical needs to the pharmacy of the patient's choosing. Dobson's company would provide the Web interface and database components of the service. Doctors could simply type in prescriptions, ask patients where they want to pick them up and electronically send them to pharmacies. Since Canadian law doesn't allow such a service to be offered on a transaction basis, the pharmacies linked to the system would pay a monthly rate, which Dobson expects to be around $250. With more than 50,000 physicians and 22,000 pharmacists in Canada, there's a huge potential market for electronically transferred scripts. Despite the lack of a transaction-based pricing model, Dobson says pharmacies, which charge an average of $9.50 as a dispensing fee, aren't likely to balk at the cost. "Price really isn't a barrier for pharmacies," Dobson, 40, who carries the title of president and CEO at Rx-Rite. "It eliminates that confusing prescription and since most pharmacies are already using computers to deal with their billing and to deal with (customers') benefits, it will probably save them money." The system could fix a system that is "fraught with potential problems," according to Jim Dunsdon, the registrar for the Ontario College of Pharmacists, the regulatory group that monitors pharmacists. In the U.S., scores of deaths have been attributed to prescription problems, something that electronic prescriptions might eliminate. However, the Canadian industry has been cautious while watching issues arise south of the border, where online prescription services have been plagued by misuse and fraud. U.S. president Bill Clinton has recently proposed legislation that would attempt to deal with improper online sales of weight loss drugs and other prescription-only medications like Viagra. The legislation would allow the Food and Drug Administration to regulate Internet pharmacies and impose a $500,000 US fine for drug sales without a valid prescription. Since the Internet pharmacy market hasn't developed in Canada, regulatory issues haven't been the main concerns when dealing with electronic prescriptions. Problems revolve around convincing pharmacies and doctors that such a service is in their best interests. Despite the fact that most pharmacies are already linked to both pharmaceutical companies and health insurance companies, selling the idea won't necessarily be easy. Shoppers Drug Mart, one of the country's largest drug store chains, says it is interested in an electronic system, but isn't interested in any system that would promote what it calls "polypharmacy" - customers using more than one pharmacy to fill their prescription needs. Therefore, a system linking doctors to Shoppers would be fine, but the organization isn't nearly as interested in an e-commerce system that would link all pharmacies. "When the pharmacy loses contact with the patient, it's not providing appropriate medication and treatment," says Arthur Konviser, Shoppers' senior vice-president of corporate affairs. Patient privacy is also an issue for Shoppers, Konviser says. And with computers evolving so quickly, he says the company would have to be assured the technology would still be around for a period of time before Shoppers would invest in it. "What can I tell you? Technology in the last century has evolved so quickly, and you don't want to invest in a technology that will be obsolete in months," Konviser notes. Privacy issues also worry Mac Sparrow, president of the Dell Pharmacy chain. Electronic commerce sites in the U.S. have demonstrated their susceptibility to attacks by hackers. "I'm worried about someone having access to this information," Sparrow says. "I'm worried about giving out my credit card on the Internet, let alone having some of my health information on it." Certainly, having your credit card information posted on a Web site by a hacker for all to see is a concern, but Dobson says Rx-Rite.com is protected by 128-bit encryption and privacy won't be an issue. Doctors would use a unique login name and password, as well as digital certificates to prove they can prescribe medication. "We're going through a lot of extra hurdles because we can't afford to have any problems with the service," Dobson says. However, there are still some concerns on the part of Dobson and pharmacists that Bill C-6, which deals with privacy of information issues, could inadvertently have an impact on the Internet-based prescription service. In the Rx-Rite system, doctors will have access to a database that will track the medications that have been prescribed to a patient who may be visiting several doctors at the same time. However, the pharmacists won't have access to the information, eliminating the potential that they could use the information to market their services to people looking to have prescriptions filled. "We're in the prescription business, not the information business," says Dobson of the possibility that his company could profit by selling patient information. The company also won't be accepting funding from pharmaceutical companies or pharmacies, fearing that if it did, the credibility of Rx-Rite would be called into question and some people would not use the service. But convincing doctors that using the service will be of benefit to them, especially since they are not going to see any cash from it, will still be a tough sell, Dobson admits. Though software companies have offered expensive and proprietary patient records systems to doctors over the past few years, physicians have been hesitant to enter the computer era. Though Rx-Rite wouldn't be charging doctors to use the service, Dobson is aware he'll still have to lobby Ontario doctors to use electronic prescriptions. "Physicians simply haven't jumped into computers, while pharmacies have had to because of their dealings with insurance companies," Dobson says, noting less than five per cent of physicians are using computers, according to surveys done by Rx-Rite. But Ontario's doctors don't necessarily have mass Luddite tendencies, according to Jill Hefley, the director of policy and communication for the College of Physicians and Surgeons of Ontario. "I wouldn't want to generalize like that," she explains. "I think there are doctors that are for and against all kinds of things." Currently doctors can send prescriptions to pharmacies by facsimile and by phone, in addition to traditional paper scripts. Despite the potential benefits of having an online database of the medications a patient is taking, Hefley questions how accurate such a system would be. On top of that, she says some patients, especially older Canadians that have heard horror stories about Internet hackers, might be reluctant to use the service. Dobson is aware of the pitfalls of dealing with Ontario's doctors, which makes his interest in the U.S., with its massive health maintenance organizations, all the more interesting for his business. The U.S. HMOs have to consider speed of service and logistical issues because they often deal with hundreds of doctors and thousands of patients, Dobson says. And whereas doctors in Canada can simply say they're not interested in using Rx-Rite.com, HMOs could dictate policy to the doctors that work for them. But making the service work in Ontario will force the company to go through several rounds of financing. If the company were to expand into the U.S., where Dobson is convinced there is immediate demand for the service, it would take much more than the $8 to $10 million he needs to start the business in Ontario. U.S. success is a possibility, Dobson says, though he remains convinced the service will work in Ontario as well. "We think we're well-positioned to prove that a model like this will work in Canada," Dobson says. "I also think that it will work in the U.S. But we're going to have to move quickly." Pharmacy Practice, February 2000 Goodbye chicken scratch --but it'll cost you By Rosalind Stefanac What if I told you the days of waiting on hold while a doctor clarifies a patient's medication dose were behind you? Or that you might never again have to decipher chicken scratch on a physician's prescription pad? Imagine a pharmacy where there were no testy customers tapping the counters while you verify their scripts; a place where you were always confident that the medication dispensed was exactly what the doctor ordered. Pharmacy fantasyland? Maybe. Only a new Canadian company insists it will soon be a reality. Rx-Rite.com is a Markham, ON-based Internet service that aims to eliminate what tops most pharmacists' pet peeve lists: illegible scripts. This Internet-based utility--which has been under development for the last year and a half--will debut in Ontario next month. Its developers predict its popularity will grow quickly, with at least one major chain and one food/department store pharmacy--in addition to several independents--registered by the end of the year. The service is for physicians and pharmacists and promises a "secure" link for exchanging patient prescription information. This means doctors registered with the service will be able to enter a prescription into a computer from their offices and have it transmitted electronically to the pharmacy via the Internet. The pharmacy--which must also be registered--receives notification of the new prescription online and the pharmacist fills it. The physician, in turn, receives an electronic confirmation that the medication has been dispensed--as well as a comprehensive list of the patient's medication history to date. No handwriting, no verbal messages, no hassles. But there's a catch: you'll have to pay a monthly fee to access the service. Doctors won't. Rx-Rite.com president, Rod Dobson, reasons that the pharmacy community is "much more automated and wired" than their physician counterparts--and in this case that works to your detriment. Dobson anticipates that doctors will need a little more persuading--and a little more initial capital--to get their office equipment up to speed, whereas most pharmacists already make extensive use of computing power to maintain patient medication profiles and to provide drug information to other healthcare professionals. Still, Dobson says the monthly fee (about $250 per pharmacy) will be offset by online advertising sponsorships. Pharmacy fees may also be waived until the volume of prescriptions received online represents a significant proportion of your business. And hey, given the potential to reduce the life-threatening risks associated with illegible scripts--and the time spent trying to prevent errors--the extra bucks may well be worth it. But here's another catch. All this patient information will reside in that intangible expanse known as cyberspace. The patient will retain control over which pharmacy gets the prescription and which physicians will be permitted to access the medication records, but ultimately all participants will have to rely on a paperless delivery system. Rx-Rite.com vows that patient records will be stored in secure databases behind firewalls, and that it will not sell, trade, rent, give access to or disclose any personally identifiable information about a prescription to a third party without consent. We also know that the development of a national model for protecting sensitive patient information online is finally a top priority on the government's agenda. But even if the security is there, the difficulty will lie in convincing users of it. Using the Internet to dispense prescription information and store patient records entails having faith that computer systems will never suffer technical difficulties. It means trusting that the people logging onto the site are, in fact, who they claim to be. It requires an alteration of a paper-based mindset that has dominated the medical community for years. And it signals a change for pharmacy that is sure to bring about blunders along with the benefits. Rx-Rite.com is a revolutionary idea for a problem that has plagued pharmacy for a long time. The question is, are you ready for it? An interview with: Walter Kostiuk, Senior Business Alliance Manager, Research
In Motion [RIM] (manufacturer of the BlackBerry wireless email
solution); Rodney Dobson, President and CEO, RxRite.com Inc.;
Dr. Samuel Gutman, Chief Medical Officer, Carewave
Communications Corporation; Julie Ford, Director, Business
Development, RxRite.com Inc.; and Jennie James, Director, Professional
Relations, RxRite.com Inc.
Kostiuk:
We are actively supporting our BlackBerry independent software
vendors and developers in the realm of healthcare, and we are
leveraging the use of the BlackBerry device wherever the mobile
professional has a need for wireless access, to be always on,
and always connected – throughout Canada and the US, and
soon entering Europe.
Dobson: There are many reasons, but one is certainly the inherent affinity between physicians and pagers. BlackBerry represents the next generation in paging – it allows us to put an out-of-the-box solution right in the hands of the physician, that requires absolutely no additional Internet connectivity. The physician is not tethered to any other device or computer, and connectivity is free from wires or infra-red synchronization. It can be used anywhere, anytime! The physician is looking for this kind of portability.
Ford: Don, as you may be aware, electronic prescribing has not yet been approved in Canada. However, Health Canada has formed a committee, called the Advisory Panel on the Electronic Transfer of Information (APETI) eRx working group, to address security issues around the electronic transfer of prescription information. RxRite is a member of this working group, along with other key stakeholders from the medical, technical, pharmacy, pharmaceutical and regulatory communities. The eRx working group will deliver its findings to Health Canada, who will in turn make final recommendations. Ultimately health care is a provincial matter, and the interpretation and implementation will be left to the provincial regulatory bodies and NAPRA. We firmly believe that electronic prescribing will revolutionize communication between physicians and pharmacists, and by extension, will enhance patient care. We are expanding our pilot project and building relationships with leading providers of pharmacy vendor systems, toward paperless prescribing, in order to be ready once the regulatory dominos fall into place.
James: The physicians enjoy access to real-time information at their fingertips. With the BlackBerry, the patient’s prescribing history gets updated immediately. The physician is able to build his or her own prescribing database, monitor prescribing patterns, and provide a better continuity of care for the patient. With patient consent, the physician has access to the longitudinal prescription history across prescribers, ensuring safer prescribing practice, better chronic care management, and a reduction in the potential for drug interactions. Ford: The pilot project that we are conducting right now is focused on physician receptiveness and adoption of the BlackBerry wireless device and electronic data transfer capabilities. The prescription filling process at the pharmacy level is not impacted by the pilot at this stage. James: In getting back to what Rodney said earlier about the rationale for the use of the BlackBerry device, the physician enjoys constant connectivity and real-time information on their patient. The highest quality of patient care is a must! The BlackBerry is a comprehensive wireless solution. In one device, the physician has access to electronic prescribing, an interactive pager, wireless email capability, web browsing, as well as a full scheduling suite. No other device allows for this level of functionality and connectivity in real-time, all the time!
Gutman: Carewave is a health telematics company, and what we’ve built is an integrated solution that improves and facilitates the communication and monitoring of community-based patients with chronic diseases and clinical trial research subjects, with the goal of improving the outcomes and care of these patients. In the realm of clinical trials, our technologies will not only reduce the cost of conducting the trials, but will also expedite the process and produce better results. In the development of our patient-centric model, we’ve taken elements of personal emergency response systems, community-based disease management, and our understanding of clinical research trials, and synthesized them into a unique application – the first mobile patient management and data capture system.
Gutman: When a patient is enrolled on the system, and based upon the requirements of the sponsoring enterprise, a series of protocols are automated to prompt the patient on any number of actions directed at both monitoring and increasing compliance. There is an automated back-end intelligence built into the system, so that for example, if the patient is experiencing congestive heart failure and is asked by their care provider to record weight on a periodic basis, the system will prompt the patient to take action (like to seek medical attention) if there is an abnormal increase in weight reporting. The change in the patient status could simultaneously be reported to the physician. The idea is to prevent the need for an acute care hospital admission, or a visit to the emergency. The system escalates the calls if there is no response, and essentially closes the loop of communication, so that no patient is left at any time without responding. For any protocol reminder, there is a predictable set of events that happen if the patient doesn’t respond. The user is the patient, but the
customer is the sponsoring enterprise. The system provides physicians
and other care providers or clinical trial coordinators with patient
data that isn’t currently available to them. The system is
designed to integrate into their current method of practice, without
having to change physician behaviour. eHCT:Let’s talk a little more about its clinical trial applications. Gutman: The intent is to streamline the process both in time and cost-savings. When you consider the number of clinical trials ongoing that are paper diary-based, and the potential for error to enter into the process, this solution allows for simple patient responses to reminders and queries and allows clean data entry in real-time. The system also verifies protocol adherence in real time, and alerts the trial coordinator if the subject is not complying. James: Yours is a really interesting system, Sam. It is a natural fit with what we are doing, in that it facilitates triage in the community. Presumably physicians who are monitoring the protocols could intervene and prescribe electronically where necessary, without the need for an office visit. Gutman: Taking it one step further, into a world where patients are unsure what to do, physicians are paged or called frequently in situations where a nurse may be able to intercede. A process of triage that is built into the back-end of the system, ensures that the physician is called to action only when appropriate (based upon best practices and evidence-based monitoring protocols). The fact that our system can be deployed as an add-on to usual care, limits the risk to a care delivery or clinical trial enterprise instituting the solution. Because we are working with affinity groups, there is the option to take the interaction patient-to-patient as well, creating a support community. This peer-to-peer aspect is something we want to build towards, and is an additional reason why we chose BlackBerry. The ‘always-on’ aspect of the system and ability to confirm and verify that messages are in fact received, clearly are important features in an emergency response situation. The core functionality of the system requires closing of the loop – so the BlackBerry was a natural choice. In addition, we’ve been able to utilize some proprietary technology on a two-way browser interface using the device, so that we can both push and pull to the patient or subject!
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Kostiuk:
We’ve spent a lot of time researching the form-factor, the
feel, and the weight of the product in the hand of a user, and
chose a keyboard to offer a superior user interface for data entry.
We believe the keyboard is a lot more functional than a stylus,
and allows the user to enter text more efficiently.