February 11, 2005

RxStar application eases prescription-reading woes

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Kevin Johnson, M.D.

RxStar application eases prescription-reading woes

To improve the safety and efficiency of the drug prescription process and achieve better documentation of outpatient medications, Vanderbilt biomedical informatics experts have collaborated with doctors and nurses at the Medical Center to create an electronic prescription writer that is integrated with the electronic medical record.

Early users have signaled approval of the new application.

“The last time we met with people in the Adult Primary Care Center, they applauded,” said the lead developer of the prescription writer, Kevin B. Johnson, M.D., associate professor and vice-chair of Biomedical Informatics.

Testing of the application, dubbed RxStar, began 11 months ago and now includes the participation of clinicians from many areas of Vanderbilt Medical Group. An aggressive implementation schedule calls for a new clinic to come aboard every few weeks during 2005; use of the application will extend across most of VMG by the end of the year, Johnson said.

“The initial, dramatic impact has been time savings, and a completely new level of assurance that prescriptions are accurate and legible,” said Richard L. Hock, M.D., assistant professor of Medicine, one of the application's many testers.

With the application now available, “I don't write out prescriptions anymore — and there can be no higher endorsement,” said another tester, Bennett M. Spetalnick, M.D., assistant professor of Obstetrics and Gynecology. “I'm annoyed on those rare occasions when I'm prevented from using it and forced to fall back on writing out prescriptions.”

“This project comes with vital collaboration from clinicians,” Johnson said. “From the many focus group sessions to the meetings of our advisory group, we've received indispensable help from doctors and nurses at each step.”

RxStar puts an end to Vanderbilt nurses waiting on hold to talk with pharmacists. From within the application itself, users can click to fax prescriptions to any area pharmacy. “It used to be that some days it was as though I spent half my time on the phone to pharmacies,” said Staff Nurse Gayle Stoneburner. “With this tool, when a patient calls for a refill, I can open the electronic record, confirm the dose, and fax the prescription to the pharmacy, all while the patient is still on the phone.”

The greatest time savings for physicians comes when renewing multiple prescriptions for a single patient, Hock said. The program knows what strengths a particular drug is sold in and the common directions associated with the drug, and it offers these as canned options. Users also can create pick-lists of the medications they prescribe most frequently. Users say it's a breeze to learn how to use the program.

Hock says quality and safety benefits are the main reason he looks forward to rapid adoption of RxStar across Vanderbilt Medical Group.

• When RxStar is used to write a prescription, the medications section of the patient problem list is automatically updated. That information can be crucial when patients come to the emergency room.

• RxStar provides automatic drug-allergy alerts (based on documentation of allergies in the problem list).

• By the end of the 2005, the application will provide drug-drug interaction alerts.

• The application will eventually include a dose calculator and alerts that sound when user-defined dosages fall outside usual limits.

Johnson is working to link drug formularies to RxStar, so that specific information can be queued up automatically regarding which drugs are covered by a patient's health plan and regarding alternative, less costly generic medications.

Studies show that prescription writers help achieve gains in safety and cost. Johnson cites a 1997 study in the Journal of the American Medical Association that found several causes of medication errors that RxStar will correct, including illegible handwriting, use of confusing abbreviations, and selecting an improper dosage form.