Dr. John Luo’s article, “Handhelds: A cure for illegible prescriptions” (Current Psychiatry, April 2003 online edition), missed some important issues.
First, once a practice computerizes or installs a network—especially a wireless network—the physician needs to guard against HIPAA violations. Each violation could result in a fine ranging from $100,000 to $1 million. The switch to a Palm-, local area network-, or Internet-based program requires security procedures and operation controls.
Second, medical file management programs offer prescription writing, but as an accessory. Prescription writing should be the prominent component of any software title.
Third, during a power failure you need backup power and database recovery software to bring your system back up if it crashes. This not only protects your database, but also ensures that your patient files and formulary are available during an emergency, when risk is greatest.
Finally, let’s say 10 patient files fall to the floor. The contents are spilled, and you hastily pick up and re-collate the files. Incorrectly collating the files will not lead to a malpractice suit.
Now let’s say your system crashes, wiping out those same 10 Internet database files, and you cannot verify a new script’s contraindications because your program has no prescription component. Your ability to manage risk is lost.
Reid Schwabach
Internet technology systems manager/underwriter
Sarasota, FL
Dr. Luo responds
I appreciate Mr. Schwabach’s points about security issues regarding use of personal digital assistants (PDAs) for prescription writing. I mention these issues in my review article in the Canadian Journal of Psychiatry.1
Practicality and safety must always temper enthusiasm for technology. Prescription writing as a prominent feature of a medical file management program is desirable if the process is as easy and fail-proof as possible. However, any electronic system must have a back-up or redundancy system in case of data loss. Also, feedback from a fax- or Internet-based system is necessary to indicate that the pharmacy received the prescription.
Back-up systems are critical with technology to manage risk if data are lost, but technological failure should be anticipated. Paper- or CD-ROM-based drug interaction guides should be available, and documenting communication to other physicians is another reasonable method of managing risk.
These issues should not deter physicians from implementing an electronic prescription system because traditional paper-based or telephone prescriptions are also at risk for error or data loss. Technology should be carefully evaluated, much as we counsel our patients about the risks and benefits of prescription medications.
John S.Luo, MD
Assistant professor of psychiatry
UCLA Neuropsychiatric Institute and Hospital
Los Angeles, CA
- Luo J. Portable computing in psychiatry. Can J Psychiatry 2004;49:24-30