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Q&A: Zix E-prescribing Making Inroads

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WASHINGTON, Oct 20, 2003 (United Press International via COMTEX) -- Electronic prescribing -- e-prescribing -- is one of the newest trends in pharmaceutical delivery systems. It allows physicians greater flexibility and information in prescribing medications for patients.

United Press International talked with Dan Nutkis, vice president of the Care Delivery Solutions Division of Zix Corp., based in Dallas, about his company's e-prescribing system and its acceptance by physicians and pharmacies.

Zix is a provider of e-messaging protection and care delivery solutions that focus on finance, healthcare and government.

Q. What constitutes e-prescribing?

A E-prescribing has become a very generic term. E-prescribing as it is broadly defined is a process of electronically prescribing and, initially, people had connoted that was really just the ability to look up and see information on a drug. They said, 'Hey, that's e-prescribing' and others said, 'No, really you have to actually look up the formulary' and the formulary would be determining which drugs were covered by which insurance companies. Then you had people who said, 'No, really, e-prescribing is the ability to electronically deliver that script to a pharmacy.' So our definition of e-prescribing actually is the complete cycle, which is the ability to determine if a drug is appropriate for the current condition or purpose, if that drug is covered by the plan for that specific member and the ability to deliver that script electronically to a pharmacy.

Q. What is the benefit for the physician?

A. The benefit for the physician is the ability to have appropriate information at the point of care. With our solution, we have the ability, currently, for 135 million patients in this country to look up their entire (drug) dispense history and that number continues to grow. So, first of all, physicians have additional information at their disposal to make better informed decisions. They also have the ability to see -- if they are not familiar with dosing for the individual's body weight the system will tell them dosing information. It also then does interaction checking to make sure this drug will not interact with one of the other drugs the patient is taking and also that the dosage is appropriate for this individual. It then also verifies that this drug will be covered by this individual's plan or what the preferred drug is on this individual's plan.

If they wanted to prescribe, let's say, a statin for cholesterol, and the physicians don't really have a preference personally between Lipitor and Zocor, when they realize it costs the patient half as much to get, let's say, Lipitor, then the physician will go ahead and say, 'Fine, we're going to prescribe Lipitor.' Then it will electronically transmit to the pharmacy so the physician no longer has to write the script or pick up the phone and call the pharmacy.

What is also significant for the physician is when the pharmacy gets this prescription, they don't have to pick the phone up and call the physician and say, 'By the way, this drug is not covered by this member's plan.' So what happens is the pharmacy picks up the phone, they call the physician, they get the physician's nurse -- actually get her voice mail. She goes and gets the charts, she pulls it, she goes to the physician and says, 'Hey, it's not covered.' Now, by the way, the pharmacy still didn't tell her what was covered. So the physician says, 'Fine, switch him to this' so they call back the pharmacy and the pharmacy says, 'Whoops, that's not covered either' and they go back. So we've actually done studies and to the physician's office it's an hour and a half per day that we save them. We did that study with Tufts health plan. It was a study of 115 people using our system and we showed that we saved them, on average, an hour and a half a day -- just in pharmacy phone calls. We also showed a reduction in medical errors by the physician of over eight medical errors per year due to drug interactions. So there is a safety issue for the physician as well in being able to use this tool.

Q. What is the benefit for the pharmacy?

A. On the pharmacy side, they don't have to make those calls, so we showed it's an hour per day per pharmacist that we save them by our system because they're not having to pick the phone up and call the physician. They also don't have the issues of handwriting -- where they have the concern about the legibility of a script. So it's a safety issue for the pharmacy as well and then also a productivity issue.

Q. What is the benefit for the patient?

A. On the patient's side, No.1, it's safety as medical errors are the No. 8 leading cause of death in the country. Also, convenience because now the script is available when they get to the pharmacy and they don't have to wait and go back and forth. We also give the ability for mail orders so there are some economics in here because the patient then is hopefully being prescribed, with no decrease in any sort of level of care, a more cost-effective drug.

Q. If there are not any written scripts, how are records kept and how is privacy ensured?

A. Zix is, at heart, a trusted organization. There's a rigid process, first of all, for providing access to the system and the initial authentication of a user. Then access is controlled through an authentication module that validates the individual and then all data is encrypted, either at rest or while being transported. So since Zix's core business, prior to getting into e-prescribing was encryption and security we are quite adept at providing that technology. All the data that is either at transport or at rest is encrypted and privacy is ensured by the encryption technology.

Q. Describe the technology required. What is the cost and is technology readily available to physicians and pharmacies?

A. Yes, On the physician's side, probably one of the leading aspects that's made the Zix secure delivery system so attractive is its simplicity and cost effectiveness. There are a lot of markets, such as the Massachusetts market or the New York market, where health plans and others are sponsoring physicians, but our system costs physicians, if they are not being sponsored, $600 per year. It runs on, really, a whole number of devices -- pocket PCs - it can run on Palms, it runs on a Blackberry and they can also use it with a tabloid or just in a Web browser. And those devices cost anywhere from $299 up to thousands of dollars depending on what their (physicians) preference is or what they already have. We have physicians all over the country using it at the point of care or using it on the golf course. It interfaces with the pharmacy -- either we fax it to them if they don't have technology or it interfaces with their existing pharmacy systems.


(In Part 2, Nutkis talks about business aspects of e-prescribing, including the aspects Wall Street is most interested in with this new and developing technology.)

Copyright 2003 by United Press International.

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