Rx Remedy

An emerging wireless application may end prescription headaches once and for all.

Founded in late 1998, health-care technology solutions provider LogOnHealth Corp. aimed to make wireless transmission of prescriptions to pharmacies the system of choice for physicians. Less than two years later, it rolled out its Prescription Center 1.0 application, built on wireless technology and the SQL Anywhere Studio database from iAnywhere Solutions Corp., a wholly owned subsidiary of Sybase Inc. that develops wireless mobile-commerce systems and services.

"The reason we chose the prescription-writing environment was we knew this was something the doctor has to deal with continuously," says Michael Jarjour, VP of marketing and a LogOnHealth co-founder. "Most of the other things—billing, etc.—are handled by staff. However, prescription writing is always relegated to the doctor."

Insurance companies policies complicate the once simple routine of writing a prescription. A common issue is having a doctor write out a prescription and then the HMO or health-care provider say its not on their formulary. "Doctors get a little booklet detailing all the drugs on each HMOs preferred drug list," says Jarjour. "The problem is, doctors are treating patients from 15 or 20 [different] HMOs.

"We said, Look, doc, what were going to give you is a handheld device that contains all the information you need to be able to immediately write the prescription for the patient and preadjudicate it, " Jarjour continues. "That means the system checks the prescription for any type of drug interaction, for any type of duplicate therapy and whether the drug is covered by the HMO."

Doctors Want Wireless As originally envisioned by LogOnHealths four founders, the Prescription Center application was to have resided on a desktop PC—until the doctors in the focus group chimed in.

"The doctors very quickly said, We cant walk out … to a computer [to write every prescription], and it doesnt make sense financially to have a computer in every exam room. We said, What about handheld devices? That immediately piqued their interest," Jarjour explains.

"Then we added another step. We said, What if its a wireless handheld? So wherever you are when a patient calls and you have to send an emergency prescription to a pharmacy, [we can enable] you to find the patients record by keying in the first two letters of the last name, then write the prescription, and send it to a pharmacy without further ado? "

The focus group loved the idea. So LogOnHealth set out to make it reality.

Oracle Versus iAnywhere At first, LogOnHealth began development on Oracle Corp.s Oracle Lite for PDAs, an object-relational database that can be embedded inside distributed client applications. Says Imran Haque, LogOnHealths VP of technology, "We werent very impressed."

There were several problems with Oracle Lite for PDAs. For one, it required that the LogOnHealth application connect to Oracle databases on the back end. For another, it used a lot of the PDAs limited memory.

The iAnywhere architecture, on the other hand, "is very open, so you could connect to multiple databases. In the health-care environment, you need to be able to connect to different databases," Haque says. Moreover, the architecture was such that "we could actually put a 10-pound bag in a 1-pound case. We can actually put 100,000 patient records in a handheld like the Palm, which is amazing."

Using iAnywhere, much of the application processing takes place on the Palm device rather than the back-end server—a plus, given pokey wireless transmission speeds. Only the actual prescription data is transmitted, says Haque. "It saves time. Time is a key criterion."

The LogOnHealth engineers worked on their own, without a product manager on the iAnywhere side. Nonetheless, they were not reticent about improvements they wanted iAnywhere to implement. "We were really pushing the limits here," Haque says. "Were getting newer and newer functionality"—processing speed, for example, especially when initializing the database. "Suppose the doctor does something where the app crashes for some reason? A year ago, it took a while for the database to reinitialize. That was a problem, because you had to wait. In the newest version, 7.1, its instantaneous."

Plugging In Prescriptions Doctors who subscribe to the LogOnHealth service use either a Palm Pilot V or Palm VII, which houses the LogOnHealth client application along with a copy of the physicians patient database.

For the physician, implementing Prescription Center is a two-step process. First, LogOnHealth records general information about the physicians practice—for example, which HMOs the doctor deals with—to credential the doctor. It also does a data dump of the demographic information on the doctors patients and converts all of that information to the LogOnHealth processing environment. The physician then does two hot syncs—the first to input the application, the second to input his patient data.

Subscribing doctors pay a wireless connectivity fee directly to their service provider. In addition, they pay a monthly $40 maintenance fee to LogOnHealth, which is waived if they write a minimum number of prescriptions. If the pharmacy in question does not accept wireless transmission, the physician can opt to send the prescription by fax or via the Internet.

"We get income from the managed-care organizations, because we provide value to them, as well as from the pharmaceutical companies," explains Haque. "Our objective is to make sure the doctor uses the solution and writes as many prescriptions on it as possible."

What about the physicians that LogOnHealth is targeting, a group known for being late adopters of any technology not medical-centric? LogOnHealth has the technical capacity to support 10,000 of them now and expects to reach that level within the year, then grow to 40,000 to 50,000 by 2003.

If Dr. Bruce Lowell is a typical subscriber, those projections could pan out. "Its very simple to use," says Lowell, an internist/gerontologist in Bayside, N.Y. "The only downside is pharmacies are still not used to it. You have to have more doctors using it. Just like now every doctor has a computer in the office, this will be the next step."