Wednesday, January 07, 2009

Just checking in on your Rx

An idea I heard somewhere:

A week after a prescription is ordered, an automatic email goes from the doctor to the patient saying:

"It has been a week since I ordered a prescription for you. Please call me if you have had any problem filing the prescription, or if you have had any unexpected reactions to it, or if you have any questions whatsoever."

Is this a good idea? Is anyone out there doing it? Do you have any results you would like to share?


Ileana said...


In my experience a doctor telling you to call for anything or anytime is empty talk. I'm sure the intention is good, but in practice they don't have time to talk to the patients. And I'm not even sure that they are aware of how many times they are shielded from talking to patients.

If you do call you need to find your way through the network of office staff and nurses whose role seems to be to protect the doctor from ever talking to a patient. I suspect that if I get a bad reaction, or chest pain or something really bad, I would get through, but for questions or filling the prescription?

Things might be different at your hospital, but unless a doctor or staff is willing to talk and really help the patient that responds to that email, don't even bother doing it.

Anonymous said...

Open ended communication is always a good idea. I do know of hospitals that have pharmacists place follow up calls to patients that have been discharged on regimens at high risk for non-adhearance or dangerous adverse effects (new diagnosis, >3 new medications, Diabetes, Asthma, CHF, anti-coagulation etc).

As far as whether or not that prevented re-admissions or was a revenue stream I am unsure. It did require a significant increase in staff.

Anonymous said...

I already get regular prescriuption renewal emails and treat them like spam. I am routinely having dose adjustments and renewals are often changed. I would not want some useful email to be missed, so at the minimum the subject line would need to be clear that this particular mail was about.

Braden said...

Generalization here, but it seems like the people who would really need the help with filling prescriptions would be the most likely to not have e-mail.

Other problems: you would need some kind of medical records system that supports e-mail. Otherwise the doctor would have to remember to print out the e-mail conversation and include it in the medical records. An automatic email wouldn't necessarily take any time for the doc to send, but responding to the follow-up would. Also, you would need to collect an e-mail address from every patient, adding one more layer onto the already complicated registration process.

I used to work at an HMO. For all the bad rep it got, it was great that when the doctor ordered a test or prescription, he could have up-to-the-minute information about when it was filled or completed because it was always in the same system. Also, our EMR allowed the doctor to e-mail the patient directly with test results, questions, or follow-up. It would end up in a secure system that the patient could log into and a notice would be sent to their personal e-mail address, thus ensuring confidentiality while still being practical. A system like that would be good, but would require a complete overhaul of your EMR.

Anyway, sorry for a comment that is longer than your original post. I'll shut up now.

Anonymous said...


It is a great idea, often times I have put the Rx away somewhere safe and forgot to fill it at my pharmacy ( do they have a pill for memory? :)

Also, checking in with patients about side effects is always a good thing

I wish my docotor would do this for me!


Anonymous said...

I don’t think it’s a very good idea because it would add substantially to healthcare costs assuming doctors expect to be paid for each e-mail generated. As I understand it, approximately 3.5 billion prescriptions were filled in the U.S. last year. Many questions concerning prescriptions can be handled by pharmacists or can wait until the next appointment with the doctor. Healthcare costs are way too high now. We can’t afford to add still more to that burden.

Anonymous said...

Hi Paul,

Two of my roommates are pharmacists at a national drugstore chain. This chain just implemented a new program where after a patient fills their medication for the first time, the pharmacist will call them a week later and ask how everything is going. I thought that was a pretty cool idea, but it’s putting a pretty big strain on their already lean staff.

Anonymous said...

It certainly strikes me as a good idea. I have not heard of anyone doing it. Would it be possible for the pharmacy to notify the physicians when the prescription is filled, than the only remain issue would be getting the patient to actually takes their medication.

Anonymous said...


I'm always suprised at ideas that involve patient care and the internet. I think looking at the demographic of patients coming through a hospital is the first step. This idea, sounds great at first, however, if you are at a hospital, like most in large urban centers, that serves low income, Medicare patients, I would guess that the majority don't have access to the internet. For many of us the internet is as common as a TV, but for the single parent on welfare with two kids to care for, a computer does not rank high on the needs list. I would guess that most poeple who have computers have the income to get the medications. This is just speculation, but I'm guessing that most poeple who don't fill Rx, don't fill them because they don't have the money and I bet don't have a computer either.

e-Patient Dave said...

Hm, interesting. Is it better if the doc does it or the pharmacy?

I sure wouldn't want it, but I'm not normal. And I imagine it would be intended for people who might not speak up in case of a problem. (Lord knows I wouldn't need an email invitation to yell in such a case.)

e-Patient Dave said...

Man, is this a great illustration of the differences between the current reality, perceived reality, and the emerging reality!

One thing to be aware of is that email access does not equal internet access. I keep hearing from co-workers that their teens hardly touch email anymore, but they sure are connected – through Facebook or SMS or other.

Anon 10:57: you carry paper scripts around?? Great example of how unreliable and error-prone that is! My doc wires the prescription to Walgreen’s, and they text me when it’s ready for pickup (often before I get home from the office). Saves time and money and it’s more reliable. Now that’s what computers are for – to make good care easier. For everyone.

Braden: “the people who would really need the help … would be the most likely to not have e-mail”: the latest Pew Internet & American Life Project data just came out, and you’re right, but (a) it’s trending up, (b) you might be surprised at the breakdown – see Pew’s internet thermometer slide 1, (c) these notifications could go to cell phones, which thermometer #2 shows are much more widely used.

Barry: assuming doctors expect to be paid for each e-mail generated? Yikes, I’d presume this would be an automatic follow-up, like the appointment reminders I get from PatientSite.

What I’d really like is that if my doc’s system knows who my pharmacy is, the pharmacy should transmit “yes he picked it up” back to the doc's system (as Jon suggests, except it should be automated). No human effort involved, no email spam. The doc’s system would only bother to raise a flag in the case of an exception. Now that’s what computers are for.

Anonymous said...

Here's my anecdote: My daughter goes to a dermatologist (with whom I went to medical school) for acne. I had to pull strings to get her the appointment inside 3 months. He prescribes 75 mg of doxycycline twice a day. There are signs all over his office saying there will be a $15 fee for phone calls to his office for prescription renewals; anyone who wants a renewal should take care of it during the visit.
I get home and discover that a 75 mg pill of doxy costs literally 10x more than either a 100 mg or a 50 mg pill. Hoping that my personal relationship with him will obviate the $15 fee, I call him up to ask if she can take 100 mg in the a.m. and 50 mg in the p.m. to save money, since I have an HSA (and am outraged at the price for a very common antibiotic). He is "shocked" at the price difference and ok's the change - with ME writing the new prescriptions.
Clearly, this is NOT a doctor who wants to think about his prescriptions, much less talk to the patient about them. So no, like Barry, I don't think your idea would fly.

nonlocal MD

Mr. MedSaver said...

I'd heard of a pharmacy that was doing something similar to this whenever an antibiotic prescription was filled. Basically, someone from the pharmacy would call the patient a few days later to see how he or she was doing. We briefly thought about doing this at our pharmacy, but then realized we'd have to hire an extra person to do so (making about 20-50 calls each day).

Anonymous said...

where is the doctor supposed to find time to read and respond to all these emails?

Either they get paid, which as Barry says adds a whole new layer of cost (with questionable overall benefit) to the system, or they don't get paid, and then probably don't do it.

Docs already are expected to do too much uncompensated paperwork/email/phone calls during a clinic day, this wouldn't fly.

Anonymous said...


Whatever technical/human workflow generated from an activity like this must be SIMPLE for the patient and SIMPLE for the staff to action while getting the doctor paid for the follow-up. Otherwise, don't waste your time...

I live in a transitioning neighborhood in Milwaukee (i.e. ghetto) and I am AMAZED by the numbers of my neighbors who have and use internet access even though they are on public assistance for a variety of things. Cell phones are universal…and while many change their phone numbers every so often because many purchase pay-as-you go plans (Cricket and others are VERY popular), that is one platform that makes communication easy.

ANYWAYS, closing the communication loop is important and email could be effective, but I think a scripted text message with a simple way to respond to questions geared towards known AE’s with a given drug are the way to go. The responses could easily flow into a web-based clinical system and generate clinical/admin workflow based on the patients responses. I believe this would also allow the doctor to bill for reviewing the chart and having someone on staff action the item…

Keep IT simple, help the patient and get the doctor paid for their quality follow-up…

e-Patient Dave said...

Following up on my remark about how usage is trending: Happily, today Lee Rainie of the Pew Internet & American Life Project published his slides that he'll present at CES on Saturday on boomers' usage of Internet and cell phones. They're here.

A couple of highlights:
Internet users: 2000=40%, 2008=74%
Cell phone owners: 2000=34%, 2008=72%
Wifi users: 2000=0%, 2008=43%
"Cloud" users: 2000<10%, 2008=43%. (That's storing data out on the web, not on the local disk. To me, PatientSite is "cloud," though a purist might correct me. To me, the data is out there where I can access it from any PC, instead of carrying it around with me.)

I know this info isn't useful for people trying to cover every individual's needs today. I'm viewing it as the direction things are heading. It takes years to develop systems and implement policies, so this is worth noting, imo.

And, Pew's "internet thermometers" (in my comment last night) indicate how usage is extending down the economic stratum.

I read somewhere recently that people developing health apps for Africa *presume* that the platform is a phone.

Anonymous said...

Hi Paul,

I think this is a good idea, and I agree with the sentiment that it doesn't need to be automated.

I suggest start with the simple (LEAN=Use tried and true technology), which in some systems is a pre-visit secure message, coupled with a post-visit secure message, from the team to the patient.

Every other industry has discovered that pre-and post-communication works wonders for improving satisfaction. In our work, we are concerned with this, and something deeper as well, our patients' time in managing their health and preventing unnecessary harm. The non-automated version takes just minutes to do for a whole day's worth of patients, and in reality, if a patient is out there that's having trouble with a medication I prescribed, I want to know about it.

As I am one to say, when we waste our patients' time, we can never get it back.

Hope this adds to the dialogue and Happy New Year!

AlanHP said...


There is some health services research which clearly shows that there are major problems with patients not filling prescriptions, and when they do, not taking the entire prescription as written.

Any program should likely be initiated from the MD or surrogate, as it is only the MD who knows that prescription has been written. If the MD uses an electronic system, that could be programmed to send an alert if the prescription has not been picked up.

Then, you need to find out if the patient has been taking the drug as prescribed, and for the entire length ( a big issue with antibiotics).

What you are suggesting is a great idea. Putting into practice so that it can be personalized and therefore effective will be a major challenge.

I used to work as an employee benefits manager for a Fortune 50 company and medication compliance was a major concern that we struggled with.