MedPlus Health Services, headquartered in Hyderabad, is a retail chain of pharmacies that provides services like Pathlabs for state-of-the-art diagnostic lab services and RiteCure for distribution of medical and surgical supplies to hospitals, pharmacies and other healthcare providers.


Healthcare tends to be a laggard when it comes to adopting technology. In some cases even when there are clear and unequivocal benefits from doing so. Adoption of electronic prescriptions and computer medication order entry (CMOE) is one such example.

Institute of Medicine (IOM) in the United States released a seminal report in 1999, called “To err is Human, Building a Safer Health System”, in which it cited that a large number of hospital deaths, possibly as great as 98,000 per year were due to medical errors. A significant number among these were due to Adverse Drug Events (ADEs) or medication related errors. ADEs can occur due to issues in ordering, dispensing or administering of the medications, but research shows that a majority of them are due to illegible prescriptions or dosing related errors during prescribing. While there is no study conducted in India to identify the magnitude of this problem, given the practices prevalent here, it would be safe to bet that it is several orders of magnitude higher.

ADEs are preventable. There is strong evidence from studies funded by Agency for Healthcare Research & Quality, USA, that up to 95 percent of the prescription related ADEs can be prevented by use of electronic prescriptions and computerized systems for ordering medicines. E-prescription systems allow physicians to generate and transmit prescriptions electronically while providing basic medication decision support (MDS) like dosage guidelines, spell checks, and drug interaction information to advanced clinical decision support (CDS) such as checking for interactions with patient’s existing medications, allergies, or health conditions as part of an electronic health record system. A study done at Brigham’s and Women’s Hospital, showed that computerized medication order entry has the potential to prevent an estimated 84 percent of drug dosage, frequency, and route errors and up to 100 percent of errors due to illegible prescriptions.

In another study conducted at the Regenstrief Institute in Indianapolis, researchers examined whether automatically suggesting ‘corollary’ orders when physicians prescribe drugs electronically would help eliminate certain errors. For example, if a patient is receiving heparin (a blood thinning medication), a corollary order would be to check the patient’s platelet count before and 24 hours after the medication is given to determine if the patient is receiving too much or not enough medication. The results showed that physicians receiving the suggestion were twice as likely to perform the necessary checks as compared to physicians who did not receive the suggestion. The number of ADEs were also significantly reduced.

From the patient’s perspective, an electronic prescription may not only be life saving but also provides tremendous convenience. The medication information can easily be maintained as part of an electronic health record (EHR) or a patient’s own personal health record (PHR) and can be shared among all his or her healthcare providers to avoid medication duplication. It eliminates the need for the patient to maintain all the disparate physical copies of prescriptions or to memorize them resulting in errors during dispensing due to illegibility, errors in transcribing or mistakes in pronunciations.

The pharmacies, particularly in India, have little or no access to the prescribing physician, making it highly impossible to clarify an illegible or incomplete prescription resulting in either guesswork on the part of the pharmacist to avoid a loss of face (pharmacists pride themselves on their ability to read the inscrutable prescriptions) resulting in a potential medication error or denial of service causing inconvenience to the patient. Electronic prescriptions would make such actions unnecessary and facilitate the pharmacies in maintaining prescription records conveniently in order to refill prescriptions and comply with the rules of the Drugs & Cosmetics Act.

Given the benefits of electronic prescriptions and related technologies, the major barriers that need to be overcome for wider adoption would be the costs associated with their use and design issues related to the software, workflow issues, hardware and connectivity issues. New technology requires training and support for upkeep and is often disruptive before it becomes truly useful. A majority of these challenges will be addressed if the technology developers perceive a demand for their products and the adoption crosses a critical mass. However, the initial impetus may have to come from the government in the form of policies mandating their use and rewarding and subsidizing early adopters and from the consumers by showing their preference for physicians or organizations who use the technology.