Is E-Prescribing the Future of Veterinary Medicine?

Drug Topics: When compared to human health, the veterinary profession has few tools available to them to support the ability for them to prescribe medication to the preferred location of the pet parent. Since 1996, a number of online pharmacies have catered and benefited from this void in the market. The results have been limited competition and an enormous amount of time spent by veterinary professionals using antiquated and restrictive technologies such as phones, faxes and proprietary portals to prescribe the proper medication to pet parents.The process and lack of options have been frustrating for both veterinary staff and pet parents.

But things are changing. A veterinarian in Texas, Dr Wendy Crouse, is the first veterinarian testing a pharmacy-agnostic e-Prescribing platform with her pet parents. Dr Crouse is helping the veterinary industry finally catch up with their human physician counterparts with the ability to e-Prescribe medications without picking up the phone and calling in the prescription and allowing pet parents to pick up their fur kids drugs at the location of their choosing, even a locally-owned independent pharmacy.

Dr. Crouse Graduated from Texas A&M in 2004 with a Biomedical Science Degree and in 2008 with a doctorate degree from Texas A&M College of Veterinary Medicine. Dr. Crouse practiced in the clinical setting in Las Vegas, Houston and Baytown, Texas for 14 years. In December 2021, she joined Heal House Call Veterinarian and in May 2022 started her own house call business part time and went full time as a house call vet at the end of 2022.

We are delighted to have Dr Crouse join us today and talk about her interest in and experience with e-Prescribing.

I'm here with Dr. Crouse. Dr. Crouse thank you so much for joining me today.

Wendy Crouse, DVM: Thank you for inviting me. I appreciate it

Drug Topics: To level set, how did the prescribing process work before you started using e-prescription and was that experience like for pet parents, veterinarian, and vet staff?

Crouse: Prior to using a e-prescription, veterinarians would either have to write a prescription out and give that to the owner to take to a local pharmacy, or we'd actually have to call in the prescription ourselves or have our staff do it if we didn't have time to. While it doesn't seem like it's a hard thing to do, it's super time consuming and depending on the pharmacy you're working with, they may make it easy, may make it difficult. When you call in a prescription, you're having to relay not only your information but also the pet parents information, that pets information, the prescription itself and then if you're handwriting a prescription, you're writing all that information out and the prescription itself too. Then the pet parent has to take it to the pharmacy, pick it up, things like that. It is time consuming. It just takes a lot out of your day and when you're already busy as a veterinarian, it just adds even more to your load.

Drug Topics: Since you are one of, if not the first veterinary to e-Prescribe, tell me about what interested you in e-prescribing? And why now?

Crouse: E-prescribe has never been available to veterinarians before. It's been in the human world I believe since the late 1990s. That's when human medicine got into e-prescribing. Honestly, I used to be in a clinic setting, I used to have all the staff members, now I am a house call veterinarian, so it's just me, myself and I. The idea of having to call in prescriptions to a pharmacy, deal with a pharmacy, is somewhat daunting. I carry a lot of medications myself on my truck but I don't carry as much as you would in a clinic. There are some drugs that even in a clinic you'd have to order or send out for.

The idea of being able to type in a prescription that gets sent electronically, not having to be on a phone waiting on a hold or anything like that, was so enticing. It would free up so much of my time, especially since I do this on my own. When it was brought to me about potentially having this opportunity available, I jumped on the bandwagon. The ability to not have to tell all the information, to go through every single step of the process, and just e-prescribe, it was fascinating to me. It's just going to make our lives so much easier as veterinarians.

Drug Topics: How do we make sure veterinarians across the country are informed when it comes to filing the prescriptions? Are pet parents even aware that they can purchase prescriptions at local pharmacies?

Crouse: You know, I think the best way to ensure veterinarians are informed, especially with these new advances in technology, is to do just what we're doing, do podcasts, share it at symposiums and vet conferences. Even sharing it on social media. So much of what we find out and do is through these different sources, print media, as well. Doing an article in a local veterinary magazine, like DVM360, something like that, just to make more and more veterinarians aware of it.

I do certainly believe pet parents are aware that they can purchase prescriptions at local pharmacies. A lot of the big box pharmacies now, you'll see advertisements on TV, you're going to see on their counters where you either take the prescription in or checkout, you'll see a sign that says, “Ask us about veterinary prescription drugs.” I think more pet parents are aware of it, just because of that advertising that they see on a regular basis.

Drug Topics: How has e-prescribing changed the prescribing experience for your practice? What has the impact been on your veterinary practice?

Crouse: I've only been doing this a few weeks, maybe a little over a month now. It [has] saved me so much time. I can input multiple prescriptions within a matter of 3, 4 or 5 minutes for multiple different pets at multiple different pharmacies and not waste 30, 45 minutes trying to call these pharmacies, be put on hold, transfer the information. It's something where it's just really lessened the time I have to spend on the phone. If most vets are like me, we don't like talking on the phone. Having to call and talk to pharmacists and relay all this information can be daunting and at the end of the day, it's the last thing you want to do. If I can hop on a computer and type all this information and e-prescribe it, have it to the pharmacy in 30, 45 minutes or sooner, than I mean it's so much easier on my part of things and it tends to take the strain off the vets, as well as the vet staff.

A lot of times, if as vets we are in a clinic and we have staff surrounding us, we'll have them do this. This can be daunting to them, too. They don't always have all the answers to questions pharmacists may ask. You get a lot of this back and forth. Just being able, like I said, to type it in has just freed up so much time for me and I can send it to the pharmacy that pet parents want. It may be a local compounding pharmacy or a mom and pop pharmacy. It may be something like a big brand store, Walmart, CVS, Walgreens, all of these are all options for this.

Drug Topics: Most parents primarily shop online when considering where to purchase their medication IF they don’t accept the veterinarian’s suggested pharmacy. In your opinion how will e-prescribing potentially change the prescription experience for your patients and their fur parents?

Crouse: I think for patients and pet parents, I do believe it'll save time and frustration on everyone's part. If, like I said just a minute ago, if the pet parent has a particular local pharmacy they love to use, maybe it's a mom and pop shop, they can use that pharmacy. They're not set on you have to use X, Y, and Z pharmacy. Maybe they know the pharmacists, maybe they're old friends and they’ve been around them forever. It's nice that they can pick and choose. As a vet, many times we can order medications if we don't carry them in stock, but it can take a few days or a week to get to the pet.

Many of the medications we use as veterinarians are used in the human world, so they can go to a human pharmacy and have it filled in a matter of hours. It is better for the patient to get started on that medication sooner. It's easier on the pet parents not having to wonder, “Okay, when is this medication going to come?” It's at their convenience. Many pharmacies are open early in the morning or late at night, 24 hours. Say that pet parent is a shift worker and they use a 24-hour pharmacy, well they can go in and pickup this prescription, they're not held to just certain times that they can pick it up. I think it'll just make the process so much easier for proscribing outside of our clinic or our house call practice.

Drug Topics: Let’s talk about why you incorporated e-prescribing into your practice from a practical application perspective. How did you hear about your current e-prescribing partner?

Crouse: I am an independent, house call veterinarian. When I first started with Heal House, I was introduced to Jonathan Padgett, who works with PetScript, which is an online compounding pharmacy that Heal has partnered with to do all our compounding medications. Many months ago, it was brought to my attention that there's a new platform that was being developed by Abraham Garcia, who is a really good friend of Jonathan’s. Abraham's amazing team [is] helping to launch veterinary medicine into the world of e-prescribing and they are only able to do that with the help of First Databank. They are the only e-prescribing company out there, and so they've worked with Abraham to get this set up for the veterinary world. Since I've known Jonathan and he knows Abraham, Jonathan approached my CEO and just asked him if he thought I would be interested in trying out the platform, giving feedback, and kind of helping them pave the way for this new technology.

Drug Topics: Help us understand the work you had to do to make the transition to e-Prescribing?

Crouse: My work was actually very, very easy. I did not have to do anything. It was definitely Abraham and his team that did all the work. They coded this whole program, they actually got access to our database for Heal House and they uploaded all our pet parent information, all our pets, and they did research on the pharmacies that I think are within a 20 to 30 mile radius of I am, since I'm the only one using it. They uploaded all the pharmacy information. Then, from there, they created a website that I just go on to I search for the pet's name, which pops up with the available pets’ names, you pick the client, pick the pharmacy, and then they have a whole list of medications that you pick from that you want to prescribe. Then you just submit it. So really, the hard part was not on me. It was all on Abram and his team, creating all of this. I just log in and do my thing.

Drug Topics: Can you tell me more about the learning curve for you as a veterinarian?

Crouse: It's not been hard, honestly. There have been bumps along the way, some of them from the platform just being new, some of them from myself making errors. I mean, we're all human. We're all trying to figure it out. The website is extremely user friendly. The biggest thing that I have come across is making sure you have the correct pet and pet parent. You may have 15 different chocolate labs named Hershey, but it's a matter of making sure it's Hershey Adams and not Hershey Anderson. Sometimes, if you're in a hurry, you could click the wrong name. I have done it; I made the mistake. Luckily, it was caught and fixed.

Other than that, the learning curve has not been hard at all. Like I said, everything is just on the website. You click drop down boxes and you're good to go. It is extremely easy and convenient. Then you have a tab that says “New RX” when you want to prescribe and you can view old RXs, you can go in and see all the ones that you've prescribed to different people in the past, what pharmacy it went to, all of their prescribing information. You do have that as a reference as well to look back on and say, “Okay, on this day I did prescribe X, Y and Z.”

Drug Topics: When thinking about Federally controlled substances, what are the challenges you face when prescribing these the traditional way, especially when you send these to a consumer pharmacy?

Crouse: Prescribing controlled substances is a feat in and of itself in the clinic. You're doing your logbooks; you're making sure they're not getting refills too soon. There's a lot that goes into the federally controlled drugs. As far as having them filled in a pharmacy, typically I was calling those in, so you're having to call in wait on the phone, wait on hold, speak to a pharmacist, give all the information. It’s just that time that it takes. Is it hard to call them in? No. Is it time consuming? Yes. With e-prescribe, at some point, it's not there yet, they're still working on it, but at some point, we will be able to send in controlled substance prescriptions just like our human doctors do for us. But there is still some authentication work that has to be done to be able to do that with the controlled drugs. It's in the works. I don't know when that will be available, but it is something that is being looked into.

Drug Topics: According to recent studies, 60% of veterinarians use or prescribe compounded medications for their patients and most compounded pharmacies require a written prescription or phone call to create a prescription. Is there an easy way to e-prescribe compounded medications on VetHubRX?

Crouse: Yes, VetHubRX actually works with PetScript, which is where I met Jonathan from, so it's an online compounding pharmacy. They were one of the first to come on with VetHubRX. You can actually go on to VetHubRX and request or prescribe a compounded medication that will then go to PetScript and be filled, so you're not having to call it in, you're not having to have an owner bring in an actual prescription, it's all done electronically. PetScript is an amazing online compounding pharmacy that we've worked with for quite a while now.

Drug Topics: What future hurdles exist that will prevent veterinarians from adopting e-Prescribing?

Crouse:I think the biggest hurdle for veterinarians, and I know many are like me, many are not, but just acceptance of new technology and new ways to do things in the vet world. Many of us are just set in our ways. We are reluctant to change, we don't want to do new things. It's that older adage, if it's not broken, why fix it, change it. But the truth is, this type of technology can have great impacts on us and how we practice. It can save us so much time, so much frustration. You're not spending your last 2 or 3 hours at the end of the day calling your prescriptions, filling out prescriptions, having your staff fill out prescriptions. It's easily accessible on a desktop, a laptop, anything like that. And, you know, I just think it's just accepting that we have this new technology available and not being afraid to try it. It's not difficult. Just the impact that it could have on us in the future and save us so much time is worth it. You know, not having to sit on hold, not having to call multiple pharmacies, there really is a good thing coming for us.

Drug Topics: Is there anything else that you wanted to talk about or any closing thoughts that you wanted to leave us with?

Crouse: You know, keep your eyes and ears open for this to come. Each week there's new updates, each day there's new updates. There's so much potential for this new technology. Just don't be afraid to use it. This will definitely change the way you practice. It's changed how I practice. It's changed the time commitment I have to have to get things done. It's freed up time. It's made my life less stressful, so it's definitely worth it.