E-prescription software in India: what a doctor should look for

A prescription pad has one job: to put a complete, legible prescription in the patient’s hand in the time the consultation allows. In India that time is short. A review of 67 countries found Indian primary-care consultations measured at about 2 minutes, and in a New Delhi teaching hospital’s medicine OPD the average consultation lasted 284.6 seconds, under five minutes. Software that is slower than your pen won’t survive a busy OPD, however good its features look in a demo.

Is it as fast as your pen?

Paper is fast because you write in shorthand: “pcm 650 1-0-1 5d af”, and the chemist knows what you mean. Software slows you down in two ways: dropdowns and forced fields. In a pad built on dropdowns, one medicine usually means typing a few letters, choosing from a list, then picking the strength, how often, when and for how long. By our count that is about nine clicks: one to choose the medicine and two for each of the four lists (1 + 4 × 2). The same line in shorthand is 19 keystrokes.

Small delays add up. If a pad costs you 20 seconds more per patient than paper, a session of 60 patients loses 20 minutes (60 × 20 seconds = 1,200 seconds). That is our arithmetic, not a measured figure, so measure your own.

Voice can be quicker still, as long as the pad shows you what it heard before it changes anything, and never adds a medicine you didn’t say. Ask the vendor:

• Can I type the abbreviations I already use: bd, tds, sos, hs, af, 5d?
• Does it remember my usual prescription for a diagnosis, and repeat the last visit in one step?
• With voice: does it understand Hindi and English, do I hold a button or is it always listening, and is the audio kept anywhere?
• How many clicks from “next patient” to the printout?

The printout and the patient’s copy

The rules ask for a few things on every prescription, and good software fills them in for you:

• Generic names, legibly and preferably in capitals. That is clause 1.5 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, as amended in 2016. Stricter 2023 regulations that would have required generic names only were put on hold within weeks, so ask what a vendor means by “NMC 2023 compliant”.
• Your registration number on every prescription (clause 1.4.1 of the same regulations).
• For prescription-only medicines (Schedules H, H1 and X), the date, your signature, the patient’s name and address, the total amount to supply and the dose, under rule 65(10) of the Drugs Rules, 1945. Under rule 65(11), the chemist may dispense it only once unless you write that it may be repeated.

Then think about the patient. In the same New Delhi study, 75.2% of patients could not read English, and those whose doctor explained the medicines only in writing knew less about them. A good pad prints the instructions in the patient’s language, in plain words: “1 गोली, दिन में दो बार, खाने के बाद” (1 tablet, twice a day, after food).

Ask:

• Does each medicine print its generic name first, in capitals?
• Is the total quantity worked out from the dose and the days?
• Can the instructions print in Hindi, or your patients’ language?
• Does it print on your letterhead, on the paper you already buy?
• Does the patient get a copy on their phone, through a link or a QR code, without an app or a login? How long does it work?
• Is WhatsApp used only for patients who said yes to messages from you?

Which safety checks actually help?

A few checks catch the mistakes that happen in a hurry:

• An allergy to a drug family, not only the exact drug: a patient allergic to penicillin should trigger a warning for amoxicillin with clavulanic acid.
• The same ingredient twice under two names: paracetamol on its own, plus a cold-and-flu tablet that also contains it.
• The day’s total of paracetamol across every brand on the prescription.
• An adult dose for a child, with a prompt to check the dose against the child’s weight.
• Medicines to avoid in pregnancy.

Be sceptical of anything that promises to catch everything. When researchers compared three major drug-interaction references, used in the UK, France and the US, only 5.74% of the drug pairs they listed appeared in all three. And warnings that fire too often get ignored: a review of international studies found that clinicians overrode 49% to 96% of drug safety alerts. A pad that warns about everything teaches you to click past warnings.

Ask the vendor to show you a warning. It should say why, on the line itself, in plain words. Ask what exactly it checks, from which list of medicines, who keeps that list up to date, and whether you can override a warning with a reason.

Working with your EMR or HMIS: what do FHIR and ABDM mean?

If your hospital already has an HMIS or EMR, the prescription should end up there without anyone typing it again. The common language for this is FHIR R4, the international standard that India’s ABDM uses for health records. ABDM’s implementation guide defines a PrescriptionRecord: the medicines prescribed in one visit, with the patient and the doctor. Ask whether the pad sends each medicine as data or only a PDF, whether your HMIS can open the pad with the patient already filled in, and who builds and pays for the work on the HMIS side.

ABDM certification is a narrower thing than it sounds. ABDM integrations are tested in the National Health Authority’s sandbox before a product goes live. The tests come as milestones: M1 for creating and verifying a patient’s ABHA, M2 for sharing records as a health information provider, and M3 for fetching records, with the patient’s consent, as a health information user. After those come functional testing, a security audit and approval, and then access to the live network.

So “ABDM-certified” tells you the software passed some of these tests and may do those jobs on the live network. It tells you nothing about speed, safety checks or ease of use. Ask which milestones it passed, when, and for which version of the software.

Who owns the prescriptions?

You or your hospital should, never the software company. Under India’s DPDP Act, the doctor or hospital is the data fiduciary, and the software company only processes the data on your behalf. Patients can also ask for their records: the 2002 regulations give you 72 hours to provide them (clause 1.3.2). Ask:

• Can I export every prescription, as PDFs and as data, whenever I want and at no charge?
• What happens to my data if I stop paying?
• Where is it hosted, and who at your company can see it?
• If the software is free, who pays for it? Is my prescribing data shared or sold, for example to medicine companies?

What happens when the power or the internet goes?

Power cuts are part of many OPD days in India. In a 2020 survey of nearly 15,000 households in 21 states, two-thirds of rural and two-fifths of urban households had a power cut at least once a day, and clinics share the same grid. Ask whether what you typed survives if the connection drops mid-prescription, whether you can still print, and how the queue catches up afterwards.

Then plan for it: keep the router and the printer on the inverter, keep a phone hotspot ready, and keep a pad of printed letterhead in the drawer for the day everything fails.

A 20-minute test before you buy

1. Bring five of today’s prescriptions, with the patients’ names removed, and time yourself writing each one in the software.
2. Write one for a child, and see whether it asks for the weight.
3. Record a penicillin allergy, then prescribe amoxicillin with clavulanic acid.
4. Prescribe paracetamol, then a cold-and-flu tablet that contains it.
5. Say one prescription aloud in Hindi or Hinglish, and check what it heard.
6. Print it and hand it to your pharmacist. Can they dispense it without calling you?
7. Scan the QR code with an ordinary phone.
8. Switch the Wi-Fi off halfway through a prescription.
9. Ask for an export of everything you wrote today.

Where DrMate Rx fits

DrMate Rx, our prescription pad, ships with DrMate and is also sold on its own. It reads shorthand the way you write it on paper, with no AI involved: “pcm 650 1-0-1 5d af” becomes PARACETAMOL 650 mg tablet, morning and night after food for 5 days, 10 tablets. Any other line, or what you say while holding the mic in Hindi or English, goes to the AI, and every change is shown to you. Each medicine prints with its generic name first, in capitals, then the brand, with the total quantity and the patient’s instructions in Hindi, on your letterhead. It warns you before you sign without a registration number.

Before you sign, it checks allergy families, paracetamol per day across brands, the same medicine twice, adult doses for children (it asks you to confirm a weight-based dose; there is no dose calculator) and pregnancy. It is not a drug-interaction database. Its suggestions are only your own habits: your usual for a diagnosis, the last visit, and your most-used medicines first among about 2.4 lakh Indian brand names.

Signed prescriptions can go to your HMIS as FHIR R4 documents shaped to ABDM’s prescription record, and your HMIS can open the pad with the patient filled in. It is not ABDM-certified and doesn’t link to ABHA. If you’d rather the prescription were drafted from the consultation itself, that is DrMate’s doctor’s room, also built. Either way, run the 20-minute test on it, Wi-Fi switch included. It’s also how your hospital’s front desk software should be judged: by a real day, not a demo.