Featuring posts written by the DoseSpot e-Prescribing Integration Team!

Follow the Leader – What We Can Learn From the First State to Mandate e-Prescribing

Posted: March 2nd, 2017 | Author: | Filed under: In the News, Public Policy | Tags: , , , , , , , , , , , , , , , | No Comments »

It’s no secret that e-Prescribing has its benefits. Many professionals agree that eRx greatly improves patient safety and reduces overall health care costs by lowering potential medication errors. Additionally, the ability to electronically prescribe controlled substances (also known as EPCS) greatly reduces fraud while preventing patients from being able to “doctor shop”, or receive multiple prescriptions for the same drug via different prescribers.

According to Paul Uhrig, Chief Legal Officer for Surescripts, between 3-9% of all opioid abusers use or have used forged prescriptions. With e-Prescribing, the ability to forge prescriptions is completely taken off the table. On top of that, with the addition of Prescription Drug Monitoring Programs (PDMPs) now implemented in all 50 states, prescribers are able to see all pertinent data that has been pulled from the patient’s electronic health record (EHR). This inevitably helps them make more knowledgeable and appropriate choices when prescribing scheduled medications.

With so many known benefits of e-Prescribing, and also because of the nationwide opioid epidemic, many states are getting on board the mandate train, which requires that by law, all prescribers must submit prescriptions electronically. There are currently 3 states which have this e-Prescribing mandate: New York, Maine, and Minnesota and many more that already have legislation in the works for an e-Prescribing mandate.

Taking the First Step: Minnesota Mandate

Minnesota was the first state to create an e-Prescribing mandate, which was intended to push all prescribers to establish and maintain an electronic prescription program that complied with state standards (listed here), effective January 1, 2011. According to the Minnesota Department of Health (MDH), Minnesota measures the status of e-Prescribing in three ways: total transactions, enabled pharmacies, and prescriber utilization. They’ve provided the following chart to demonstrate the increase in e-Prescribing transactions since 2008:

We can see that there was a pretty steep jump in 2011, which is when the mandate went into effect. However, the climb from 2011-2013 was slow yet steady.

Reinforcement of the Mandate, or Lack Thereof

The Minnesota Department of Health reiterates that there is currently no enforcement mechanism for not complying with the state’s e-Prescribing mandate. MDH does stress the benefits of e-Prescribing to providers as well as threaten with the possible implications of non-compliance from a patient/healthcare perspective. When the mandate was first released, it was implied that there would most likely be future establishment of enforcement methods. However, as of today, there is still no means of forcing providers to comply with the mandate.

Because there are no negative repercussions to providers who do not comply, there are many that choose to still utilize paper prescriptions, especially when it comes to sending controlled substances. According to Surescripts, only 3.5% of doctors in Minnesota were using EPCS in 2016. Additionally, the Minnesota Department of Health showed that drug overdose deaths increased 11%, reporting 516 deaths in 2014 to 572 deaths in 2015. These statistics could very well be unrelated to each other, but it still goes to show that that there is work to be done in Minnesota in regards to the opioid epidemic and electronic prescribing.

Some Considerations

Even though there is proof that it has its benefits, the challenges that come with implementing e-Prescribing can’t be ignored. Understandably, and rightfully so, prescribers have long expressed that their main focus is on their patients and they generally don’t enjoy being dictated by the government if it means being intrusive in helping their patients. This is especially true when it involves new systems that require onboarding and training time, but it can also be an even bigger challenge for prescribers to find the funds to support the implementation of an e-Prescribing system.

With these two large considerations in mind, it’s important that future states not only allow healthcare software companies and associated practices ample time to get their e-Prescribing systems up and running, but also offer some form of incentive or enforcement mechanism to keep prescribers in compliance. However, it’s even more important to remind prescribers that the perceived difficulty during the transition time in the beginning is minimal in comparison to how many benefits will transpire in the future. It’s all about taking that first step.

Author: Shannon K.

Sources: Minnesota Department of Health; Minnesota Department of Health Fact Sheet; MN e-Prescribing Guidance; Decision Resources Group; USA Today; Managed Care Magazine

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.


Mandate Madness – 3 States Propose e-Prescribing Legislature in the First Two Months of 2017

Posted: February 28th, 2017 | Author: | Filed under: In the News, Public Policy | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | No Comments »

New York will soon be celebrating their one year e-Prescribing mandate anniversary at the end of March and on the heels of this inaugural, impactful mandate, it’s exciting to see other states hopping on the e-Prescribing bandwagon. Not only did Maine announce its own e-Prescribing legislation that’s effective in just four months, but since the start of 2017, three additional states have introduced similar mandates. One common denominator most prevalent to note, however, is the overwhelming commitment by each state to combat the opioid crisis in order to decrease overdose death rates and improve patient safety overall.

Let’s review the three states that have recently proposed e-Prescribing legislation.

Pennsylvania

Pennsylvania experienced an astounding 3,264 opioid overdose deaths in 2015, a 20.1% increase from 2014. With the rising, devastating numbers in tow, Pennsylvania has decided to take further action and follow suit with New York and Maine.

On February 6, 2017, Pennsylvania State Senator Richard Alloway and Pennsylvania State Representative Tedd Nesbit announced the introduction of legislation that will require all opioid prescriptions such as OxyContin®, Percocet®, and Norco® to be e-Prescribed in Pennsylvania. The proposed bill will not only require controlled substances to be sent electronically, but will also enforce Schedule II medications not to be refilled by the pharmacy. For Schedules III and IV prescriptions, the bill requires that such prescriptions, “shall not be filled or refilled more than six months after the date thereof or be refilled more than five times after the date of the prescription unless renewed by the practitioner.”

The state is committed to a fast turnaround on implementing this legislation and as a result, especially for the protection of patients, the General Assembly is being urged to pass this vital legislation before June 30, 2017.

Connecticut

Yet another state devastated by the increasing drug overdose deaths from opioids, Connecticut Governor Dannel Malloy recently announced an increase in state funding to address opioid addiction and also introduced a series of legislative proposals, including one that will require all opioid prescriptions to be electronically prescribed. Governor Malloy not only highlighted the reduction in fraud that e-Prescribing can accomplish relative to curbing drug diversion, but also specifically noted the benefits of being able to track prescription data as a means to document both prescriber and patient information for electronic transactions.

“A pad of paper doesn’t come from a particular site. It is hard to trace,” Malloy said. “If you do it electronically, you can instantaneously trace, and it’s easier for us to document who is getting the drug, and who is prescribing the drug.”

As part of Governor Malloy’s proposal, a bill that outlines giving patients the ability to include a form in their medical file that indicates that they do not want opioid treatment has also been included. With value based care underway, this serves as another way to encourage patients to make their own health care and treatment decisions for what they deem works best for them.

Like Pennsylvania, the protection of patients across Connecticut is of utmost importance to the state, therefore Governor Malloy is pushing for this imperative legislation to be effective as of January 1, 2018.

Virginia

In Virginia, it has been estimated that 1,000 people died from overdose in 2016, a 33% increase from the prior year. Moving quickly, the General Assembly of Virginia unanimously approved legislature on January 26, 2017 requiring any prescription containing an opiate to be issued as an electronic prescription and will also prohibit any pharmacist from dispensing a controlled substance that contains an opiate unless the prescription is issued electronically.

On February 23rd, Virginia Governor Terry McAuliffe signed five bills to address the opioid epidemic, including the mandate for all opioid prescriptions to be prescribed electronically by July 1, 2020. It will also create a working group to study how best to implement this change.

What’s unique about this legislature, however, is that it all began with a practicing dentist who happens to be a state delegate for Virginia.

“We have all seen the tragic headlines that highlight the devastating impact that opioid addiction has had – and continues to have – on families and communities throughout the Commonwealth and the Nation,” said Delegate Todd Pillion. “This is an issue that I see not only as a legislator, but as a prescriber myself.”

As such, Delegate Pillion decided to utilize his profound, and heartfelt, voice to address the opioid epidemic that is sweeping our nation at alarming rates. Having personal experience under his belt, he was responsible for the original proposed e-Prescribing mandate in Virginia.

Where do other states stand?

With 3 states proposing legislature in the first 60 days of 2017, we anticipate more states to follow. As many individuals involved in the aforementioned state legislations have mentioned, it just makes plain sense to prescribe the most addictive, but necessary, medication through e-Prescribing. It is finally, and rightfully, being viewed as an optimal tool to overcome this drug crisis.

Electronically prescribing opioids will not only decrease drug overdose deaths and increase patient safety, but it will also:

  • Combat the rising issue of prescription fraud within a dental practice, including misuse of a dentist’s DEA number, forged signatures, and stolen prescription pads by patients or an Insider Threat.
  • Allow a prescriber to query a patient’s medication history at point of care in order to determine if they are “doctor shopping”, or visiting multiple prescribers strictly to receive opioid prescriptions.
  • Add to patient convenience by reducing wait times in pharmacies.
  • Increase patient medication pick-up adherence. Between 28% and 31% of all paper prescriptions either never make it to the pharmacy or are not picked up at all.

Stay tuned for more states that will undoubtedly be proposing similar legislature in order to work together toward a common goal for the safety of patients overall.

Sources: Virginia Gazette; Bearing Drift; Centers for Disease Control and Prevention; CBS Local; WNPOR

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.


Patient Engagement Technology: What’s All the Fuss About?

Posted: February 21st, 2017 | Author: | Filed under: Basics, In the News | Tags: , , , , , , , , , , , , , , | No Comments »

Patient engagement: the latest development in the healthcare industry, or is it?

You see, patient engagement has always existed. A little well-known term in the business world, “consumer engagement”, pioneered the strategies years ago that are utilized to engage customers, create better experiences, and enhance brand relationships to retain customers and increase revenue.

To be quite frank, these strategies have no “wow” factor. Engage with your customers to create brand loyalty and increase sales? Groundbreaking. Engage with your patients to improve health outcomes and lower associated costs? I see a trend coming on here.

While the healthcare industry has long understood the importance of having a patient engaged in their own health, it’s been said that the industry is typically five years behind with technological advancements. Perhaps it’s the resistance to change, the varying patient populations relative to age, or the perceived obstacles with seamless integrations for all pertinent parties, specifically EHRs.

However, one thing is certain: patient engagement technology is a viable solution that patients need, and deserve, to stay accountable and to stay connected in order to better manage their health.

The Benefits of Patient Engagement Technology

Now that patients are becoming more trusting of technology thanks to the Internet and social media, they have easier access to healthcare information at their fingertips. How many times have you googled your symptoms or visited WebMD rather than consulted with a doctor? Don’t be shy, we’ve all done it.

The downfall to these methods, however, is the potential danger involved if patients are self-diagnosing themselves without proper medical intervention. So, why not pair the two together?

The goal of patient engagement technology is to create a better relationship between providers and their patients. It’s also said that patients whom engage as decision-makers in their care tend to be healthier and have better outcomes, especially those dealing with chronic diseases.

Other benefits of using technology for patient engagement include:

The Challenges of Patient Engagement Technology

Though the benefits make sense, there are many challenges these latest tools are faced with. Not only is it new technology, but patient engagement will also require a cultural shift relative to changing behaviors and different communication preferences. Let’s not forget the operational and implementation challenges either.

Before an organization can determine what technology to use, it has to understand its users. Creating these personas will help healthcare technology organizations design better engagement tools with patients in mind, especially for older patients who might be less tech-savvy. It’s no easy feat getting providers and their patients to learn how to use these tools, as getting them up and running is most often viewed as a burden. That’s why there needs to be better integration with clinical workflows and simple-to-use products so providers aren’t wasting time on these technologies.

Furthermore, there needs to be more innovation in patient engagement tools. A glucose meter, an arm band, or a simple appointment reminder just isn’t going to cut it in today’s day and age. Give us substance, give us value, and give us healthier patients.

Other challenges of providers using technology for patient engagement include:

3 Patient Engagement Technology Companies to Watch

With so many patient engagement technologies being introduced to the market, here are 3 innovative companies making waves:

1. Klara

Klara takes collaboration to the next level. It’s not just a messaging application nor just an appointment reminder. Its platform engages all medical professionals for patients in order to be more efficient, more productive, and to work better as a team. They even tell you why “patient portals suck”. For more information please visit www.klara.com.

See how Klara works:

2. Medelinked

Medelinked encourages patients to manage their health by connecting with the healthcare community around them. It’s a secure mobile and online health platform that allows patients to build their health profile to discover, connect, and share their health and wellness information with their trusted healthcare providers. It not only connects individual patients, but families as well. For more information please visit www.medelinked.com.

See how Medelinked works:

3. AbleTo

AbleTo enables patients, payers, and providers to work together with their impressive behavior health care coordination platform that’s available nationwide to identify, engage, assess, and treat patients dealing with stress, anxiety, and depression. They pride themselves in reducing co-morbid behavioral health issues to improve patient outcomes, decrease the cost of care and help people reclaim their health and happiness. For more information please visit www.ableto.com.

Listen to one patient’s journey with AbleTo:

Sources: NEJM Catalyst; Health IT Outcomes; EHR Intelligence; CIO; HIMSS

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.


Has the Pendulum Swung Too Far? Chronic Pain vs. Opioid Addiction

Posted: February 15th, 2017 | Author: | Filed under: Controlled Substances, In the News | Tags: , , , , , , , , , , , , , , | No Comments »

Video courtesy of CBS Los Angeles

It’s estimated that 100 million Americans struggle with chronic pain, yet most are facing a barrage of obstacles while seeking treatment in order to appropriately manage their pain. With the current opioid epidemic sweeping the nation, people want the number of opioid overdoses to fall, but patients don’t want to be made to suffer, and rightfully so.

Has the opioid crisis and its implications prevented legitimate chronic pain sufferers from receiving the treatment and associated services they require to productively function in life?

As of recently, more than half of prescribers across America are cutting back on opioid prescriptions, and nearly 1 in 10 have stopped prescribing them altogether. They’re ultimately struggling to find a balance about the merits of using opioids to treat pain, especially in the absence of effective and affordable alternatives.

With this reality, it appears that the chronic pain population is facing an uphill battle, especially with the justified fear of prescribers pulling back in such a chaotic way that could be harmful to patients. Opioid drugs affect the body in an extreme manner and are not something a patient should stop abruptly or without appropriate medical oversight. It needs to be a monitored process, especially for those who have been on long term treatment.

In fairness to the other component of the chronic pain equation, are those patients that truly suffer from opioid addiction. As noted in a recent Boston Globe article, physicians face myriad pressure as they struggle to treat addiction and chronic pain, two conditions in which most physicians receive little training and often intertwine with one another.

Addiction is a complex disease that requires multifaceted solutions and a team approach. No single physician can provide the breadth of treatment required, nor are the necessary payment mechanisms in place to facilitate the “entirety” approach to treating addiction. That and the lack of physician education in addiction further fuels the long battle chronic pain patients are currently experiencing. Without proper knowledge of the physician, is every chronic pain patient now being viewed as an addict? Is that a realistic prejudice they’re being faced with?

In many cases, physicians are walking away completely – they don’t even want to see patients in chronic pain, but others urge to partner with patients and stay with them to help find other options. Such alternatives include The Spaulding Program, a program aimed at developing and teaching coping mechanisms, strategies, and “tricks” to manage and get through the pain. Although the program experiences great success, it had to limit its operation 20 years ago due to insurers ceasing payment for their comprehensive form of care.

It’s hopeful that the concern over opioids will lead to improved care, by deepening the doctor-patient relationship and opening the door for conversation to talk about managing pain, thus pointing to the desperate need for alternative treatments. For now, what is a chronic pain sufferer to do?

Author: Mark H.

Sources: Health.com; The Hill; American Academy of Pain Medicine; Boston Globe; Kevin MD Blog; CBS Los Angeles

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.


What the NFL Can Teach Us About Health Care Interoperability

Posted: February 2nd, 2017 | Author: | Filed under: Basics, In the News | Tags: , , , , , , , , , , , , , , , , , , | No Comments »

Football Stadium; 50-Yard Line

With Super Bowl LI right around the corner, and as a lifelong NFL fan, I started to think about how crucial an integrated team is and how it can be applicable in so many occurrences. The latest buzz of health care interoperability, and the need for a connected health care system, further proves this point.

Let me explain.

NFL teams need proper strength and conditioning programs to improve agility and overall athletic ability for elite sport performance. Likewise, each position on a football team has a specific job, and they must work in sync to defend their opponent, gain yards, and score touchdowns to come out on top. Behind the scenes, their playbook is constantly being strategized, with plays being practiced over and over, while also throwing vital wrenches into the mix to keep the other teams guessing.

The same can be said for health care technology. Think of health IT as a football team. You have:

  • Key Decision Makers – the Coaches
  • Development and Implementation Teams – the Defensive and Offensive Lines
  • Providers – the Quarterbacks
  • Patients – the Fans

While the coaches are leading the pack and deciding what is best for their respective teams, they must collaborate with other members. Key decision makers might be at the top of the funnel, but they need to work with other departments, providers, and patients to bring new technology into health care delivery as efficiently as possible.

The defensive and offensive lines (development and implementation teams) also need to work together and follow suit with what the quarterback thinks is best for a particular play, i.e. what is best for the providers at point of care. The football (data) is passed back and forth, with the end goal of moving the ball down the field and scoring touchdowns, thereby creating loyal fans (patients) that continue to support and cheer for their team.

The ultimate “Super Bowl” win, in health IT’s case, is enhancing the patient experience and increasing patient satisfaction, while keeping all pertinent individuals connected.

Here are three things good ‘ol pigskin can teach us about health care interoperability:

1. Technology is Crutch for Game Time Success

Technology powers the league to monitor games and evaluate its officials, drives the instant replay system that helps officials in getting calls right, and enables communications that coaches, players and officials use during games.

All of this technology is particularly demanding on game day, when it must operate smoothly for a time-sensitive, live event that is unpredictable and sometimes played in bad weather. Making it all work requires attention to detail and the technical knowledge to troubleshoot on the fly and make the game seem like a well-oiled machine.

We know how important technology’s role in health care is, that’s a given. Latest developments like telehealth and remote monitoring programs are becoming increasingly popular, especially within rural areas. The demand for such technology has been in place for years, yet adoption and appropriate reimbursement models still move at a snail’s pace. Even so, the electronic efficiency put in place will allow providers to do what they do best and spend more time with their patients, while also improving the value of treatment relative to patient outcomes.

2. Make Smarter Game Time Decisions

Technology also helps players and teams communicate and gives coaches the tools needed to create game plans and to adjust them at any moment. It speeds up the pace of games, ensures that they run fairly and smoothly, while also improving the fans’ experience watching the game from home and at the game itself.

If a coach sees that certain plays aren’t working against a particular opponent, they adjust at time of play. They embrace innovation as a strategy, which is exactly what health care organizations and providers need to do. In order to make smarter treatment decisions, providers need the appropriate data and technological ability within a well-connected network for the well-being of their patients.

3. There Is No “I” in Team

I know this saying is extremely old, and perhaps a bit cheesy. However, it still serves a great point. Do you think the greatest teams in NFL history could have gotten to the Super Bowl as a one-man team? Besides the logistics of how the game of football is actually played, there isn’t one player completely responsible for the game’s entirety. Sure, there may be an MVP, but it’s the synergy of the team working together to achieve the same goal that makes them a winner.

With health IT, it works in the same manner. There cannot be responsibility placed on one sole party and there cannot be a disconnect between key players. At the snap, a quarterback typically doesn’t change the play that was already discussed unless there are certain circumstances involved. An off tackle won’t suddenly become an up the middle play last minute. No one would be prepared and the ball would most likely be fumbled.

Ideally, there needs to be a shift in how health data is exchanged between providers and other data users, including how it is accessed by patients. This is why the goal of seamless communication across providers exists, regardless of which EHR or Practice Management vendors they work with. While many are already in place, utilizing more powerful application programming interfaces (APIs) would allow for various systems to talk to each other and exchange data to create a better connected network.

So, what does this all mean?

A football team may not always be in perfect unison – there may be picks and fumbles along the way – but those that make it to the Super Bowl have proven their ability time and time again throughout the season because of their collective effort. This is ultimately what health IT is striving for with their interoperability goals. Still, this isn’t something you want to throw a “Hail Mary” for and hope for the best. Continue to place patients at the center of health care interoperability and there will be a Lombardi Trophy for everyone involved in due time.

Sources: NFL Operations; Modern Healthcare; EHR Intelligence

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.


Maine’s New Mandate and What It Means for Opioid Prescribers

Posted: November 28th, 2016 | Author: | Filed under: Controlled Substances, In the News, Public Policy | Tags: , , , , , , , , , , , , , , , , , , , , , , , | No Comments »

Maine is well known for its rocky coastline, iconic lighthouses, sandy beaches, and lobster shacks. However, past the classic scenery is where you’ll find the state dealing with a crisis that others across the United States are also experiencing: the opioid epidemic.

In 2015, Maine suffered an astounding 272 drug overdose deaths, following 208 deaths of the same cause in 2014. Sadly, there is no end in sight. Maine’s Attorney General Janet Mills declared that drug overdose deaths are up 50% in 2016, with the first 6 months of the year experiencing 189 drug overdose deaths alone. What’s worse, the number of overdose-related deaths in 2016 is expected to reach a new record, surpassing those numbers of 2014 and 2015.

“Heroin addiction is devastating our communities,” Maine Governor Paul LePage said in a statement. “For many, it all started with the overprescribing of opioid pain medication.”

As a state with the largest number of patients per capita on prescription for long-acting opioids, the news that prescribed pain medication is further fueling opioid addiction is unsettling.

This is why Maine has decided to take action.

Maine’s new statue, “An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program,” entails a number of rules and regulations designed to reduce the harm of over-prescribing opioids relative to the abuse and misuse of such substances. This bill, signed into law by Governor LePage, mandates a number of changes for doctors and dentists who prescribe controlled substances in Maine.

[Read: The Maine Mandate – Confronting Controlled Substances Head-On]

What changes will be implemented?

Dosing and Duration of Schedule II Medications

First, this law imposes limitations on the medication dosage, as well as the duration of a prescription, that can be prescribed to a patient. According to Gordon Smith, JD, Executive Vice President of Maine Medical Association (MMA), the original bill limited opioid prescriptions to three days for acute pain and fifteen days for chronic pain. However, this legislation will now mandate a limit of seven days for acute pain and thirty days for chronic pain on opioid prescriptions. This law goes in to effect January 1, 2017.

In terms of dosing, prescribers may not prescribe any combination of opioid medication in an aggregate amount of more than 100 Morphine Milligram Equivalents (MMEs) per day to new opioid patients (after July 29, 2016). Existing opioid patients with active prescriptions in excess of 100 MMEs per day are referred to as “Legacy Patients” and prescribers may not prescribe any combination of opioid medication in an aggregate amount of more than 300 MMEs per day from July 29, 2016 to July 1, 2017.

Prescription Monitoring Program

Maine prescribers are required to query the Prescription Monitoring Program (PMP) database prior to prescribing opiates. Although this requirement has been in place since 2005, surveys indicate that only 7-20% of Maine prescribers currently utilize the state’s PMP.

The purpose of checking this central state database is to identify patients who may be doctor shopping and minimize multiple controlled substance prescriptions for one patient. This aligns with the state’s hope of empowering healthcare providers to recognize potential substance abuse and treat patients accordingly.

PMP’s can also be most effective when linked with an e-Prescribing solution. Working together, e-Prescribing eliminates the need for paper prescriptions, thus reducing the risk of altered dispense quantities, stolen prescriptions or prescription pads, and the reselling of such prescriptions before they’re filled as a means of lessening the red flags if a patient is doctor shopping.

[Read: The Link Between PDMP’s and e-Prescribing]

Continuing Education

Via this statute, prescribers must complete three hours of continuing education every two years as a condition of prescribing opioid medications. This specific addiction training is only required if a prescriber wishes to continue prescribing opioids.

Electronic Prescribing

All opioid prescriptions must be sent electronically as of July 1, 2017.

What exceptions are part of this mandate?

The Maine Medical Association (MMA) confirms that exceptions from the law’s provisions may be granted for the following:

  • Cancer Patients
  • Hospice Care
  • End-of-Life Care
  • Palliative Care
  • Patients on Medication-Assisted Therapy (MAT)
  • Patients receiving medication in hospitals and nursing homes

The MMA is currently seeking an exception for burn victims as well.

Due to the supremacy clause of the U.S. Constitution, federal law takes priority over state law, therefore prescribers within the Department of Veterans Affairs (the VA) cannot be regulated by this type of legislation so long as the medication is dispensed at a VA pharmacy. Furthermore, dosage and duration limits would not apply to a prescription written for a veteran by a prescriber outside of the VA system if the prescription were filled in a VA pharmacy.

How does this bill measure up?

With this bill, Maine becomes the third state behind Minnesota and New York to require e-Prescribing and the second to require the electronic sending of a controlled substance after New York imposed a similar mandate in March of 2016. Since the implementation of New York’s mandate, total numbers of opioid analgesics prescribed fell by 78% within the first four months.

Important dates to remember:

7/29/2016

Prescribers may not prescribe any combination of opioid medication in an aggregate amount of more than 100 Morphine Milligram Equivalents (MMEs) per day to new opioid patients

7/29/2016 – 7/1/2017

Prescribers may not prescribe any combination of opioid medication in an aggregate amount of more than 300 MMEs per day to “Legacy Patients”

1/1/2017

Duration limitation goes into effect. All opioid prescriptions cannot exceed seven days for acute pain or thirty days for chronic pain.
7/1/2017 All opioid prescriptions must be sent electronically

Lastly, as part of the state’s strategy, Maine has launched Dose of Reality, a website to help educate and inform their citizens of the dangers of painkillers and where to turn for help.

Author: Lindsey W.

Sources: Maine Medical Association; Maine.gov; Medscape; WCSH6; Bangor Daily News

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.


3 States Laying Down the Law on Opioids

Posted: October 27th, 2016 | Author: | Filed under: Basics, Controlled Substances, In the News, Public Policy, Security, Standards | Tags: , , , , , , , , , , , , , , , , , , | No Comments »

On par with our last post, the widespread media attention and devastating losses associated with our nation’s current opioid epidemic has sparked certain state legislatures to regulate and improve providers’ prescribing habits for prescription painkillers.

With good intentions in tow, some rulings seem to lack readily available solutions that are proven to curb this crisis. However, they do realize that their recent proposals do not mark the end of this uphill battle, rather multifaceted solutions need to be in place to truly, and successfully, overcome this epidemic.

[Read: Overdose Awareness – The Time to Stand Together is Now]

Here are three states that have recently proposed rulings on how opioids should be prescribed:

Vermont

Coined as a “cutting-edge” approach to overcoming the opioid crisis, Governor Peter Schumlin announced proposed limits on the number of opioid medications that could be prescribed.

Like every other state, Vermont has seen an incredible increase in deaths related to opioid and heroin overdose in recent years and Governor Schumlin is no longer sitting on the sidelines.

Earlier this year, he approached both the FDA and pharmaceutical industry in his State of the State address claiming that OxyContin “lit the match that ignited America’s opiate and heroin addiction crisis,” and that the booming American opiate industry knows no shame, an outcry after the FDA approved OxyContin for children a few months ago.

The proposed ruling states that the severity and duration of pain will determine the specific limit for a prescription of opioids. For example, a minor procedure with moderate pain would be limited to 9-12 opioid pills and the amount would increase based on the procedure performed and the level of pain a patient claims. The ruling would also require providers to discuss risks, provide an education sheet to the patient and receive an informed consent for all first-time opioid prescriptions.

The Green Mountain State’s Governor believes that limiting the number of opioid pills prescribed would be an effective way to reduce addiction, yet some folks believe the ruling would only encourage patients to seek illicit drugs elsewhere if they cannot receive pain medication through their provider.

This does make sense considering many former and current heroin abusers have stated that their addiction started from a prescription and when the pill bottle ran out, they were left seeking these drugs on the streets, which have proven to be very, if not more, dangerous than the prescription.

However, the intent of the Governor’s ruling is to prevent addiction from ever happening in the first place. His ruling is specific to cases of acute pain, therefore changing the over-prescribing habits and learned behavior of utilizing opioids as first-line therapy; habits that ensued in large part due to incentives, the surge of pharmaceutical marketing tactics and claims that painkillers were not addictive.

[Read: How Costly Are Prescription Pain Meds?]

New Jersey

With the rate of drug overdose deaths on the rise by 137% since 2000, New Jersey is another state to recently propose new regulations on how and to whom opioids are prescribed.

New Jersey, much like many other states, believes that prevention is key when fighting this crisis and they couldn’t be more correct. Unfortunately, several barriers often occur when seeking appropriate treatment after a patient becomes addicted, (for example, providers are limited to certain amounts for which they can administer reversal drugs), and therefore why not PREVENT addiction, rather than simply TREAT addiction when at many times, it’s too late?

Senator Raymond Lesniak has introduced a bill that would put restrictions on health insurance coverage for opioid medications, while also requiring prescribers to first consider alternative pain-management treatments, follow federal prescribing guidelines and explain the risk of addiction with such substances to their patients before prescribing. Furthermore, providers will need to complete several steps before receiving approval of an opioid prescription. These steps include providing a patient’s medical history, conducting a physical exam and developing an appropriate medical plan for treating a patient’s pain.

While new rulings in place can certainly shift this epidemic, Angela Valente, the executive director of the Partnership for a Drug-Free New Jersey, said it best:

“Awareness and education is the key factor in preventing the abuse of opiates—everyone must have a role in reversing this epidemic, including lawmakers, parents, coaches, educators, and yes, even doctors and dentists.” – Angela Valente

Dr. Andrew Kolodny, executive director of Physicians Responsible for Opioid Prescribing, further backs Valente’s point while also motioning that the medical community has been prescribing too aggressively.

[Read: The Opioid Epidemic: Are Dentists the Black Sheep?]

Pennsylvania

Unfortunately, Pennsylvania experienced 3,500 deaths last year as a result from drug overdose, one of the highest overdose rates in the nation.

The state has had a Prescription Drug Monitoring Program for quite a few years now, however it wasn’t functional until August 2016, when their new program was officially rolled out. Pennsylvania requires providers to query the state’s prescription drug database the first time they prescribe a controlled substance to a patient or if they have reason to believe that the patient is doctor shopping.

Governor Tom Wolf addressed other initiatives underway including requiring providers to query the database EACH time they prescribe opioids, updating medical school curriculum and continuing education, changes to the process of pain care to lower inappropriate use of opioids, and improved screening, referral and treatment for addiction.

What’s bothersome in Pennsylvania, is the method in which these substances have to be prescribed. The Pennsylvania Controlled Substance Act requires narcotic prescriptions to be handwritten on paper prescription pads, yet every other substance can be electronically prescribed. This allows the risk of written prescriptions being lost, stolen, or sold. Luckily, Senator Richard Alloway intends to introduce this measure before the legislative session’s end.

It’s promising to see how the above states are utilizing their state’s Prescription Drug Monitoring Program, or PDMP. All three require their prescribers to query the affiliated state database, however the parameters in which, or how often, they check varies.

While said efforts are better than no effort at all and states are starting to fully understand the need for multifaceted solutions in order to overcome this epidemic, one key solution is missing. E-Prescribing.

[Read: The Link Between PDMP’s and e-Prescribing]

How does e-Prescribing help combat this epidemic?

  • e-Prescribing diminishes the possibilities of duplicate or lost prescriptions since the prescription is sent directly to the patient’s pharmacy
  • A patient will no longer have a paper prescription where the dispense quantity can be altered
  • Prescribers will have access to a patient’s medication history, therefore they can determine if a patient is “doctor shopping” or has a history of substance abuse

To learn how to incorporate e-Prescribing as a solution to the opioid epidemic, schedule a meeting with DoseSpot today.

Sources: NY Times; Boston.com; ABC News; Press of Atlantic City; PennLive

About DoseSpot

DoseSpot is a Surescripts™ certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.


Massachusetts’ Prescription Monitoring Program Takes a New Turn

Posted: October 20th, 2016 | Author: | Filed under: Controlled Substances, In the News, Standards | Tags: , , , , , , , , , , , , , , , , , , , | No Comments »

For the first 6 months of 2016 in Massachusetts, there have been almost 500 confirmed cases of unintentional opioid overdose deaths and an estimated 500 additional cases have not yet been confirmed.

The majority of overdoses found in MA are due to substances such as fentanyl and heroin, but rates of cocaine and benzodiazepines present in opioid deaths have been steady since 2014. Although the rates of heroin and prescription drugs present in opioid deaths have been decreasing due to many efforts that have been implemented across the nation, the rate of fentanyl has been on the rise. This is in large part due to the fact that many opioid addictions start at the hands of a prescriber with a prescription and when the pill bottle runs dry, patients are left seeking other options that produce the same euphoric effect.

With the rapid increase of deaths and devastation by way of the current opioid epidemic plaguing the state, Massachusetts has recently implemented further requirements concerning practitioner’s prescribing protocols. Specifically, with the state’s Prescription Monitoring Program, or PMP.

The PMP serves as a database for all prescription drugs that are dispensed across the state, including those that are highly sought after for non-medical use and represent the highest potential for abuse, better known as Schedule II-V drugs such as narcotics, sedatives, and stimulants.

When properly used, the PMP aids in the identification and prevention of drug misuse, diversion, and potential doctor shopping by providing a patient’s medication history of the past 12 months. It is meant to be utilized as a key clinical decision-making tool that allows providers to receive a big picture view of the patient they are treating in real time.

As a solution to this widespread epidemic, Massachusetts has introduced new legislation and requirements when utilizing the MassPAT (Massachusetts Prescription Awareness Tool).

Effective October 15, 2016, practitioners must abide by the following:

  1. A registered individual practitioner must utilize the prescription monitoring program each time the practitioner issues a prescription to a patient EACH time for a narcotic drug in Schedule II or III.
  2. A registered individual practitioner must utilize the prescription monitoring program prior to prescribing to a patient for the first time:
    1. A benzodiazepine; OR
    2. Any controlled substance in Scheduled IV or V which the department has designated in guidance as a drug that is commonly abused and may lead to dependence. At this time, there are no drugs that have received this designation.

Prior to the aforementioned requirements, legislation ruled that practitioners, among other factors, need only check the state PMP when prescribing a controlled substance to a patient for the first time, while it is now required for a practitioner to check the system EVERY time when prescribing Schedule II or III drugs.

An example of just how serious Massachusetts is about this crisis, and also believed to be the first agreement of its kind, CVS recently paid almost $800k to the state because pharmacists were not checking prescriptions or the database thoroughly. In exchange, CVS agreed to provide its pharmacists access to the PMP website, train its pharmacists to register for and use the PMP as appropriate, and has further agreed to implement policies that would require pharmacists to consult the PMP before dispensing certain opioids in MA.

Massachusetts and CVS, among many other organizations, recognize the importance of the state’s PMP as a tool to detect and prevent the abuse and misuse of controlled substances. The PMP is not meant to be another government-controlled, green monster hanging on a practitioner’s back at all times; it is meant to serve as a safety extension for practitioners, but most importantly for their patients.

PMP’s can also be most effective when linked with an e-Prescribing solution. Working together, e-Prescribing eliminates the need for paper prescriptions, thus reducing the risk of altered dispense quantities, stolen prescriptions or prescription pads, and the reselling of such prescriptions before they’re filled as a means of lessening the red flags if a patient is doctor shopping.

About DoseSpot

DoseSpot is a Surescripts™ certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.


The Uber of Healthcare…No, Really.

Posted: September 29th, 2016 | Author: | Filed under: Basics, In the News | Tags: , , , , , , , , , , , , , , , , , , | No Comments »

As the healthcare industry shifts to a value-based care delivery model, that is, the value equivalent to patient outcomes over cost, more and more initiatives are being introduced as a way to combat the ever-increasing wasted costs our healthcare system experiences. This includes efforts to reduce hospital readmissions, better manage pharmacy drug spend and medication adherence, and broaden access to care, especially for the elderly, disabled and low-income patients.

While many programs are in place to provide services for the above mentioned, one may not realize how transportation costs are attributing to the rising healthcare spend. One may also not view Uber as an innovative solution for reducing such costs, however the company, partnered with Circulation, has recently announced a HIPAA compliant pilot program with certain hospitals that will provide non-emergency medical transportation in urban areas within Massachusetts, Pennsylvania and Delaware.

Why does this matter?

In a given year, 3.6 Million Americans, including almost one million children, will miss doctor’s appointments due to a lack of transportation or one’s inability to drive, resulting in wasted spend for the healthcare system. More specifically, Medicaid spends $3 Billion per year on non-emergency medical transportation, with a third of those payments being deemed inappropriate.

How does it work?

Circulation is integrated with existing and on-demand secure healthcare information systems that schedules non-emergency medical rides that are affordable and tailored for patients’ specific needs such as wheelchair accessibility. Patients do not even need to utilize the Uber mobile app or own a smartphone. They can simply call to schedule their pick-up time and after dispatch confirms their eligibility and transport authorization, they will receive a text, call or email confirming the driver’s estimated pick-up time and description of the vehicle to which they are then safely driven to and from their destination.

Research thus far has proven to reduce wait times for transportation by almost 30 percent and cut costs by almost a third, while boasting patient satisfaction at 80 percent.

Uber and Circulation provide more than just a ride – they are creating a seamless experience for patients, providers and hospital staff all from one convenient interface and in real-time. The system not only allows the scheduling of transportation, but also notifies providers when a patient has arrived for their appointment.

With the current unmodernized healthcare transportation system in place, this program proves to be an innovative step in the right direction.

Sources: Business Wire; HealthcareIT News; Circulation; JAMA

Photo Credit: Google Play

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.


Company Spotlight: Baby Doctor

Posted: September 8th, 2016 | Author: | Filed under: Basics, In the News, Standards | Tags: , , , , , , , , , , | No Comments »

Coined as “The Uber of Pediatricians,” DoseSpot customer, Baby Doctor is making waves with their latest on-demand services connecting parents with doctors.

Does your child have a sinus infection? A stomachache? How about a sore throat? Baby Doctor has you covered. Happy, healthy kids is their company’s mission and by implementing a service of boutique-style, personalized house calls, they are able to provide just that.

By using their website or app, parents are able to request a visit from a Pediatrician, Pediatric Nurse Practitioner, or Family Nurse Practitioner for a variety of symptoms a child may be experiencing and the provider appears at their home within 60 minutes or less.

This not only benefits parents, but insurance providers and emergency rooms throughout the city as well since it collectively saves them all time and money.

An average ER visit can cost upwards of $1,500 and two-thirds of ER visits aren’t true emergencies, but Baby Doctor offers their on-demand services for a fraction of the cost. Though they’re not considered an in-network provider, at least not yet anyways, Baby Doctor offers an itemized receipt for parents to submit to their insurance company for out-of-network reimbursement.

With their 50 board certified providers in Manhattan, Baby Doctor is hoping to expand to Brooklyn, the Bronx, and Queens by end of 2016, with further expansion into New Jersey come 2017.

By paving the way with their unique delivery model, Baby Doctor is devoted to providing an efficient, personalized and affordable means of healthcare to parents for their children, all while broadening patient engagement and levels of satisfaction.

Stay tuned for this blossoming company as it will undoubtedly remain at the forefront of on-demand innovation.

For more information on Baby Doctor, please visit their website: www.BabyDoctor.com.

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.