To continue our round table blog series, we shed light from the technical side of dentistry’s role in the opioid epidemic. This time, we sat down with Jason Wolan, Director of EHR Implementation at Great Expressions Dental Centers.
How does your organization view the opioid epidemic as well as your dentists’ role in this crisis?
Great Expressions Dental Centers recognizes an opioid epidemic in this country driven largely by what has historically been a very lax approach to responsible prescribing. Today a lack of commitment by major stakeholders to take hard stances on better regulating the manufacturing and supply of these drugs continues to fuel the fire. In many cases, exploration of alternative pain management therapies and more rigid prescribing protocols that mitigate excess supply and drive more frequent doctor-patient interaction for those on long-term pain management therapies would likely result in major strides to not only reduce excess supply, but reduce unnecessary consumption as well. As a leading DSO and supplier of these medications, it is our job in the dental industry to lead by example and set progressive prescribing protocols that focus on responsible pain management therapies reinforced by firm controls and processes that deter abuse.
Are you having internal conversations about how your organization can curb the use of opioids or dispense trends?
Internally, our transition to an electronic prescribing platform has really been the catalyst for all of this primarily allowing us to gain insight into the prescribing habits of our providers. Prior to prescribing electronically, we relied heavily on spotty computerized provider order entry (CPOE) and “good faith” prescribing based on paper prescriptions being written with little or no audit trail. Today, we are phasing out paper prescribing with an ultimate goal of reporting on prescribing habits, particularly as they relate to opioid prescribing, allowing us better insight into drug-volume and drug-frequency combinations that may raise red flags.
How do you think e-Prescribing assists in efforts to curb opioid prescribing habits?
First and foremost, e-Prescribing, as is the case with most transitions to electronic mediums, will allow for better organizational oversight which will likely cause an industry shift as providers begin to recognize the results of increased transparency. Access to this aggregated data will create an unprecedented level of ad-hoc and scheduled reporting of prescribing habits with the ability to begin to profile behaviors and automatically intervene as necessary. In the past, while prescribing could be tracked, much of the data was burdensome and time consuming to compile, but as electronic prescribing platforms and the industry standards have become so available, the ease with which most organizations can monitor and proactively engage providers today should be a major driving force in deterring abusive prescribing. Reinforcing the latter will come with a societal transformation of less tolerance for prescriber supported prescription drug abuse and the increased media coverage, both at the state and federal level, prosecuting the offending prescribers.
Do you have access to data that you currently, or plan to, utilize in regards to proving how your practices are focused on responsibly prescribing these substances?
Great Expressions Dental Centers is currently generating weekly reports of prescribing focused on drug-volume/drug-frequency combinations. While the organization has not completely transitioned to electronic prescribing, we have significantly reduced access to paper prescribing and expect to see the true value of electronic prescribing when we are able to profile our organizational prescribing practices in its entirety.
Are there any policies in place, or may be in the future, regarding how many pills should be dispensed per controlled substance?
As a DSO, our clinical operations, policies, and procedures, and guidelines are all set by our Chief Clinical Officer. A consistent patient experience defined by responsible care coordination for all Great Expressions Dental Center’s patients is the cornerstone of the brand we have established. A large part of that includes driving responsible practicing techniques and ensuring that our patients’ interests are front and foremost, this of course includes responsible prescribing to mitigate the risks associated with opioid prescribing and has existed prior to our engagement with electronic prescribing. In the future, we hope to leverage the platform further in this regard.
To listen to the full round table, download your copy here.
Some responses have been slightly edited for clarity and length.
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.
As the opioid epidemic continues to grow across the nation, DoseSpot recently sat down with Key Opinion Leaders from Dental Support Organizations (DSOs) to discuss how their organization is implementing best practices to decrease opioid overdose deaths and increase patient safety, as well as their viewpoint on what dentistry’s role is during this crisis.
For part I of our blog series, our focus is on the clinical element of dentistry’s role in the opioid epidemic with Dr. John Zweig, Chief Dental Officer of Dental Associates.
How does your organization view the opioid epidemic as well as your dentists’ role in this crisis?
Dental Associates is keenly aware of the problem with opioids and we take a very deliberate role in managing patients’ pain appropriately with the minimum required medication. Educating patients and matching pain relief management with the present dental problem is very important.
Do you provide your dentists education, training, or resources regarding controlled substances?
Continually, Dental Associates has educated its providers on appropriate pain control measures and the use of controlled drugs. The challenge remains with patients whom insist on strong medications and working with them to minimize the prescriptions and the type of drugs used. More patient education is required, and our use of patient prescription histories is becoming more widely used to discover how to explain the minimum amount of medication used.
Within your dental practices, how do you communicate the important relationship between dentists and controlled substances?
Within our provider education, orientation and our monitoring of prescriptions, we continue to provide feedback to minimize prescriptions for controlled drugs both in type and quantity of medication provided.
How do you think e-Prescribing assists in efforts to curb opioid prescribing habits?
It actually reduces fraud; it ensures that we are writing the prescriptions the way we want them to be and that they get to the right people. Electronic prescriptions allows us to monitor this because potentially we may have a provider who is unknowingly or unwittingly giving out large amounts of drugs and we can have a conversation with them, potentially educate them, or make them aware of the situation. This isn’t about a “gotcha game,” it’s about educating providers on best practices.
How do you handle/communicate with patients that may have a substance abuse issue?
Well, many times, first, we use the Wisconsin prescription drug monitoring program (PDMP). That has been in existence and the state has been encouraging us to use it. When using it, we find that many of the patients we’re concerned about are in pain management programs and so we refer them back to their pain managers to resolve their pain needs, so we’re not making it too complicated. For those not in a pain management program, we communicate the facts on their known prescriptions and advise them that we may be unable to prescribe more. We discover with that information, the push-back is minimal.
Anything else you think would be relevant in addressing dentistry’s role in curbing this epidemic?
The issue is a big problem, but I still think it requires education for patients and also the providers, because people have the expectation to reduce demand for pain medication. We need to educate the doctors on best practices with medications that are not controlled substances. We need to monitor and educate everyone.
Stay tuned for Part II: DSOs’ technical insight into dentistry’s role in the opioid epidemic.
To listen to the full round table, download your copy here.
Some responses have been slightly edited for clarity and length.
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.
Time is often not on our sides and we find ourselves with less hours in the day to catch up on the news and to learn new things. Video and auditory content is a great alternative to reading and can be convenient and insightful to get informed about things that interest you. TED (Technology, Entertainment, Design) Talks have been increasing in popularity as well as volume over the years. Here are 5 of our favorite TED Talks from over the years that highlight a wide range of Health IT topics. Enjoy!
Wearables, Beyond the FitBit
What if doctors could monitor patients at home with the same degree of accuracy they’d get during a stay at the hospital? Bioelectronics innovator Todd Coleman shares his quest to develop wearable, flexible electronic health monitoring patches that promise to revolutionize healthcare and make medicine less invasive. More here.
An Oldie, but a Goodie: Innovation in Health IT
Daniel Kraft offers a fast-paced look at the next few years of innovations in medicine, powered by new tools, tests and apps that bring diagnostic information right to the patient’s bedside. More here.
Progression of Collecting Health Data: From Paper to the Cloud
Collecting global health data is an imperfect science: Workers tramp through villages to knock on doors and ask questions, write the answers on paper forms, then input the data — and from this messy, gappy information, countries and NGOs need to make huge decisions. Data geek Joel Selanikio talks through the sea change in collecting health data in the past decade — starting with the PalmPilot and Hotmail, and now moving into the cloud. More here.
Get Curious, Start Innovating
Science is a learning process that involves experimentation, failure and revision — and the science of medicine is no exception. Cancer researcher Kevin B. Jones faces the deep unknowns about surgery and medical care with a simple answer: honesty. In a thoughtful talk about the nature of knowledge, Jones shows how science is at its best when scientists humbly admit what they do not yet understand. More here.
Nanotechnology and the Future of Disease Detection
What if every home had an early-warning cancer detection system? Researcher Joshua Smith is developing a nanobiotechnology “cancer alarm” that scans for traces of disease in the form of special biomarkers called exosomes. In this forward-thinking talk, he shares his dream for how we might revolutionize cancer detection and, ultimately, save lives. More here.
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.
On February 23-24, 2017, I had the privilege of visiting the Windy City to attend the 152nd Chicago Dental Society (CDS) Midwinter Meeting. With the show theme of “leadership”, the bustling event attracted more than 28,000 attendees and the agenda was full of influential speakers, enticing exhibits, insightful lectures, and networking opportunities.
Opening Day
The conference kicked off with a bang on Thursday to a packed exhibit hall featuring more than 6,000 exhibitors comprised of 500+ booths. The opening session that evening was led by John F. McDonough, President and CEO of the Chicago Blackhawks. Through his speech he discussed leadership and its direct correlation to success. Something that really resonated with me was when he said, “In sports it’s hard to win, really hard to win. So much more goes in to it than just talent.” In retrospect, I think this thought applies to much more than sports, but also in industry. It takes a lot more than just talent, or a great product, or great service to be a leader in your industry, be that in dental practice management solutions, running a dental practice, or in e-Prescribing.
Awards
A number of prestigious awards were presented throughout the weekend to individuals who best portray the key values of not only the Chicago Dental Society, but also the dental industry as a whole. The winners were as follows:
Dr. K. William ‘Buddy’ Mopper was presented the Gordon J. Christensen Lecturer Recognition Award as an acknowledgement of his contributions to the dental profession in the area of conservation dentistry which places a value on conserving teeth opposed to extraction and implants.
Dr. Thomas Sullivan, past President of the Illinois State Dental Society and former Vice President of the American Dental Association (ADA), was awarded the George H. Cushing Award for his contribution to public awareness and importance of oral health.
Dr. Flava Lamberghini was awarded the CDS Foundation Vision Award in recognition of philanthropy by providing preventive dental care to students in more than 60 Chicago public schools.
An award was also provided to third-year dental student, John Tran, who wrote an interesting essay titled, “Thinking about Another Sweet Gulp? Think Againâ€, that reviewed the risk that sugar and sweetened drinks have on your teeth. You can read the full essay here.
Continuing Education
Continuing education drew large crowds with over 200 courses offered on a wide variety of topics ranging from clinical topics like 3D imaging, prosthodontics, implants and CPR, to business development topics such as communication and technology. Again, an overall theme of leadership could be seen throughout many of the courses with topics covering Practical Leadership, Strategic Leadership, Visionary Leadership, Business Decision-Making and Leadership, and of course the Leadership 101 course.
Networking and Special Events
A number of networking events were held as a means to gather individuals from similar locations and experience. Some well attended events included the New Dentist Reception held for dentists who have practiced for ten or fewer years and a special breakfast reception for the Wisconsin residents. There was also a special buffet luncheon provided for dental students and dentists alike to learn about the Chicago Dental Society’s Mentor Program and there was even a Country Night which offered the musical tunes of a country cover band. In staying with the yearly theme of ‘leadership’, fashion leaders were highlighted at the Fashion Show and Luncheon. The show wrapped up on Saturday with the ever-special President’s Dinner Dance which featured the Chicago Dental Society President Phillip Fijal and the music of the High Society Orchestra.
Reflection
Overall, I found the Chicago Midwinter Meeting to be impressive and inspiring. Throughout my time on the exhibit room floor, I was able to witness dentists old and new, dental students, hygienists, office staff, and even supportive family members taking in all the show had to offer. New skills were learned, new equipment was tested, and new business relationships were made. I look forward to seeing how this show will continue to grow at the 153rd Midwinter Meeting next year which will focus on “A Dental Triad: Pride, Passion, and Professionalism.â€
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.
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 shopâ€, 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.
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.
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.â€
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.â€
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.â€
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 shoppingâ€, 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.
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: 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 engagementâ€, 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:
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 suckâ€. For more information please visit www.klara.com.
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.
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.
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.
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?
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 opioid crisis has taken our nation by storm, claiming an average of 78 victims a day, all of whom lost a vicious battle with opioid addiction. According to the National Governors Association, the current epidemic is being fueled by inappropriate opioid prescribing, as 4 out of 5 heroin users reported misusing prescription opioids before switching to heroin. Now, governors across the United States are taking action against the epidemic with a range of public health and safety strategies that address everything from prevention to treatment to recovery. In order to successfully attack the opioid crisis head on, they’ve decided to create an Opioid Road Map which will act as a tool to outline these strategies for states nationwide.
A Road Map Was Born
The Road Map was developed by the National Governors Association (NGA) to help states respond to the growing crisis of opioid abuse and overdose, as well as strengthen law enforcement efforts and abilities to address illegal activity. The individual state can either follow the road map step-by-step or they can pick and choose which pieces to utilize based on their needs.
The Opioid Road Map is a three-part process as outlined by the NGA:
Step 1 – Assess the Situation
Step 2 – Develop and Select Policies
Step 3 – Finalize Policies, Implement, and Evaluate Results
To develop the Road Map, the NGA worked with 13 states between 2012 and 2015 to create effective statewide programs to battle the opioid epidemic. Input was received from multiple stakeholders including pain specialists, law enforcement officials, health care payers, substance use disorder treatment professionals, and more. Numerous resources were shared in order to build this Road Map and having the ability to optimize and utilize the data collected from state Prescription Drug Monitoring Programs (PDMPs) was key to the Road Map’s creation.
The Role of PDMPs
The PDMPs of individual states is a database that contains controlled substance prescribing and dispensing data submitted by pharmacies and prescribers. This information is used to monitor and analyze all prescribing activity for use in abuse prevention, research and law enforcement. In regards to the Opioid Road Map specifically, the NGA is encouraging states to use their PDMPs as a tool for prescribers to gather real-time information on prescription opioids, and to analyze trends and outcomes associated with policies and programs.
According to the NGA, in order to maximize the use and effectiveness of state PDMPs, the following should be required:
Pharmacists must report to the state’s PDMP within 24 hours of dispensing
PDMP data must be used to provide proactive analyses and reporting to professional licensing boards and law enforcement
PDMPs must be easy to use and PDMP data should be integrated into the Electronic Health Record (EHR)
PDMPs should be interoperable with other states
Since these Prescription Drug Monitoring Programs already exist within forty nine states, it would be beneficial to utilize this data not only for preventing occurrences such as “doctor shopping†(people seeking multiple pain prescriptions from multiple prescribers) and identifying at risk patients, but also for achieving goals put forth by the Road Map in relation to research, law enforcement, and policy reform.
Road Map Expectations
By utilizing the Road Map, states will find background information on the current issue of opioid abuse and which factors are involved with prescription opioid misuse and addiction. They will also have access to the different steps outlined which act as a how-to guide for assessing the situation, selecting policies, and evaluating initiatives. Another item of value they could get from using the road map is a summary of evidence-based health care and public safety strategies to reduce opioid abuse.
By utilizing the Road Map, states will be able to work together to not only brainstorm about how to prevent and respond to the opioid epidemic, but more importantly, they will be able to put a plan into action which will achieve those defined objectives, with the ultimate goal of saving more lives in the process.
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.
Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases that are used to track the prescribing and dispensing of controlled prescription drugs with the intent of helping to detect suspected abuse or diversion. These electronic databases provide important information regarding a patient’s controlled substance history that can be accessed by authorized individuals or agencies including law enforcement, medical examiners, addiction treatment programs, public and private payers, pharmacies, healthcare providers, and more.
All states except Missouri, the District of Columbia, and Guam have enacted PDMP legislation that mandate healthcare providers to record, consult and monitor prescribing data. Since the widespread implementation of PDMPs and corresponding legislations, there have been stories and statistics that seem to indicate success, however, there has also been feedback that indicates some major troubles with these databases and their use.
With PDMPs being utilized all over the country, should we expect a major turn-around in the prescription opioid crisis that is sweeping the nation? Are these databases in fact doing the job that they are intended to do? Or, are there major issues that are preventing their success? Let’s explore together.
The Benefits of PDMPs
PDMPs are considered to be the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk. They are intended to not only medically benefit patient care, but also to serve as a tool for law enforcement and other agencies concerned with opioid-related threats to the public health. This is because the information entered in to a PDMP can help prescribers and pharmacists identify patients at high-risk who would benefit from early interventions.
Further evaluations of PDMPs have demonstrated changes in prescribing behaviors, the use of multiple providers by patients, and decreased substance abuse treatment admissions. From a public health standpoint, PDMPs can be used by state health departments to better understand the current opioid addiction epidemic to better create new intervention methods.
As an example, in 2010, Florida established a PDMP and prevented health care providers from dispensing prescription opioid pain relievers directly from their office. That same year, there was a 50% decrease in oxycodone overdose deaths in the state. This change is thought to represent the first documented, substantial decline in drug overdose mortality in any state during the previous ten years.
Likewise, in 2012, prescribers in New York and Tennessee were required to check the state’s PDMP before prescribing opioids and the following year, New York saw a 75% drop in patients “doctor shopping†and Tennessee saw a 36% drop.
The Unfortunate Reality of PDMPs
Although PDMPs have significant potential to improve public health and patient outcomes, they do have the following shortcomings:
1. Under-Utilization
The inconsistent use, or under-utilization, of PDMPs is considered to be the biggest issue plaguing the database, as a PDMP is most useful when queried before prescribing and most maximized where usage is state mandated. A recent survey found that with physicians prescribing in a state without a PDMP mandate, only 22% were aware of their state’s PDMP, and only 53% had actually used it. These facts clearly indicate that state legislation is a critical success factor for the effectiveness of PDMPs to save patient lives.
2. Lack of Accessibility
Another issue with PDMPs is the ease of use and access, or lack thereof. States vary widely in which user categories are permitted to request and receive prescription history reports and under what conditions. Research suggests that usage may improve if states were to allow providers to appoint non-prescribing staff members to access the database on their behalf.
Furthermore, not all PDMPs share information across state lines. This can lead to important information being missed and can allow at-risk patients to receive more prescriptions for controlled substances than intended. However, more states are realizing the importance of sharing data across state lines and have recently become a part of PMP InterConnect.
3. Varying Times of Information Entry
Another matter of concern with PDMPs is varying times of information entry. When a controlled substance is dispensed to a patient, the prescription and patient information is entered by the pharmacy to the state PDMP. However, this information is entered at varying intervals – hourly, daily, or even monthly. If there is a long interval between dispense and submission times into the state PDMP, users will not have the most up-to-date information on a patient’s most recent prescriptions, thereby eliminating the maximum benefit of a PDMP. Currently, Oklahoma is the only state that collects data in real time, whereas, most states allow up to a week or longer for data submission.
4. Patient Adoption
Many prescribers attribute their worry about a patient’s reaction when checking the PDMP as a major disadvantage. In a recent survey, providers reported a variety of issues that arose when they reviewed the PDMP:
88% of patients reacted with anger or denial when questioned
73% of clinicians said that those angered patients sometimes did not return
22% of clinicians reported that the confronted patients had never asked for help with drug addiction or dependence problems
These clinicians also indicated that the unveiling of this information was not only upsetting to patients, and damaging to practitioner-patient relationships, but was also found to be inaccurate at times.
Additional concerns include added costs of more frequent office visits if prescribers become more cautious about writing prescriptions with refills, feelings of embarrassment when questioned about substance abuse, and patients turning to the illicit drug market if they are refused a controlled substance prescription.
Although the American Medical Association and American Society of Addiction Medicine stress the need to treat PDMP data just as well, if not better, than any other medical record, patients are becoming more vocal in their discomfort with PDMPs, claiming they make them feel that a medical consultation is no longer private.
5. Reluctant Prescribers
Like their patients, prescribers also show growing concern that they will be judged based on PDMP data. While most prescribers are assumed to support interventions to prevent fraudulent prescribing, high profile criminal prosecutions of prescribing large amounts of opioids can make prescribers reluctant to prescribe controlled substances in general for fear of legal retribution, also known as the “chilling effectâ€.
There is also greater perceived legal risk for prescribing or dispensing too much pain medication than for prescribing or dispensing too little pain medication. Because many practicing physicians have little if any formal training that would enable them to identify drug diversion, there is fear that PDMPs may wrongfully suspect and categorize some conscientious and caring physicians as fraudulent prescribers when they are actually prescribing in good faith, but lack training.
What Does This All Mean?
In this era of information technology, PDMPs are likely here to stay. While there are the aforementioned pitfalls of PDMPs, it is important to remember that there are still benefits to PDMPs in the public health sector, law enforcement, and of course, healthcare systems. What may be most helpful is to realize what changes could be made to make the PDMP process an ideal one.
From the standpoint of many prescribers, an ideal PDMP would:
Alert its users to signs of illegal drug use
Be easy to access
Provide real time updates
Be mandatory
Have interstates accessibility
Perhaps over time if these changes were to be made, we would see more consistent use of PDMPs, especially as a tool to help overcome the opioid epidemic. A clear standard of practice against which providers’ care would be judged could also further advance the utilization of PDMPs in each state. Lastly, adequate training on addiction and pain management, along with a careful review of who should access a PDMP, could also attribute to better utilization and help accelerate the acceptance of each states’ prescription drug monitoring programs.
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.
Follow
