Through an Attendee’s Lens: Chicago Dental Society Midwinter Meeting Recap

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 Again”, 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.”

Author: Lindsey W.

Sources: Chicago Dental Society; Chicago Dental Society Facebook; Chicago Dental Society Honorees

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.

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

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.

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

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.

Opioid Road Map: How the Government Plans to Battle the Opioid Epidemic by Utilizing PDMPs

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:

• Prescribers should be querying PDMPs before prescribing Schedule II, III, IV controlled substances
• 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.

Author: Shannon K.

Sources: National Governors Association; NGA Road Map Outline; GCN 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.

5 Shortcomings You Need to Know About Prescription Drug Monitoring Programs (PDMPs)

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.

[Read: The Link Between PDMPs and e-Prescribing]

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.

[Read: 3 States Laying Down the Law on Opioids]

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 effect”.

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.

Author: Lindsey W.

Sources: Centers for Disease Control and Prevention; Lynn Webster MD; PDMP Assist; Wolters Kluwer; Shatterproof; National Center for Biotechnology Information

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.

Don’t Get Tripped by ROPES: A How-To Guide Highlighting What Prescribers Need to Know When It Comes to New York’s e-Prescribing Registration and Renewal Process

If you are a prescriber in the state of New York, you probably know by now that electronic prescribing (e-Prescribing) of both controlled and non-controlled substances has been mandatory since March 27, 2016. As part of this mandate, all prescribers who will be sending controlled substances are required to register their e-Prescribing software as well as report to the controlled drug registry each time a controlled medication is prescribed or dispensed. In order for users to access the registry, the prescriber must first create an online Health Commerce System (HCS) account. Once the HCS account is active, the prescriber can then access ROPES to register their certified electronic prescribing software application for controlled substances.

The good news is that applying for an HCS account is as easy as filling out an online form and having a New York State driver’s license (or photo ID).

Applying for an HCS Account

Requirements: New York state valid driver’s license or photo ID and New York State Education Department registered medical professional license

To apply, you will need to access the following page: https://apps.health.ny.gov/pub/top.html

After you have applied and have been granted an HCS account, you will be able to sign back in via this link: https://commerce.health.state.ny.us

You may also use the following link as a reference to see in full detail a direct guide of the application process: https://apps.health.ny.gov/pub/ctrldocs/paperless_docp.pdf

In addition to requiring an account in the Health Commerce System (HCS), if prescribers intend to order controlled substances electronically, they will also need to register their certified electronic prescribing application software with the New York State Department of Health, Bureau of Narcotic Enforcement (BNE). This is done by filling out a ROPES form online through an HCS account.

What is a ROPES form?

A ROPES form is a new online application that allows the practitioner/organization to renew their registration for the Official Prescription Program and register their certified electronic prescribing software application for controlled substances. ROPES stands for Registration for Official Prescriptions and E-prescribing Systems. Only the prescriber can access the ROPES application.

Pre-requisite Requirements for ROPES

• Prescriber must be already registered with the Official Prescription Program (OPP)
• Prescriber must have an active DEA registration
• Prescriber must have an active NY license
• Prescriber must NOT be a registered Physician Assistant (PA) – PA’s must continue to submit the OPP registration form (DOH-4329) along with the PA Authorization Form (DOH-5054) to renew their OPP registration.

Completing the ROPES Form

In order for a prescriber to fill out a ROPES form, he/she must log into his/her HCS account (outlined above) by accessing the following weblink: https://commerce.health.state.ny.us and following the next few steps:

• Select “my content” at the top of the page
• Scroll down and select “All applications”
• Scroll over and select “R”
• Scroll down and select “ROPES” and complete the form

The ROPES form requires that the prescriber identifies the third party audit certifying organization and the date of the third party audit. Keep in mind that it is the software vendor that must be certified not the prescriber. The software vendor will supply all necessary information about this certification to the prescriber. The ROPES form must be renewed every two (2) years in order to remain valid. The prescriber must renew their OPP registration first via the one step process prior to renewing their current ROPES registration.

Questions?

Any questions regarding the ROPES form or the process can be directed to the BNE at narcotic@health.state.ny.us or by calling 1-866-811-7957.

For prescribers utilizing DoseSpot who have questions regarding the ROPES required third party audit information, please contact DoseSpot support at 888-847-6814.

Author: Shannon K.

Sources: Practice Fusion; New York State Dental Association; New York State Department of Health

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 7 Benefits of e-Prescribing for the Dental Community

The role of oral health and its contribution to the population’s overall health, as well as the nation’s bottom line, has been in frequent discussions lately. With advocated access to dental care by a number of entities, governments and foundations, patients now understand that visiting their dentist is much more than receiving that fresh, clean feeling. It’s improving their quality of life.

However, with the ever increasing numbers of dentists and patients, along with Dental Support Organizations (DSOs) gaining significant prominence in the industry, the practice of dentistry is becoming more and more competitive. Patients now have more options to choose from when selecting their dentist and several factors weigh on their decision.

To align with this market shift, what is one component that the dental community can implement with ease to enhance their competitive advantage and attract and retain more patients? Or better yet, increase patient satisfaction, efficiency, and revenue, while simultaneously decreasing risks for dentists?

The solution: e-Prescribing.

Electronic Prescribing, known in short as e-Prescribing, has become a pertinent technology within dental practices that addresses the above conflicting goals. By incorporating e-Prescribing into the dental workflow at the point of patient engagement, several inherent efficiencies are presented:

1. Medication History

During a patient and dentist encounter, e-Prescribing enables dentists to verify a patient’s medication history and view up to two years of prescribed medications. This level of transparency allows for smarter treatment decisions and recognition of a patient who may be “doctor shopping” for controlled substances.

2. Safety

From a safety perspective, any drug-allergy or drug-drug interactions are flagged instantaneously while the clinical judgement of the dentist is still maintained if he/she elects to prescribe the medication. Dental-specific information such as a medication’s particular dental use, effects on dental treatment, and effects on bleeding are all seamlessly provided at point of care as well.

3. Productivity

With e-Prescribing, the totality of time to write a prescription for the patient is reduced from the traditional manual paper method, resulting in more time for direct interaction with the patient. The intrinsic productivity of e-Prescribing and its resulting patient interaction time may lead to incremental revenue as the opportunity is presented to discuss other dental issues and procedures.

4. Quality

Assessing e-Prescribing from a quality perspective, patient outcomes are significantly more accurate, consistent with quality initiates practiced in industry. It is getting it right the first time. As healthcare in general shifts to more measured and predictable patient outcomes, e-Prescribing goes a long way in addressing this new dynamic as it assists in providing a full panoramic view of a patient’s health.

5. Risk Reduction

Another benefit of e-Prescribing is risk reduction, especially when it comes to prescribing controlled substances. When controlled substances are electronically prescribed, the patient cannot lose the prescription or alter the dispense quantity or the medication itself. The prescription will be sent directly to the pharmacy with no chance of intermediaries touching it. In turn, this also banishes the need for paper prescription pads, thus eliminating the risk and liability involved with stolen prescription pads.

6. Patient Satisfaction

Perhaps the most significant aspect of the e-Prescribing equation is the increase in patient satisfaction. The extra time spent on dropping off and waiting for a prescription to be filled at the pharmacy is essentially eliminated as e-Prescribing diminishes the middle man and creates a seamless transaction for the patient.

7. Profitability

Due to improved efficiencies and increased patient satisfaction with e-Prescribing, a snowball effect is created relative to rising revenue. Not only will an increase in patient volume and retention occur, but administrative duties for office staff will lessen. Thanks to the more cost-effective vehicle of e-Prescribing, there will be no staff time required to manage the ordering and stocking of costly paper prescription pads and tamper-proof printing paper for controlled substances.

Overall, e-Prescribing is one tool in the dentist’s arsenal to meet the challenges of practicing dentistry today, which will allow for a more patient-centric strategy to be implemented, resulting in happier patients and dentists!

Author: Mark H.

Sources: Science Direct; Deming; Surescripts

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.

e-Prescribing of Controlled Substances – How Does Your State Measure Up?

Navigating the waters of e-Prescribing can seem like a very daunting task considering the various state and federal regulations. To assist you in understanding, let’s review the information relative to e-Prescribing of Controlled Substances (EPCS) in all 50 states and how your state is measuring up.

Until recently, one-half of all U.S. States prohibited e-Prescribing of controlled substances. The thought was that paper prescriptions were safer and more secure. On September 15, 2015, however, Vermont became the last state to allow electronic prescribing of controlled substances, or Schedule II-V medications, making this process legal in all 50 U.S. states.

“We certainly believe that because of the enhanced security associated with e-Prescribing of controlled substances, the opportunity for abuse, misuse, and fraudulent activity is going to be dramatically reduced,” said Ken Whittemore, BSPharm, MBA, Senior Vice President of Professional and Regulatory Affairs at Surescriptsâ„¢, a nationwide health information network.

With this process now legal in all 50 states, and the safer option at that, it may be surprising to find that as of the most recent data available, only 7% of prescribers are sending controlled substances on the Surescripts network.

So, why the discrepancy? Are pharmacies not accepting electronic prescriptions? Are prescribers not able, or willing, to send these prescriptions electronically? Is this process too difficult? Why is this process used in some states so heavily, but so infrequently in others?

Pharmacies are ready!

In 2010, the DEA published a final ruling giving not only practitioners the option to write controlled substances electronically, but also for pharmacies to receive, dispense, and archive electronic prescriptions.

“It became incumbent upon a number of stakeholder groups in the pharmacy industry to tackle the issue and bring states into alignment with the DEA’s rule,” Ken Whittemore, BSPharm, MBA told Pharmacy Today.

Many pharmacy stakeholder groups, including APhA, the National Alliance of State Pharmacy Associations (NASPA), the National Association of Chain Drug Stores, and Surescripts, worked together over a 5-year period to rework some state laws, a process that can take a long time. Between 2010 and 2015, the pharmacy end of the spectrum worked hard on adoption and enablement, while prescriber enablement trailed. Using data from Surescripts, a study published in the January 2015 American Journal of Managed Care found that pharmacies with technology in place to accept e-Prescriptions for controlled substances increased from 13% in 2012 to 30% in 2013. By contrast, only 1% of all prescribers were capable of e-Prescribing controlled substances in 2013.

However, between 2012 and 2013, the number of e-Prescriptions for controlled substances grew dramatically from 1,535 to 52,423. Talk about a rapid jump!

According to the 2015 Surescripts National Progress Report, an average of 81% of pharmacies were enabled for EPCS in 2015. States including Hawaii and Mississippi were at the bottom of this list with less than 70% of pharmacies enabled, while states in the Northeast such as Massachusetts, New York, New Hampshire, and Rhode Island led this list with over 90% of pharmacies enabled for EPCS.

As of December 1, 2016, these numbers have only risen, with both Hawaii and Mississippi now having over 75% of pharmacies enabled. New York and Maine lead the race on that front with 96.8% and 95.2% of pharmacies enabled currently. This is in large part due to the state mandates put into place in 2016 and 2017, respectfully.

How about the prescribers?

With so many pharmacies enabled for EPCS, and legislature allowing this process in all 50 states, it may be surprising to know that an average of 3.39% of prescribers were enabled to e-Prescribe controlled substances according to the 2015 Surescripts National Progress Report.

Lengthy and time-consuming software auditing and prescriber identity proofing processes are likely factors that have stalled prescriber adoption of EPCS, but for pharmacists, the initial setup is much easier. In addition, there have not been enough incentive for prescribers to adopt EPCS.

e-Prescribing was a requirement under the federal Meaningful Use Electronic Health Record (EHR) program, which incentivizes the use of EHRs through financial payments. However, e-Prescribing of controlled substances was specifically exempted from Meaningful Use Stages 1, 2, and 3. For these reasons, it isn’t surprising that in 2015 the state with the highest number of prescribers enabled was New York, as that was one of the only states with an e-Prescribing state mandate in effect at that time.

In 2015, New York had 26.6% of their prescribers enabled for EPCS, with Nebraska not far behind at 15%. Fast forward to December 1, 2016 and prescriber enablement has grown tremendously in some states, but remain dismally low in others. New York now has 71.5% of prescribers enabled, with no other state having even one-third of their prescribers enabled for EPCS. In fact, the average percentage for EPCS enabled prescribers remains even as of December 1, 2016, at only 8.4% despite all of the benefits of EPCS.

Why are these numbers so varied?

Electronic prescribing of controlled substances (EPCS) reduces fraud and keeps patients from getting multiple prescriptions for the same drug, so why are some states seeing major buy-in while other states are lagging? Much of this is impacted by states that have legislation in place to either require or reinforce the use of e-Prescribing, as outlined below.

Minnesota

Minnesota was the first state to implement an e-Prescribing mandate in 2008 in order to improve quality outcomes and efficiency in health care. The state mandate required prescribers, pharmacists, pharmacies, and pharmacy benefit managers (PBMs) to be up and running with e-Prescribing by January 1, 2011, however, only 13% of prescribers are actually enabled for EPCS as of late. Could this be because legislation doesn’t enforce its own law or penalize prescribers for not adhering to this legislature? Marty LaVenture, director of the Minnesota Office of Health IT and e-Health, seems to agree and notes, “policy levers could be used to encourage full adoption and use of e-Prescribing capabilities.”

New York

As you may already know, New York was the first state to require e-Prescribing of all prescriptions, both controlled and non-controlled, and the first to implement penalties for failing to adhere to this ruling. Penalties include, but are not limited to, loss of license, civil penalties, and/or criminal charges. With the highest rate of prescriber EPCS enablement, it’s evident that New York prescribers are taking this quite seriously.

Maine

Maine is the next state to implement an e-Prescribing regulation as of July 1, 2017 where all opioids prescriptions must be sent electronically. With only 0.6% of prescribers enabled for EPCS in the state according to the Surescripts report, and up to 2.9% as of the beginning of December 2016, it’s clear that Maine has a long way to go for all prescribers to be ready to follow this regulation.

In Summary

Although it’s legal in all 50 states, and there are many reasons EPCS is safer than on paper or another method, there is still a great discrepancy between EPCS enabled pharmacies and EPCS enabled prescribers due in part to the strict requirements put in place on the prescribers. While the statistics referenced here show that provider adoption of EPCS is still low in comparison to the pharmacy adoption we have seen, it’s important to remember that the e-Prescribing of non-controlled substances also took years to reach the level we now see today. It seems the only tried and true way for these numbers to rise quickly and meet the numbers we currently see for pharmacy enablement is to implement regulations and penalties for not adhering to this requirement as outlined in the above state mandates. All eyes are now on Maine to see how their journey goes.

Check out the maps below to see how your state measures up!

Author: Lindsey W.

Sources: American Pharmacists Association; USA Today; Surescripts 2015 National Progress Report; Surescripts EPCS; Minnesota Department of Health; Maine Medical Association; e-Prescribing Blog; CMS

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 to more than 150 health care software companies since 2009. For more information, please visit www.DoseSpot.com.

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

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:

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.

Climbing the Ladder to Success: An Evening with the Power Women of Health IT

On Monday, November 7, 2016, Health 2.0 Boston held a panel discussion with three of 2016’s 75 Most Powerful Women in Healthcare IT named by HealthData Management and the DoseSpot team was fortunate to be in attendance. The three influential women brought up many interesting points and offered inspiring words of wisdom to the crowd, the majority of which were females. Although the event was structured with prepared questions for the panelists, these power women provided answers that were honest, open and personal, thus creating a comfortable and therapeutic-like atmosphere. This event navigated the different paths that were taken by each of the female leaders and highlighted the trials and tribulations that they encountered while on the rise to success in a primarily male-driven industry.

The Panel

• Helen Figge, PharmD, MBA, FHIMSS – SVP, Global Strategic Development, LumiraDx, Inc.
• Sue Schade, MBA, LCHIME, FCHIME, FHIMSS – Principal, StarBridge Advisors
• Cara Babachicos – Corporate Director/CIO, Community Hospitals at Partners Healthcare

Here are DoseSpot’s key take-away points from the panel discussion:

Culture

All three Health IT leaders agreed that when it comes to the topic of company culture, it is not only important to be a part of a workplace where women are valued, but also to be part of a workplace where women have the ability to flourish and be the competent employee they worked and studied so hard for. Cara Babachicos, specifically, mentioned that internal happiness and success are the most important components of one’s career and the company someone works for should be promoting those components. It is one thing to be qualified for a position, yet another to be the right fit. Consistently evaluating if you are the right fit for a specific position or company is crucial in your path to success.

Mentorship

Are mentors a necessity to rise to the top? All three women agreed that it is not necessarily a career killer if one does not have a mentor. However, being able to navigate and find someone whom you can model after is going to immensely help on your career journey.

Helen Figge mentioned that even if you don’t have a mentor per se, you can still find a particular skill(s) in someone that you can model yourself after and learn from, as long as you don’t set boundaries for yourself of who you could one day become.

Another interesting point made was that a mentor doesn’t necessarily have to be a person you WANT to be; it can be a person who makes you realize who you DON’T want to be. Lessons can be learned from all types of people, of all different backgrounds, personalities and roles.

Rising Above

Each one of the ladies on the panel highlighted the largest obstacle they were required to overcome in order to become who they are today. Helen, who addressed a disability she has experienced her whole life, had to adjust and overcome many challenges to work harder in school and in her career. She courageously saw past her physical obstacle to see the trajectory of what she wanted to be in the long run. Her advice? Like yourself. No matter what.

Cara’s biggest obstacle was having patience. As with building anything great or influential, it takes time. Her advice was to be more patient with yourself and your life, both personally and professionally. Eventually, all of the pieces will come together.

Lastly, one of Sue’s greatest obstacles was dealing with bullying behavior from colleagues, primarily men back in the 80’s when a woman with authority in IT was a rarity. She made it clear to always be willing to speak up for yourself and make sure your superior is aware of what is going on in the workplace, even if stepping up is the hardest thing to do. As a leader of hundreds of employees, she further pointed out that she may not know everything that’s going on in her department. An employee may act differently in front of leadership than they do in front of their peers.

Words of Wisdom

The three power women of health IT left us with a few final points to think about when climbing the career ladder of success:

Speak Up! – Stand up for yourself and for what you deserve, even if it may feel uncomfortable.

Know Your Stuff – Constantly challenge yourself and learn new things. Be an overachiever. Success comes to those who work for it!

Don’t Question Yourself – Even if you feel nervous or anxious, strive to be authentic and confident in everything you do.

Trust Your Gut – If you have to question something, always do what’s right for the organization. Your company will thank you for it.

And finally, at the end of it all: Always do what’s right for you.

About Health 2.0

The Boston Chapter of Health 2.0 is a part of the national Health 2.0 organization, which is the premiere showcase and catalyst for the advancement of new health technologies. Through a global series of conferences, developer competitions, and leading market intelligence, Health 2.0 drives the innovation and collaboration necessary to transform health and health care. For more information, please visit: www.bostonhealth20.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.