A Round Table Discussion: Dental Support Organizations’ (DSO) Views on the Opioid Epidemic, Part II

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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.

A Round Table Discussion: Dental Support Organizations’ (DSO) Views on the Opioid Epidemic, Part I

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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.

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

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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.

The Relationship Between Dental Support Organizations (DSOs) and the Evolving Healthcare Delivery Model

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The significant role of oral health and its contribution to an individual’s well-being has come under scrutiny as of late. In 2014, it was estimated that more than 181 million Americans would not visit a dentist because of several barriers to care, or a self-diagnosis of “my mouth is healthy – I do not need to visit the dentist.” Other reasons noted by individuals not seeing their dentist on a consistent basis were: cost or no insurance, limited dental access in their area or lack of transportation, or they simply did not have the time.

With this data in tow, a more efficient and readily available business model has become increasingly popular within dentistry: Dental Support Organizations.

What is a DSO?

According to the Association of Dental Support Organizations (ADSO), Dental Support Organizations (DSOs) contract with dental practices to provide critical business management and support, including non-clinical operations, and range from small to large size organizations serving dental practices throughout the country.

The business models of DSOs do differ and while the neighborhood family dentist typically treats the general patient population, dental practices supported by DSOs often focus on specific populations. For example, some DSOs are entirely focused on meeting the needs of pediatric patients, while others are focused on more rural populations. This is not to say that DSOs do not serve the general population, as many still do.

The Patient Experience

The true patient benefit of a DSO model lies in the integrated technologies and streamlined processes. DSOs offer patients many time saving benefits including:

• Online appointment booking systems
• Online bill pay
• Flat rate appointments
• Flexibility to visit dentists between multiple offices
• Electronic prescription routing

Dental Infographic by Dental Care Alliance

The Role of Technology Within DSOs

DSOs are at the forefront of technology, both from a clinical and administrative standpoint. They pride themselves on remaining innovative, not only to better treat their patients, but to also have a competitive advantage and to attract and maintain new dentists. From billing software to detailed patient charting to specific treatment mechanisms, technology is embedded in nearly every workflow.

While many DSOs have thrown out their dentists’ paper prescription pads and have adopted electronic prescribing (e-Prescribing) software, there is still plenty of room to grow. e-Prescribing software provides dentists with the ability to send non-controlled and controlled prescriptions electronically directly to the patient’s pharmacy which adds convenience to the patient’s experience.

In addition to the prescription writing feature, e-Prescribing includes high value functionality for the dentist, patient and management teams such as:

• Insight into a patient’s current medication regimen.
• Ability to check for drug-to-drug and drug-to-allergy interactions at the point of care to help improve treatment decisions.
• Reporting capabilities that share what is prescribed and in what quantities to assess for in regards to compliance. This is especially crucial with the current opioid epidemic and having the ability to track prescriptions for controlled substances.
• Documentation for both the dentist and the patient including dental specific dosing information, as well as medication monographs.

What’s Ahead for DSOs

DSOs are continuing to shake up the dental industry. New DSOs continue to emerge, while existing ones are frequently acquiring new dental practices, therefore expanding and continuing to growing throughout the country. As previously discussed, cost and limited access to care were the most popular barriers, but DSOs offer streamlined solutions for both barriers as they are committed to the improvement of oral health in the United States through the accessibility of high-quality dental care. It is only a matter of time before more and more dentists hop on board.

Sources: American Dental Association; Association of Dental Support Organizations (ADSO); ADSO Whitepaper; National Institute of Dental and Craniofacial Research; Centers for Disease Control and Prevention; Dental Care Alliance

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.

Nuts and Bolts of e-Prescribing: The Tools You Need to Get Started

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Now that you’re well-versed in the world of e-Prescribing, let’s go one step further and prepare you for your own health care software’s e-Prescribing journey.

Here are some helpful tools to get you started.

Integration Tool Kit

The DoseSpot e-Prescribing Integration Tool Kit reviews everything you need to know about e-Prescribing integrations and what a partnership with DoseSpot e-Prescribing entails. Specifically, you will learn:

• DoseSpot’s e-Prescribing Integration Platforms: Integration JumpStart and Integration Plus+
• The markets we serve: Medical, Dental, and Digital Health
• Development features, functionality, and API
• Integration project cycles
• The benefits of partnering with DoseSpot

Get your copy here.

How to Prepare Guide

With more than 150 e-Prescribing integrations under our belt, we know a thing or two about what an e-Prescribing integration requires. In our How to Prepare Guide, we take the guesswork out by providing you with the following information:

• Specific patient demographic requirements
• Character limits and field requirements
• How to correctly transmit patient demographic information from your health care software to DoseSpot

Get your copy here.

Need more information? Feel free to schedule a meeting with us!

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

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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 101, Part III: End Users

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As we discussed in our previous post, e-Prescribing is the electronic transmission of a prescription from the prescriber’s device to the patient’s pharmacy of choice, therefore replacing the traditional paper prescription.

How does e-Prescribing work for end users?

While e-Prescribing software comes in many shapes and sizes, e-Prescribing integration is directly integrated into healthcare software such as an Electronic Health Record / Electronic Medical Record, telehealth application, or dental practice management solution. By way of integrating e-Prescribing into a healthcare software, the e-Prescribing platform becomes an integral component of a healthcare software’s product offering.

e-Prescribing integration seamlessly allows a prescriber to log into their existing healthcare software, select a patient, then search for, enter and send an e-Prescription for the patient in a few short steps. The process saves the prescriber time while improving patient outcomes.

What are the benefits of a custom, white labeled solution?

When an e-Prescribing solution is “white labeled”, this means the e-Prescribing user interface mirrors the look and feel of the healthcare software in which the e-Prescribing solution has been embedded. Colors, fonts, font sizes, layout – you name it – can all be completely customized to provide a seamless experience for end users.

Furthermore, mobile optimization has become a major trend as more healthcare software solutions are operating in the cloud and prescribers are accessing applications from multiple devices and multiple locations. This is why it’s important that the e-Prescribing functionality performs well in different environments, but most importantly, on smaller screens.

Responsive design is critical in ensuring that any e-Prescribing solution is accessible on every device. It’s the best one size fits all solution as this type of design allows the webpage to expand and contract in order to perfectly fit within any screen in both the traditional office and mobile settings. Ultimately, responsive design cuts down on development time as the e-Prescribing user interface does not need to be adjusted manually for each type of device (i.e. mobile, tablet, laptop, or desktop).

What does it take to cross the finish line and go live?

To go live with e-Prescribing and be able to send prescriptions electronically, all healthcare software companies must go through a Surescriptsâ„¢ e-Prescribing integration review. Surescripts operates the largest health information network that connects the diverse and expansive community of care partners nationwide, including pharmacies, providers, benefit managers, and health information exchanges.

As part of this e-Prescribing integration review, healthcare software companies will have to successfully execute various test scenarios during a web meeting with Surescripts. Test scenarios will be provided for the following services:

• NewRx: Route new prescriptions to the patient’s pharmacy of choice
• Refills: Receive prescription renewal requests and submit responses between doctor and pharmacy
• Medication History: View aggregated medication history data from pharmacies and pharmacy benefit managers (PBMs) upon receipt of patient consent.
• Prescription Benefit: Surescripts’ Prescription Benefit service puts eligibility, benefits and formulary information at a prescriber’s fingertips at the time of prescribing. This enables prescribers to select medications that are on formulary and are covered by the patient’s drug benefit.
• Electronic Prescribing of Controlled Substances (EPCS): Product has achieved Surescripts EPCS certification and has provided third-party audit documentation as required by the DEA.

Upon completion, healthcare software companies will be listed on the Surescripts website.

Healthcare software companies also looking for the ability to Electronically Prescribe Controlled Substances (EPCS) will need to go through a similar testing process with an approved e-Prescribing of Controlled Substances auditor such as the Drummond Group Inc., one of the first DEA approved certification bodies for EPCS.

Learn about DoseSpot’s e-Prescribing integration process by downloading our latest Integration Tool Kit.

Don’t miss the other parts of our e-Prescribing 101 series:

e-Prescribing 101, Part I: The Basics

e-Prescribing 101, Part II: Controlled Substances

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 101, Part II: Controlled Substances

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To continue our e-Prescribing 101 blog series, we shine light on controlled substances. What they are, their relationship to e-Prescribing, as well as the correlation between prescription drugs and the current opioid epidemic.

What is a controlled substance?

A controlled substance is a drug or chemical, such as illicitly used drugs or prescription medications, that is regulated by a government based on the drug or chemical’s manufacture, possession, or use.

Why are certain drugs categorized as a controlled substance?

A drug is typically classified as “controlled” due to the potential detrimental effects on a person’s health and well-being. As a result, state and federal governments have seen fit to regulate such substances.

It’s for this reason that drugs, substances, and certain chemicals used to make drugs of this caliber are classified into five categories. The drug segregation is dependent upon the drug’s acceptable medical use and the drug’s abuse or dependency potential.

What are the medication schedules for controlled substances?

Schedule I

• Drugs with no currently accepted medical use and hold a high potential for abuse.
• Examples: Heroin, Marijuana (Cannabis), LSD, and Ecstasy

Schedule II

• Includes drugs that are accepted for medical use, but have a high potential for abuse, with use potentially leading to severe psychological or physical dependence.
• Examples: Vicodin, OxyContin, Adderall, and Ritalin

Schedule III

• Drugs with a moderate to low potential for physical and psychological dependence, with less abuse potential than Schedule I or Schedule II drugs.
• Examples: anabolic steroids, testosterone, and Tylenol with codeine

Schedule IV

• Drugs within this category have a low potential for abuse and dependence.
• Examples: benzodiazepines (Xanax, Valium, Ativan), Tramadol, and Ambien

Schedule V

• The lowest schedule for controlled substances, these drugs have lower potential for abuse and consist of preparations containing limited quantities of certain narcotics.
• Examples: Robitussin AC, Lyrica, and Motofen

What is EPCS?

EPCS stands for the Electronic Prescribing of Controlled Substances and is a technology that has been put into place to help address the rising issue of prescription drug abuse in the United States.

Understanding two-factor authentication

This two-step process is part of EPCS and ensures that only an authorized prescriber can electronically sign and send controlled substance prescriptions to a pharmacy, thus increasing patient safety. The process includes the entry of something you have, such as a token generated one-time code, and something you know, like a password. There are various options for two-factor authentication including: fob tokens, mobile phone applications, smart cards, USB thumb drives, and fingerprint scanners.

What is an opioid?

Opioids are substances that act on the body’s opioid receptors to produce euphoric effects, better known as a “high”, and are most often used medically to treat moderate to severe pain that may not respond well to other pain medications.

Why are opioids so addictive?

Opioid drugs work by binding opioid receptors in the brain, spinal cord, and other areas of the body to reduce the sending of pain messages to the brain, thus simultaneously reducing the physical feelings of said pain. They create artificial endorphins, the body’s natural painkillers, which tap into the “reward” sector of someone’s brain. However, with chronic use, opioids eventually trick the brain into stopping the production of these endorphins naturally. In doing so, the tolerance level increases and a patient is left with taking more medication to achieve the same effect.

They are most dangerous when taken in certain ways to increase the “high”, such as crushing pills and then snorting or injecting the powder, or combining the pills with alcohol or drugs, especially benzodiazepines. While some patients do take them for their intended purpose, they can still risk dangerous adverse reactions by not taking them exactly as prescribed, i.e. they take more at one time, or combine them with other medications not checked by their doctor.

Unfortunately, the fear of the intense withdrawal symptoms is often the biggest culprit when it comes to patients remaining addicted and ultimately leads them to continue taking the medication even if they no longer want to.

The correlation between prescription opioids and the opioid epidemic

In 2012 alone, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills. In comparison to ten, even five years ago, this number is dramatically increasing as time goes on and more and more opioid overdoses are being reported on a daily basis.

Physicians and dentists are collectively responsible for providing 81.6% of opioid prescriptions in the United States and because of this, they have a very unique role in mitigating the impact of this opioid epidemic. Opioid addiction often starts at the hands of healthcare professionals simply trying to do their job, prescribing pain medications to relieve their patients of painful woes, especially during post-operative recovery.

While many prescriptions are meant for initial, short-term treatment, some doctors and dentists authorize refills time and time again because they want to help patients whom claim that they are still in pain. However, when the pill bottle and refills run out, patients are left seeking alternatives to create that euphoric escape they’ve become so accustomed to. This could mean an endless search of several different doctors to prescribe more substances (also known as doctor shopping), purchasing pills on the black market, or worse, turning to heroin as a cheaper and more readily available alternative.

Furthermore, the associated stigma often deters patients from receiving proper rehabilitation treatment and even if they do seek treatment, the government currently limits the number of patients a single provider may treat with drugs such as buprenorphine or methadone, which are both proven to reduce cravings and save lives. This leads to many patients relapsing.

How does e-Prescribing help?

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

Don’t miss the other parts of our e-Prescribing 101 series:

e-Prescribing 101, Part I: The Basics

e-Prescribing 101, Part III: End Users

Sources: DEA; DrugAbuse.gov; FDA

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 101, Part I: The Basics

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Another year has come and gone. Time to start fresh, gain new perspective, and bring it back to basics. e-Prescribing basics, that is.

During our reflection on 2016, the DoseSpot realized that there’s so much information out there regarding e-Prescribing and its different components; so many key opinion leaders and incredible resources to tap into to help educate the world about e-Prescribing. However, how could we make it easier? How can we assist those who just want to learn more about e-Prescribing in general without the endless Google searches?

That’s why we decided to create a three-part blog series covering all e-Prescribing basics; a one-stop-shop to answer all of your e-Prescribing questions and curiosities.

We can promise you this – this is one New Year’s resolution we won’t give up on.

Let’s get started.

What is e-Prescribing?

The term e-Prescribing has become a popular buzzword in the healthcare industry, but what exactly does it mean? To put it simply, electronic prescribing, known in short as e-Prescribing, is a method of prescription transaction that allows prescribers to write and send prescriptions to pharmacies electronically instead of writing, phoning-in, or faxing. It ultimately replaces the costly paper prescription pad and tamper-proof printing paper from a prescriber’s office for good.

e-Prescribing solutions have the following capabilities:

• NewRx: Route new prescriptions to the patient’s pharmacy of choice.
• Refills: Receive prescription renewal requests and submit responses between doctor and pharmacy.
• Medication History: View aggregated medication history data from pharmacies and pharmacy benefit managers (PBMs) upon receipt of patient consent.
• Prescription Benefit: Surescripts’ Prescription Benefit service puts eligibility, benefits and formulary information at a prescriber’s fingertips at the time of prescribing. This enables prescribers to select medications that are on formulary and are covered by the patient’s drug benefit.
• Electronic Prescribing of Controlled Substances (EPCS): Product has achieved Surescripts EPCS certification and has provided third-party audit documentation as required by the DEA.

What are the benefits?

e-Prescribing is not just the ability to send prescriptions electronically to pharmacies. It can also increase care quality in a number of ways:

• Eliminates the time and effort of trying to understand the prescriber’s handwriting, as well as the chance of an error in that translation.
• Makes sure that the prescriber is providing enough specific information for the pharmacist to fill the prescription, including the name of the drug, the dosage, its physical form, the route, and the prescriber’s instructions.
• Ensures that any drug-drug and drug-allergy interactions based on a patient’s medication history are found and reported to the prescriber before the prescription order is completed.
• Checks a patient’s pharmacy benefit and associated formulary at point of care to encourage the prescriber to choose the best medication option, both medically and financially.
• Increases 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 once patients see how much it will cost.
• Drives down healthcare costs and improves patient satisfaction by getting medications to patients in a timely, convenient, and secure manner at the patient’s pharmacy of choice.
• Curbs prescription drug abuse and increases patient safety. No longer will a patient have access to a paper prescription, therefore no more altered dispense quantities, stolen prescription pads, or lost or duplicate prescriptions.
• Lowers costs associated with purchasing expensive paper prescription pads and the time and resources spent on redundant administrative tasks.
• Simplifies clinical workflows and allows prescribers to do what they do best and spend more time with their patients.

Who can e-Prescribe?

State or provincial legislation governs who can write a prescription, and under these rulings, any licensed physician, dentist, nurse practitioner, etc. allowed to write prescriptions by hand can also prescribe electronically.

Many electronic prescribing vendors also allow the use of proxy users, such as nurses, medical assistants, or office staff. While they cannot legally send a prescription to a pharmacy, they are able to access the e-Prescribing solution and fill in all required fields of the prescription for a prescriber to then approve and send.

What pharmacies allow e-Prescribing?

All 50 states and D.C. allow the e-Prescribing of both controlled and non-controlled substances and more than 90% of pharmacies can receive e-Prescriptions. Of course this includes the larger retail pharmacy chains such as CVS and Walgreens and mail-order pharmacies like Catamaran and Express Scripts.

Don’t miss the other parts of our e-Prescribing 101 series:

e-Prescribing 101, Part II: Controlled Substances

e-Prescribing 101, Part III: End Users

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.

Addressing Dentistry’s Role in the Opioid Epidemic

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Unfortunately, the opioid epidemic that is currently grappling the United States isn’t exactly news. Headlines appear on a daily basis in regards to this addiction, the overdoses and fatalities, as well as the healthcare community’s contribution to this crisis, both the good and the bad.

We’ve seen Congress, the Surgeon General, and many other organizations make extreme efforts to combat this crisis, yet despite the widespread media attention, many healthcare professionals still don’t realize how dangerous the drugs can be or how addictive they are.

DoseSpot recently conducted a live webinar in an effort to educate and discuss the critical role that dentists in particular play in mitigating the current opioid epidemic that is upon us and during that time, the following crucial points were made:

The blame game needs to stop

Blaming others only diverts the necessary action of collectively coming together as a nation, regardless of one’s associated industry. Healthcare, Law Enforcement, Politics – there needs to be a strong, unified foundation for which we can assemble and fight this battle together.

Break the habit: prescribing patterns of pain medication

Dentists serve a unique role in overcoming this epidemic due to the nature of their work and the procedures they perform, specifically wisdom teeth extraction. It’s a fair statement that the majority do not enter the healthcare industry with ill intent of harming their patients, yet it’s also fair to say that lack of proper education and prior pharmaceutical marketing tactics have fueled poor prescribing patterns. In order to change one’s behavior, programmed thoughts and approaches must be reevaluated.

Opioid addiction does not discriminate

This addiction can affect anyone regardless of one’s socioeconomic status or in some cases, a person’s relationship to their dentist. What DoseSpot coins as “The Insider Threat,” we reveal how certain folks pose a potential risk relative to obtaining controlled substances, both knowingly and secretively. Stories of addiction that are shared during our recent webinar further prove that opioids do not discriminate.

Solutions are available

The truth of the matter is, there is not one single solution that can work independently. It needs to be a collective effort and innovation is critical to success. There needs to be multifaceted solutions to tackle this complex problem ranging from increasing specialty training and education to proper treatment technology, data, and analytics.

To learn more on dentistry’s role in the opioid epidemic, watch the full webinar here.

Presenters:

Greg Waldstreicher, CEO, DoseSpot

Dr. John Zweig, Chief Dental Officer, Dental Associates

Donald Whamond, Chief Technology Officer, Dental Associates

Jason Wolan, Director of EHR Implementation, Great Expressions Dental Centers

Daniel Smelter, Director of Business Analysis, Benevis, Inc.

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.