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.

What the NFL Can Teach Us About Health Care Interoperability

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

Let me explain.

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

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

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

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

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

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

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

1. Technology is Crutch for Game Time Success

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

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

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

2. Make Smarter Game Time Decisions

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

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

3. There Is No “I” in Team

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

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

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

So, what does this all mean?

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

Sources: NFL Operations; Modern Healthcare; EHR Intelligence

About DoseSpot

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

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

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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.

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.

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

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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

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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.