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.

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

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

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

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

Taking the First Step: Minnesota Mandate

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

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

Reinforcement of the Mandate, or Lack Thereof

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

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

Some Considerations

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

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

Author: Shannon K.

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

About DoseSpot

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

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

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

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

Pennsylvania

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

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

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

Connecticut

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

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

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

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

Virginia

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

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

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

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

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

Where do other states stand?

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

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

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

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

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

About DoseSpot

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

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

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Video courtesy of CBS Los Angeles

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

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

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

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

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

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

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

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

Author: Mark H.

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

About DoseSpot

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

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

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Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases that are used to track the prescribing and dispensing of controlled prescription drugs with the intent of helping to detect suspected abuse or diversion. These electronic databases provide important information regarding a patient’s controlled substance history that can be accessed by authorized individuals or agencies including law enforcement, medical examiners, addiction treatment programs, public and private payers, pharmacies, healthcare providers, and more.

All states except Missouri, the District of Columbia, and Guam have enacted PDMP legislation that mandate healthcare providers to record, consult and monitor prescribing data. Since the widespread implementation of PDMPs and corresponding legislations, there have been stories and statistics that seem to indicate success, however, there has also been feedback that indicates some major troubles with these databases and their use.

With PDMPs being utilized all over the country, should we expect a major turn-around in the prescription opioid crisis that is sweeping the nation? Are these databases in fact doing the job that they are intended to do? Or, are there major issues that are preventing their success? Let’s explore together.

The Benefits of PDMPs

PDMPs are considered to be the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk. They are intended to not only medically benefit patient care, but also to serve as a tool for law enforcement and other agencies concerned with opioid-related threats to the public health. This is because the information entered in to a PDMP can help prescribers and pharmacists identify patients at high-risk who would benefit from early interventions.

Further evaluations of PDMPs have demonstrated changes in prescribing behaviors, the use of multiple providers by patients, and decreased substance abuse treatment admissions. From a public health standpoint, PDMPs can be used by state health departments to better understand the current opioid addiction epidemic to better create new intervention methods.

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

As an example, in 2010, Florida established a PDMP and prevented health care providers from dispensing prescription opioid pain relievers directly from their office. That same year, there was a 50% decrease in oxycodone overdose deaths in the state. This change is thought to represent the first documented, substantial decline in drug overdose mortality in any state during the previous ten years.

Likewise, in 2012, prescribers in New York and Tennessee were required to check the state’s PDMP before prescribing opioids and the following year, New York saw a 75% drop in patients “doctor shopping” and Tennessee saw a 36% drop.

The Unfortunate Reality of PDMPs

Although PDMPs have significant potential to improve public health and patient outcomes, they do have the following shortcomings:

1. Under-Utilization

The inconsistent use, or under-utilization, of PDMPs is considered to be the biggest issue plaguing the database, as a PDMP is most useful when queried before prescribing and most maximized where usage is state mandated. A recent survey found that with physicians prescribing in a state without a PDMP mandate, only 22% were aware of their state’s PDMP, and only 53% had actually used it. These facts clearly indicate that state legislation is a critical success factor for the effectiveness of PDMPs to save patient lives.

2. Lack of Accessibility

Another issue with PDMPs is the ease of use and access, or lack thereof. States vary widely in which user categories are permitted to request and receive prescription history reports and under what conditions. Research suggests that usage may improve if states were to allow providers to appoint non-prescribing staff members to access the database on their behalf.

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

Furthermore, not all PDMPs share information across state lines. This can lead to important information being missed and can allow at-risk patients to receive more prescriptions for controlled substances than intended. However, more states are realizing the importance of sharing data across state lines and have recently become a part of PMP InterConnect.

3. Varying Times of Information Entry

Another matter of concern with PDMPs is varying times of information entry. When a controlled substance is dispensed to a patient, the prescription and patient information is entered by the pharmacy to the state PDMP. However, this information is entered at varying intervals – hourly, daily, or even monthly. If there is a long interval between dispense and submission times into the state PDMP, users will not have the most up-to-date information on a patient’s most recent prescriptions, thereby eliminating the maximum benefit of a PDMP. Currently, Oklahoma is the only state that collects data in real time, whereas, most states allow up to a week or longer for data submission.

4. Patient Adoption

Many prescribers attribute their worry about a patient’s reaction when checking the PDMP as a major disadvantage. In a recent survey, providers reported a variety of issues that arose when they reviewed the PDMP:

• 88% of patients reacted with anger or denial when questioned
• 73% of clinicians said that those angered patients sometimes did not return
• 22% of clinicians reported that the confronted patients had never asked for help with drug addiction or dependence problems

These clinicians also indicated that the unveiling of this information was not only upsetting to patients, and damaging to practitioner-patient relationships, but was also found to be inaccurate at times.

Additional concerns include added costs of more frequent office visits if prescribers become more cautious about writing prescriptions with refills, feelings of embarrassment when questioned about substance abuse, and patients turning to the illicit drug market if they are refused a controlled substance prescription.

Although the American Medical Association and American Society of Addiction Medicine stress the need to treat PDMP data just as well, if not better, than any other medical record, patients are becoming more vocal in their discomfort with PDMPs, claiming they make them feel that a medical consultation is no longer private.

5. Reluctant Prescribers

Like their patients, prescribers also show growing concern that they will be judged based on PDMP data. While most prescribers are assumed to support interventions to prevent fraudulent prescribing, high profile criminal prosecutions of prescribing large amounts of opioids can make prescribers reluctant to prescribe controlled substances in general for fear of legal retribution, also known as the “chilling effect”.

There is also greater perceived legal risk for prescribing or dispensing too much pain medication than for prescribing or dispensing too little pain medication. Because many practicing physicians have little if any formal training that would enable them to identify drug diversion, there is fear that PDMPs may wrongfully suspect and categorize some conscientious and caring physicians as fraudulent prescribers when they are actually prescribing in good faith, but lack training.

What Does This All Mean?

In this era of information technology, PDMPs are likely here to stay. While there are the aforementioned pitfalls of PDMPs, it is important to remember that there are still benefits to PDMPs in the public health sector, law enforcement, and of course, healthcare systems. What may be most helpful is to realize what changes could be made to make the PDMP process an ideal one.

From the standpoint of many prescribers, an ideal PDMP would:

• Alert its users to signs of illegal drug use
• Be easy to access
• Provide real time updates
• Be mandatory
• Have interstates accessibility

Perhaps over time if these changes were to be made, we would see more consistent use of PDMPs, especially as a tool to help overcome the opioid epidemic. A clear standard of practice against which providers’ care would be judged could also further advance the utilization of PDMPs in each state. Lastly, adequate training on addiction and pain management, along with a careful review of who should access a PDMP, could also attribute to better utilization and help accelerate the acceptance of each states’ prescription drug monitoring programs.

Author: Lindsey W.

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

About DoseSpot

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

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 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.