To continue our round table blog series, we shed light from the technical side of dentistry’s role in the opioid epidemic. This time, we sat down with Jason Wolan, Director of EHR Implementation at Great Expressions Dental Centers.
How does your organization view the opioid epidemic as well as your dentists’ role in this crisis?
Great Expressions Dental Centers recognizes an opioid epidemic in this country driven largely by what has historically been a very lax approach to responsible prescribing. Today a lack of commitment by major stakeholders to take hard stances on better regulating the manufacturing and supply of these drugs continues to fuel the fire. In many cases, exploration of alternative pain management therapies and more rigid prescribing protocols that mitigate excess supply and drive more frequent doctor-patient interaction for those on long-term pain management therapies would likely result in major strides to not only reduce excess supply, but reduce unnecessary consumption as well. As a leading DSO and supplier of these medications, it is our job in the dental industry to lead by example and set progressive prescribing protocols that focus on responsible pain management therapies reinforced by firm controls and processes that deter abuse.
Are you having internal conversations about how your organization can curb the use of opioids or dispense trends?
Internally, our transition to an electronic prescribing platform has really been the catalyst for all of this primarily allowing us to gain insight into the prescribing habits of our providers. Prior to prescribing electronically, we relied heavily on spotty computerized provider order entry (CPOE) and “good faith” prescribing based on paper prescriptions being written with little or no audit trail. Today, we are phasing out paper prescribing with an ultimate goal of reporting on prescribing habits, particularly as they relate to opioid prescribing, allowing us better insight into drug-volume and drug-frequency combinations that may raise red flags.
How do you think e-Prescribing assists in efforts to curb opioid prescribing habits?
First and foremost, e-Prescribing, as is the case with most transitions to electronic mediums, will allow for better organizational oversight which will likely cause an industry shift as providers begin to recognize the results of increased transparency. Access to this aggregated data will create an unprecedented level of ad-hoc and scheduled reporting of prescribing habits with the ability to begin to profile behaviors and automatically intervene as necessary. In the past, while prescribing could be tracked, much of the data was burdensome and time consuming to compile, but as electronic prescribing platforms and the industry standards have become so available, the ease with which most organizations can monitor and proactively engage providers today should be a major driving force in deterring abusive prescribing. Reinforcing the latter will come with a societal transformation of less tolerance for prescriber supported prescription drug abuse and the increased media coverage, both at the state and federal level, prosecuting the offending prescribers.
Do you have access to data that you currently, or plan to, utilize in regards to proving how your practices are focused on responsibly prescribing these substances?
Great Expressions Dental Centers is currently generating weekly reports of prescribing focused on drug-volume/drug-frequency combinations. While the organization has not completely transitioned to electronic prescribing, we have significantly reduced access to paper prescribing and expect to see the true value of electronic prescribing when we are able to profile our organizational prescribing practices in its entirety.
Are there any policies in place, or may be in the future, regarding how many pills should be dispensed per controlled substance?
As a DSO, our clinical operations, policies, and procedures, and guidelines are all set by our Chief Clinical Officer. A consistent patient experience defined by responsible care coordination for all Great Expressions Dental Center’s patients is the cornerstone of the brand we have established. A large part of that includes driving responsible practicing techniques and ensuring that our patients’ interests are front and foremost, this of course includes responsible prescribing to mitigate the risks associated with opioid prescribing and has existed prior to our engagement with electronic prescribing. In the future, we hope to leverage the platform further in this regard.
To listen to the full round table, download your copy here.
Some responses have been slightly edited for clarity and length.
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.
As the opioid epidemic continues to grow across the nation, DoseSpot recently sat down with Key Opinion Leaders from Dental Support Organizations (DSOs) to discuss how their organization is implementing best practices to decrease opioid overdose deaths and increase patient safety, as well as their viewpoint on what dentistry’s role is during this crisis.
For part I of our blog series, our focus is on the clinical element of dentistry’s role in the opioid epidemic with Dr. John Zweig, Chief Dental Officer of Dental Associates.
How does your organization view the opioid epidemic as well as your dentists’ role in this crisis?
Dental Associates is keenly aware of the problem with opioids and we take a very deliberate role in managing patients’ pain appropriately with the minimum required medication. Educating patients and matching pain relief management with the present dental problem is very important.
Do you provide your dentists education, training, or resources regarding controlled substances?
Continually, Dental Associates has educated its providers on appropriate pain control measures and the use of controlled drugs. The challenge remains with patients whom insist on strong medications and working with them to minimize the prescriptions and the type of drugs used. More patient education is required, and our use of patient prescription histories is becoming more widely used to discover how to explain the minimum amount of medication used.
Within your dental practices, how do you communicate the important relationship between dentists and controlled substances?
Within our provider education, orientation and our monitoring of prescriptions, we continue to provide feedback to minimize prescriptions for controlled drugs both in type and quantity of medication provided.
How do you think e-Prescribing assists in efforts to curb opioid prescribing habits?
It actually reduces fraud; it ensures that we are writing the prescriptions the way we want them to be and that they get to the right people. Electronic prescriptions allows us to monitor this because potentially we may have a provider who is unknowingly or unwittingly giving out large amounts of drugs and we can have a conversation with them, potentially educate them, or make them aware of the situation. This isn’t about a “gotcha game,” it’s about educating providers on best practices.
How do you handle/communicate with patients that may have a substance abuse issue?
Well, many times, first, we use the Wisconsin prescription drug monitoring program (PDMP). That has been in existence and the state has been encouraging us to use it. When using it, we find that many of the patients we’re concerned about are in pain management programs and so we refer them back to their pain managers to resolve their pain needs, so we’re not making it too complicated. For those not in a pain management program, we communicate the facts on their known prescriptions and advise them that we may be unable to prescribe more. We discover with that information, the push-back is minimal.
Anything else you think would be relevant in addressing dentistry’s role in curbing this epidemic?
The issue is a big problem, but I still think it requires education for patients and also the providers, because people have the expectation to reduce demand for pain medication. We need to educate the doctors on best practices with medications that are not controlled substances. We need to monitor and educate everyone.
Stay tuned for Part II: DSOs’ technical insight into dentistry’s role in the opioid epidemic.
To listen to the full round table, download your copy here.
Some responses have been slightly edited for clarity and length.
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.
Time is often not on our sides and we find ourselves with less hours in the day to catch up on the news and to learn new things. Video and auditory content is a great alternative to reading and can be convenient and insightful to get informed about things that interest you. TED (Technology, Entertainment, Design) Talks have been increasing in popularity as well as volume over the years. Here are 5 of our favorite TED Talks from over the years that highlight a wide range of Health IT topics. Enjoy!
Wearables, Beyond the FitBit
What if doctors could monitor patients at home with the same degree of accuracy they’d get during a stay at the hospital? Bioelectronics innovator Todd Coleman shares his quest to develop wearable, flexible electronic health monitoring patches that promise to revolutionize healthcare and make medicine less invasive. More here.
An Oldie, but a Goodie: Innovation in Health IT
Daniel Kraft offers a fast-paced look at the next few years of innovations in medicine, powered by new tools, tests and apps that bring diagnostic information right to the patient’s bedside. More here.
Progression of Collecting Health Data: From Paper to the Cloud
Collecting global health data is an imperfect science: Workers tramp through villages to knock on doors and ask questions, write the answers on paper forms, then input the data — and from this messy, gappy information, countries and NGOs need to make huge decisions. Data geek Joel Selanikio talks through the sea change in collecting health data in the past decade — starting with the PalmPilot and Hotmail, and now moving into the cloud. More here.
Get Curious, Start Innovating
Science is a learning process that involves experimentation, failure and revision — and the science of medicine is no exception. Cancer researcher Kevin B. Jones faces the deep unknowns about surgery and medical care with a simple answer: honesty. In a thoughtful talk about the nature of knowledge, Jones shows how science is at its best when scientists humbly admit what they do not yet understand. More here.
Nanotechnology and the Future of Disease Detection
What if every home had an early-warning cancer detection system? Researcher Joshua Smith is developing a nanobiotechnology “cancer alarm” that scans for traces of disease in the form of special biomarkers called exosomes. In this forward-thinking talk, he shares his dream for how we might revolutionize cancer detection and, ultimately, save lives. More here.
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.
Patient engagement: the latest development in the healthcare industry, or is it?
You see, patient engagement has always existed. A little well-known term in the business world, “consumer engagementâ€, pioneered the strategies years ago that are utilized to engage customers, create better experiences, and enhance brand relationships to retain customers and increase revenue.
To be quite frank, these strategies have no “wow†factor. Engage with your customers to create brand loyalty and increase sales? Groundbreaking. Engage with your patients to improve health outcomes and lower associated costs? I see a trend coming on here.
While the healthcare industry has long understood the importance of having a patient engaged in their own health, it’s been said that the industry is typically five years behind with technological advancements. Perhaps it’s the resistance to change, the varying patient populations relative to age, or the perceived obstacles with seamless integrations for all pertinent parties, specifically EHRs.
However, one thing is certain: patient engagement technology is a viable solution that patients need, and deserve, to stay accountable and to stay connected in order to better manage their health.
The Benefits of Patient Engagement Technology
Now that patients are becoming more trusting of technology thanks to the Internet and social media, they have easier access to healthcare information at their fingertips. How many times have you googled your symptoms or visited WebMD rather than consulted with a doctor? Don’t be shy, we’ve all done it.
The downfall to these methods, however, is the potential danger involved if patients are self-diagnosing themselves without proper medical intervention. So, why not pair the two together?
The goal of patient engagement technology is to create a better relationship between providers and their patients. It’s also said that patients whom engage as decision-makers in their care tend to be healthier and have better outcomes, especially those dealing with chronic diseases.
Other benefits of using technology for patient engagement include:
The Challenges of Patient Engagement Technology
Though the benefits make sense, there are many challenges these latest tools are faced with. Not only is it new technology, but patient engagement will also require a cultural shift relative to changing behaviors and different communication preferences. Let’s not forget the operational and implementation challenges either.
Before an organization can determine what technology to use, it has to understand its users. Creating these personas will help healthcare technology organizations design better engagement tools with patients in mind, especially for older patients who might be less tech-savvy. It’s no easy feat getting providers and their patients to learn how to use these tools, as getting them up and running is most often viewed as a burden. That’s why there needs to be better integration with clinical workflows and simple-to-use products so providers aren’t wasting time on these technologies.
Furthermore, there needs to be more innovation in patient engagement tools. A glucose meter, an arm band, or a simple appointment reminder just isn’t going to cut it in today’s day and age. Give us substance, give us value, and give us healthier patients.
Other challenges of providers using technology for patient engagement include:
3 Patient Engagement Technology Companies to Watch
With so many patient engagement technologies being introduced to the market, here are 3 innovative companies making waves:
Klara takes collaboration to the next level. It’s not just a messaging application nor just an appointment reminder. Its platform engages all medical professionals for patients in order to be more efficient, more productive, and to work better as a team. They even tell you why “patient portals suckâ€. For more information please visit www.klara.com.
Medelinked encourages patients to manage their health by connecting with the healthcare community around them. It’s a secure mobile and online health platform that allows patients to build their health profile to discover, connect, and share their health and wellness information with their trusted healthcare providers. It not only connects individual patients, but families as well. For more information please visit www.medelinked.com.
AbleTo enables patients, payers, and providers to work together with their impressive behavior health care coordination platform that’s available nationwide to identify, engage, assess, and treat patients dealing with stress, anxiety, and depression. They pride themselves in reducing co-morbid behavioral health issues to improve patient outcomes, decrease the cost of care and help people reclaim their health and happiness. For more information please visit www.ableto.com.
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.
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
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.
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.
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.
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.
Unfortunately, the opioid epidemic that is currently grappling the United States isn’t exactly news. Headlines appear on a daily basis in regards to this addiction, the overdoses and fatalities, as well as the healthcare community’s contribution to this crisis, both the good and the bad.
We’ve seen Congress, the Surgeon General, and many other organizations make extreme efforts to combat this crisis, yet despite the widespread media attention, many healthcare professionals still don’t realize how dangerous the drugs can be or how addictive they are.
DoseSpot recently conducted a live webinar in an effort to educate and discuss the critical role that dentists in particular play in mitigating the current opioid epidemic that is upon us and during that time, the following crucial points were made:
The blame game needs to stop
Blaming others only diverts the necessary action of collectively coming together as a nation, regardless of one’s associated industry. Healthcare, Law Enforcement, Politics – there needs to be a strong, unified foundation for which we can assemble and fight this battle together.
Break the habit: prescribing patterns of pain medication
Dentists serve a unique role in overcoming this epidemic due to the nature of their work and the procedures they perform, specifically wisdom teeth extraction. It’s a fair statement that the majority do not enter the healthcare industry with ill intent of harming their patients, yet it’s also fair to say that lack of proper education and prior pharmaceutical marketing tactics have fueled poor prescribing patterns. In order to change one’s behavior, programmed thoughts and approaches must be reevaluated.
Opioid addiction does not discriminate
This addiction can affect anyone regardless of one’s socioeconomic status or in some cases, a person’s relationship to their dentist. What DoseSpot coins as “The Insider Threat,” we reveal how certain folks pose a potential risk relative to obtaining controlled substances, both knowingly and secretively. Stories of addiction that are shared during our recent webinar further prove that opioids do not discriminate.
Solutions are available
The truth of the matter is, there is not one single solution that can work independently. It needs to be a collective effort and innovation is critical to success. There needs to be multifaceted solutions to tackle this complex problem ranging from increasing specialty training and education to proper treatment technology, data, and analytics.
Dr. John Zweig, Chief Dental Officer, Dental Associates
Donald Whamond, Chief Technology Officer, Dental Associates
Jason Wolan, Director of EHR Implementation, Great Expressions Dental Centers
Daniel Smelter, Director of Business Analysis, Benevis, Inc.
About DoseSpot
DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.
How does digital health affect the circle of life?
Today, a patient’s well-being rests in the hands of multiple healthcare professionals, including primary care providers, specialists and surgeons – and sometimes in their own hands with the latest medical devices and technological advances.
In keeping up with this new delivery model, it’s important to understand how people of all ages, pediatric to geriatric, attribute to the nation’s overall population health, its effects on the healthcare system and the United States’ bottom line, while also understanding how technology can play a major role.
DoseSpot is a Surescriptsâ„¢ certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.
On par with our last post, the widespread media attention and devastating losses associated with our nation’s current opioid epidemic has sparked certain state legislatures to regulate and improve providers’ prescribing habits for prescription painkillers.
With good intentions in tow, some rulings seem to lack readily available solutions that are proven to curb this crisis. However, they do realize that their recent proposals do not mark the end of this uphill battle, rather multifaceted solutions need to be in place to truly, and successfully, overcome this epidemic.
Here are three states that have recently proposed rulings on how opioids should be prescribed:
Vermont
Coined as a “cutting-edge†approach to overcoming the opioid crisis, Governor Peter Schumlin announced proposed limits on the number of opioid medications that could be prescribed.
Like every other state, Vermont has seen an incredible increase in deaths related to opioid and heroin overdose in recent years and Governor Schumlin is no longer sitting on the sidelines.
Earlier this year, he approached both the FDA and pharmaceutical industry in his State of the State address claiming that OxyContin “lit the match that ignited America’s opiate and heroin addiction crisis,†and that the booming American opiate industry knows no shame, an outcry after the FDA approved OxyContin for children a few months ago.
The proposed ruling states that the severity and duration of pain will determine the specific limit for a prescription of opioids. For example, a minor procedure with moderate pain would be limited to 9-12 opioid pills and the amount would increase based on the procedure performed and the level of pain a patient claims. The ruling would also require providers to discuss risks, provide an education sheet to the patient and receive an informed consent for all first-time opioid prescriptions.
The Green Mountain State’s Governor believes that limiting the number of opioid pills prescribedwould be an effective way to reduce addiction, yet some folks believe the ruling would only encourage patients to seek illicit drugs elsewhere if they cannot receive pain medication through their provider.
This does make sense considering many former and current heroin abusers have stated that their addiction started from a prescription and when the pill bottle ran out, they were left seeking these drugs on the streets, which have proven to be very, if not more, dangerous than the prescription.
However, the intent of the Governor’s ruling is to prevent addiction from ever happening in the first place. His ruling is specific to cases of acute pain, therefore changing the over-prescribing habits and learned behavior of utilizing opioids as first-line therapy; habits that ensued in large part due to incentives, the surge of pharmaceutical marketing tactics and claims that painkillers were not addictive.
With the rate of drug overdose deaths on the rise by 137% since 2000, New Jersey is another state to recently propose new regulations on how and to whom opioids are prescribed.
New Jersey, much like many other states, believes that prevention is key when fighting this crisis and they couldn’t be more correct. Unfortunately, several barriers often occur when seeking appropriate treatment after a patient becomes addicted, (for example, providers are limited to certain amounts for which they can administer reversal drugs), and therefore why not PREVENT addiction, rather than simply TREAT addiction when at many times, it’s too late?
Senator Raymond Lesniak has introduced a bill that would put restrictions on health insurance coverage for opioid medications, while also requiring prescribers to first consider alternative pain-management treatments, follow federal prescribing guidelines and explain the risk of addiction with such substances to their patients before prescribing. Furthermore, providers will need to complete several steps before receiving approval of an opioid prescription. These steps include providing a patient’s medical history, conducting a physical exam and developing an appropriate medical plan for treating a patient’s pain.
While new rulings in place can certainly shift this epidemic, Angela Valente, the executive director of the Partnership for a Drug-Free New Jersey, said it best:
“Awareness and education is the key factor in preventing the abuse of opiates—everyone must have a role in reversing this epidemic, including lawmakers, parents, coaches, educators, and yes, even doctors and dentists.†– Angela Valente
Dr. Andrew Kolodny, executive director of Physicians Responsible for Opioid Prescribing, further backs Valente’s point while also motioning that the medical community has been prescribing too aggressively.
Unfortunately, Pennsylvania experienced 3,500 deaths last year as a result from drug overdose, one of the highest overdose rates in the nation.
The state has had a Prescription Drug Monitoring Program for quite a few years now, however it wasn’t functional until August 2016, when their new program was officially rolled out. Pennsylvania requires providers to query the state’s prescription drug database the first time they prescribe a controlled substance to a patient or if they have reason to believe that the patient is doctor shopping.
Governor Tom Wolf addressed other initiatives underway including requiring providers to query the database EACH time they prescribe opioids, updating medical school curriculum and continuing education, changes to the process of pain care to lower inappropriate use of opioids, and improved screening, referral and treatment for addiction.
What’s bothersome in Pennsylvania, is the method in which these substances have to be prescribed. The Pennsylvania Controlled Substance Act requires narcotic prescriptions to be handwritten on paper prescription pads, yet every other substance can be electronically prescribed. This allows the risk of written prescriptions being lost, stolen, or sold. Luckily, Senator Richard Alloway intends to introduce this measure before the legislative session’s end.
It’s promising to see how the above states are utilizing their state’s Prescription Drug Monitoring Program, or PDMP. All three require their prescribers to query the affiliated state database, however the parameters in which, or how often, they check varies.
While said efforts are better than no effort at all and states are starting to fully understand the need for multifaceted solutions in order to overcome this epidemic, one key solution is missing. E-Prescribing.
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
Prescribers 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
To learn how to incorporate e-Prescribing as a solution to the opioid epidemic, schedule a meeting with DoseSpot today.
DoseSpot is a Surescriptsâ„¢ 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.
For the first 6 months of 2016 in Massachusetts, there have been almost 500 confirmed cases of unintentional opioid overdose deaths and an estimated 500 additional cases have not yet been confirmed.
The majority of overdoses found in MA are due to substances such as fentanyl and heroin, but rates of cocaine and benzodiazepines present in opioid deaths have been steady since 2014. Although the rates of heroin and prescription drugs present in opioid deaths have been decreasing due to many efforts that have been implemented across the nation, the rate of fentanyl has been on the rise. This is in large part due to the fact that many opioid addictions start at the hands of a prescriber with a prescription and when the pill bottle runs dry, patients are left seeking other options that produce the same euphoric effect.
With the rapid increase of deaths and devastation by way of the current opioid epidemic plaguing the state, Massachusetts has recently implemented further requirements concerning practitioner’s prescribing protocols. Specifically, with the state’s Prescription Monitoring Program, or PMP.
The PMP serves as a database for all prescription drugs that are dispensed across the state, including those that are highly sought after for non-medical use and represent the highest potential for abuse, better known as Schedule II-V drugs such as narcotics, sedatives, and stimulants.
When properly used, the PMP aids in the identification and prevention of drug misuse, diversion, and potential doctor shopping by providing a patient’s medication history of the past 12 months. It is meant to be utilized as a key clinical decision-making tool that allows providers to receive a big picture view of the patient they are treating in real time.
As a solution to this widespread epidemic, Massachusetts has introduced new legislation and requirements when utilizing the MassPAT (Massachusetts Prescription Awareness Tool).
Effective October 15, 2016, practitioners must abide by the following:
A registered individual practitioner must utilize the prescription monitoring program each time the practitioner issues a prescription to a patient EACH time for a narcotic drug in Schedule II or III.
A registered individual practitioner must utilize the prescription monitoring program prior to prescribing to a patient for the first time:
A benzodiazepine; OR
Any controlled substance in Scheduled IV or V which the department has designated in guidance as a drug that is commonly abused and may lead to dependence. At this time, there are no drugs that have received this designation.
Prior to the aforementioned requirements, legislation ruled that practitioners, among other factors, need only check the state PMP when prescribing a controlled substance to a patient for the first time, while it is now required for a practitioner to check the system EVERY time when prescribing Schedule II or III drugs.
An example of just how serious Massachusetts is about this crisis, and also believed to be the first agreement of its kind, CVS recently paid almost $800k to the state because pharmacists were not checking prescriptions or the database thoroughly. In exchange, CVS agreed to provide its pharmacists access to the PMP website, train its pharmacists to register for and use the PMP as appropriate, and has further agreed to implement policies that would require pharmacists to consult the PMP before dispensing certain opioids in MA.
Massachusetts and CVS, among many other organizations, recognize the importance of the state’s PMP as a tool to detect and prevent the abuse and misuse of controlled substances. The PMP is not meant to be another government-controlled, green monster hanging on a practitioner’s back at all times; it is meant to serve as a safety extension for practitioners, but most importantly for their patients.
PMP’s can also be most effective whenlinked 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.
About DoseSpot
DoseSpot is a Surescriptsâ„¢ 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.
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