In a rare open letter to the nation’s doctors, U.S. Surgeon General, Vivek Murthy sounded a rallying cry to engage their greater participation in the opioid-abuse crisis afflicting our country. Missing from the Murthy’s commendable call to arms, though, was mention of the role technology plays in reducing drug diversion and doctor shopping, and providing ready access to services to support patients.
Those of us in healthcare IT know that technology is critical to this cause. Unfortunately, providers aren’t adopting as quickly as they could the substance abuse-fighting technologies that are widely available to them. This includes a variety of technology solutions such as:
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E-prescribing technology, particularly EPCS to support the electronic prescribing of controlled substances, which is key to helping providers more efficiently deploy and monitor prescription medicines. EPCS can also reduce the public stigma for opioid-addicted persons who would be now be able to use their local pharmacies instead of being required to go to specially-designated facilities.
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Medication adherence monitoring technology that lets providers gauge in real time a patient’s level of compliance with drug therapy
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Clinical decision support that helps doctors avoid adverse drug events and medication errors
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State-run prescription drug monitoring programs (PDMPs) designed to help law enforcement track the use of controlled substances and help prescribers identify those seeking illicit access to controlled substances
{mosads}Specific to the opioid abuse epidemic, the most important next step is the integration and availability of PDMP data within e-medication management solutions (e-prescribing, medication history services, medication adherence tools, etc.) resulting in the greater use of PDMP data to help curb opioid abuse.
This past March, New York State took a major step toward addressing this crisis when it began requiring e-prescriptions for all controlled substances as well as all non-controlled substances, frequently referred to as “legend drugs.” Known as “I-STOP,” the Internet System for Tracking Over-Prescribing Act, originally passed in 2012, New York’s experience serves as a case study for other states that wish to modernize their prescribing infrastructure and address opioid abuse.
Maine will also require opioid medications to be prescribed electronically via Drug Enforcement Agency-certified EPCS solutions beginning in July, 2017. Several other states including Massachusetts, Missouri and Maryland are also considering or working to pass mandatory EPCS requirements for prescribers.
Unfortunately, neither New York nor Maine PDMP data is currently accessible to health IT vendors for integration into the prescribing workflow of providers.
E-prescribing is well understood to assist prescribers by allowing patients and doctors to better guard against medication errors, such as drug-to-drug interactions, reduce common errors inherent in paper-based prescribing, including illegible handwriting, misinterpreted abbreviations and unclear dosages, and provide critical decision support tools.
Despite the fact that, nationwide, more than 70 percent of doctors transmit most prescriptions electronically, the vast majority of these prescriptions are only for legend drugs. In comparison, less than 10 percent are using EPCS solutions to e-prescribe controlled substances. However, in New York, the I-STOP legislation has driven adoption of EPCS to over an estimated 70 percent.
The Medical Society of the State of New York conducted a survey of its members and found a large percentage of prescribers believed that forcing mandatory compliance was placing an undue burden on their practices. Improving integration between PDMPs and electronic health records will alleviate some of these burdens and allow for better compliance.
States must work more closely with the healthcare community to remove obstacles that will allow as close to 100 percent compliance as possible and leadership in healthcare IT companies must be more vocal about our role and responsibilities in enabling doctors on the ground.
The Surgeon General’s Office call to action reminds us again the importance of integrating e-medication management tools and EPCS solutions with PDMP data cannot be overestimated and is the best path toward helping our customers — the doctors — make the right decision, at the right time, with the right data on the right platforms.
Dr. Thomas Sullivan is the Chief Strategy and Privacy Officer at DrFirst and a Former Chair, Council on Medical Services, American Medical Association
The views expressed by contributors are their own and not the views of The Hill.