Home Forums Discussions General Discussion E Rx for controlled substances

Welcome from Houston ACUC

Chris Trembly told us that AC has not received enough requests for Controlled Substance ERx to move forward.

It requires 2 factor authentication. This then would require that you receive either a separate email or txt to your phone. The problem is that it might take as long as 5 minutes for this to occur. In their discussions with providers the feeling is that that would be too long.

If you are interested, you should send her a PM at Chris@AC on the board

They expect the MU Certified version 6.7 by June. It will include the ability to use ICD10 and to toggle on or off to test.

V6.7 will be integrated with a Patient Portal which will allow you to securely send information through Updox (for free). You can CURRENTLY update to a separate free Updox secure portal NOW, and send information to patients or physicians securely, but it is not integrated directly (It can read the demographic info from AC)

Oh, version 6.7 will automatically switch to ICD10 on October 1, 2014.

All prior dx will stay where they were. Snomed is required and will make coding easier. You will be able to put in high blood pressure or initials (say ess hyper) and Hypertension options will pop up. Green is good, yellow is bad blue yellow needs more specification.

About 50% ICD9s will automatically map to ICD10 codes. We will still have green and yellow for adequate.

She recommended http://imagic.nlm.nih.gov/imagic/code/map for getting a lot of information.

ICD9s will remain in their format from prior visits (in case you need to rebill or such)
Help files will be available in the product.

Thanks Wendell for the information and code mapper, now tabbed to my bookmark list!!!!!

I have worked out a system for printing Schedule 2-5 drug prescriptions on prescription sized paper (quarter sheets) -- from AC, so the prescription at least are recorded in codified form in the EMR. It is, however, a pain in the [censored], and I really wish the DEA could look at the reality of medical care. What I am doing is no more secure -- probably less so -- than just transmitting the Rx's to the pharmacy.

Maybe I wasn't clear, apparently there is a solution, it's just very clunky and time consuming. AC did not pursue it because feedback received was not positive. They are willing to relook at it if enough people say it is worthwhile.

What you are describing would not be worthwhile -- it is even more
clunky than my own workaround.

I'm asking DEA to be reasonable.
Fat chance.

I agree with Tom. I would give negative feedback also, and I wouldn't want AC to pursue it. A password is all it should require at most.

Now that I have been projecting e-prescribing, e-faxing, and actual printing of scripts in the exam rooms on the extra 24 inch monitors, patients are getting a much better understanding of all the extra unnecessary clicks and down right silliness of the outdated DEA laws as they see the actual process in action. It is an extremely persuasive "argument".

There really is no logic behind not being able to e-prescribe all drugs.

I have encouraged my patients to talk to their congressmen and senators about the archaic laws that need to be updated and changed. Unless they love watching me develop bilateral carpal tunnel syndrome.

Wendell,

I should add, my handling of the topic above is a bit like Mack's reaction, in Yertle the Turtle. Near the end of the story, when old Mack is a bit compressed being at the bottom of the pile and belches. I apologize for the belch.

However, the 2 step authentication, should be like the process using a gmail account. When I sign on to my account, I receive a 6 digit code on my phone instantaneously. It works quite well.

Is there any explanation why the process should take up to 5 minutes? That is really surprising, and I agree that would be much too long.

I do not know. It was during a presentation at ACUC Houston that she made the comment. The bigger the bureaucracy, the slower the response, I suppose, but I really don't know.

Hey people I feel your pain. Ha, Ha I am a pain doc.
Just be happy e-precribe works for non-controlled drugs. As far as controlled meds there are many more DIFFERENT federal vs state laws, some trump the other and some are more stringent than the other. Usually the tougher law wins. Then each state has a pharmacy board which can get their feelings hurt when a law is changed and no one asked them. Even more stupid they can influence e-prescribe laws b/c they are concerned that there are some little mom and pop pharmacies that don't have a computer. ( here in Georgia they actually said that !)
It is a lot more complicated than just point verification. Hey there are drug dealers out there that are pretty good a computer stuff.
Don't look at these issues as a pain in the ---, look at them as the government is really trying to keep prescribed narcotics off your local playground. But, remember how long and inefficiently it takes any government agency to do the right thing.
Nate

I was actually quite happy before e-prescribe. Now the requirement to have two separate systems is truly a pain.

Of course, in the old days there was no way anyone would get away with prescribing all the narcotics we do now -- the Board would can you in a heartbeat -- so keeping track was less of a problem.

Epic's solution.....all non-scheduled scripts automatically default to eprescribe (you never see the New Crop interface) and all scheduled drugs automatically default to print to regular paper which is then wet-signed and faxed by staff to the pharmacy. You do have the ability to change the default each time so that any script can be printed to the secure paper script printer. Non-scheduled drugs print out with my named digitally signed and scheduled drugs print without a signature and are then signed and handed to the patient. For entities such as the VA which apparently still cannot handle eprescribing, you get a pop-up saying the script cannot be eprescribed and it then automatically defaults to the secured paper script. All requests for refills come into my Epic In-Basket and again I never see the New Crop interface. They are approved and sent back via the In-Basket and are recorded in the medication list as last date refilled.

Chris might want to ask users instead of waiting for an uprising to occur....Narcotic diversion is a problem across America and we need that functionality added

Dedicated diverters and abusers can get around all this flim-flam. It's about as effective as TSA. I find out about diversion from the grapevine -- the only communication system that is really difficult to hijack

Wow, a lot of tension on this issue.
However, if you prescribe any DEA regulated medication, you must and are required to care about drug diversion.
Look at your DEA registration. Not only does it give you the legal privledge to write for controlled drugs ,it REQUIRES you to suspect, report, and ACT on possible diversion. It's like the DEA can use you as a non-paid investigator.
If you don't like it, surrender your DEA and complain all you want. BUT that's how it is.
In my area there are four (4) federal agents assigned to prescription drug diversion. Thats the whole state of Georgia. We all know the federal government is FUBAR, but in this area they actually need our help.
Nate

I believe that in NYS all controlled substances must be e-prescribed by March ??, 2015. Just received some sort of notice of this.

This is slightly off topic, but can the AC system interface with a state's prescription monitoring program (PMP) like the one in New York State?

Not off topic at all. I'm not sure though. But, here we are required to take part in the PMP. Sorry I can't help Wayne.

I just saw this about NYS:

I-STOP made New York one of the first states to schedule the universal mandate of e-prescribing for controlled substances in December of 2014, and the applicable regulations were issued in March 2013. This will nearly eliminate the problem of forged or stolen prescriptions?used both by addicts, and criminal organizations obtaining pills to resell on the street.

So, if eRx of controlled substances is going to be mandated for our state, we really need AC to add that capability.

I agree. And, someone is finally smart enough to know that it is not only safer, it will nearly eliminate narcotic diversion.

Plus, I would be able to send a Concerta script from home rather than making them wait until Monday, although we have a slide that tells them we don't do refills on the weekend.

Wayne, I am really busy. What does it say for Maine. You can tell me to quit being so lazy if you want.

For Maine:

Maine's Prescription Monitoring Program (PMP) is a tool created to prevent and detect prescription drug misuse and diversion, and improve patient care through better coordination of care. PMP maintains a database of all transactions for schedule II, III and IV controlled substances dispensed in the State of Maine. This database is available free online to prescribers and dispensers by the Office of Substance Abuse and Mental Health Services (SAMHS) in the Maine Department of Health and Human Services. Anyone with a DEA number is encouraged to register to request patient reports. The database is searchable online, so it is available anywhere one has Internet access. Clinicians can use the program to check the history of a new patient and to monitor on-going treatment. PMP is another tool clinicians can add to their toolkit for preventing and intervening against misuse and diversion of prescription drugs.

So it looks like it is not a mandate for you in Maine.

Thanks for your time Wayne.

No sweat.

Hi -
Since e-prescribing requires a second-level of authentication beyond being logged in as a prescriber, we have looked at ways to comply with this requirement.
The '5 minutes' Wendell was referring to is the total "possible" time to write the script based on the following process:

1. select the drug and enter your sig
2. wait for a numeric code to be sent to either your email or via text message
3. enter the 'code' given into the screen
4. wait for the code to be validated by the software
5. complete / send electronically

It is possible to install a biometric device (finger print or eye scanner) and use that as the second level of authentication, but as you may imagine, these devices can be costly.

Thanks for your feedback on this issue.

Chris

Thanks Chris. As you may have now noticed, e-prescribing of controlled substances is mandated for physicians in New York State beginning December 2014. While NYS is the first state to mandate this, i doubt it will be the last.

Is AC continuing its efforts to implement this? We are really going to need this at year-end.

Text message seems secure. Email doesn't.

Another option would be an RSA or Norton (VIP Access) App on your phone that generates a security code that can be verified at the other end. This is the system our hospital system uses to authenticate external log-ins from home or office.

Greg

NY state is requiring e-prescribing for all meds including controlled meds by 3/27/15. I have just been informed that Amazing charts is going to add this function hopefully by the end of the year. Apparently, the DEA had to verify and approve the program. In NY state, all controlled scripts will have some type of unique ID added to each script equivalent to a serial # currently use on a paer script. I had previously spoken with Newcrop- the middleman e-prescribing vendor. Both they and surescripts are compatible. The AC ehr just needs to make certain adjustments

Stuart wasser MD
long Island

They have, they just sound not so dependable, although rather foolproof.

AC is working with Newcrop to implement NY's requirement.

They had been holding off on implementation because the two step confirmation system seemed overly complex and in their meeting with physicians this did not seem to be well accepted.

With the mandate, it has become a priority and should be available later this year.

everybody remember, all these laws, rules and regs about electronic prescribed controlled drugs go thru STATE and Fed. If the local gov. is messed up, it doesn't matter what the feds say.
Check your state government before the feds.
Also remember, governments don't run on logic. Don't expect them to go with a solution that's logically obvious to us.

Nate

Looking at Amazon USB finger print scanners range from $28-105
Not a bad investment if it saves time in authentication via email or text

All of my Lenovo X2xx machines have built-in fingerprint scanners. Could those be used as the second level of authentication?

Has anyone used facial recognition for this or other purposes, such as Fast Access by Sensible Vision? I use it on computers in my exam rooms and on my laptop at my desk and am quite happy with it.

Norm Numerof, M.D.
Internal Medicine in the Vail Valley