There are a lot of issues here. She would likely be able to get an exemption and still use paper, but it is hard to get around the PMP requirements. I would think that a doctor competent enough to prescribe opioids or other CII through CV medications should be competent enough to use a computer. Here is all she would have to do:
1. A computer is set up for her so all she needs to do is log on in the morning.
2. One icon on the desktop is all she would need. A shortcut to the PMP. With the username and password remembered by the browser or by a password app, it would log in automatically. You would then type in the patient's name and their DOB and hit enter. Even if you are not using the PMP data to look for signs of diversion, it is enough to cover the requirement.
3. While it seems obvious that she is being very helpful and accommodating to her patients by allowing visits for $50.00, it can look very suspicious with the possibility of a cash for opioid scheme. In fact, the DEA, state medical board and Medicaid/Medicare track that closely. In fact, pharmacists are not required to check the PMP on every script, but in our state, they are required to check the PMP if the patient pays in cash.
4. Not to judge her by age, but I am sure the board of medicine monitors that as far as competency. (I do not mean being 90 does not allow one to have competence), but I would think if she really wants to stay in practice, she would not wish to draw attention to herself.
5. And here is the nail in the coffin. Yes, someone other than she can do the PMP data, but they have to be a delegate of the doctor. Therefore, the doctor has to be the administrator of the PMP website for her practice. Delegates (at least in Maine) must be submitted and approved by the board. Almost goes without saying that they would have to work in her office.
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