Central Texas Colon and Rectal Surgeons had its electronic health record (EHR) integration with the state’s prescription monitoring program (PMP) in place for fewer than two days before managing partner David Fleeger, MD, saw how it could stop drug diversion and patients on the hunt for medication they don’t need.
A mandate for physicians to check the PMP before prescribing opioids and three other drug classes looms later this year. Dr. Fleeger’s practice got ahead of the game in March, when an EHR update added a connection to PMP Aware, the prescription drug database the Texas State Board of Pharmacy maintains.
Soon after, a patient called Dr. Fleeger’s medical assistant (MA) asking for a refill on Oxycontin, and Dr. Fleeger used the integration feature to access PMP Aware quickly. It showed the same patient had seen an oncologist the day before and had gotten a 30-day supply of Oxycontin. He directed the MA to tell the patient to use the medication she already had.
“It lets you see what they got when they got it,” said Dr. Fleeger, president-elect of the Texas Medical Association. “If they’ve gotten 30 Oxycontin yesterday, they probably don’t need anything more from me today.”
TMA is advocating for electronic integration as the best solution to what seems like a daunting mandate that, as of now, will hit Texas physicians in less than six months. Starting Sept. 1, physicians will be required to check the PMP before issuing any prescription for opioids, barbiturates, benzodiazepines, or carisoprodol, a mandate the Texas Legislature passed during the 2017 session.
As this year’s session of the legislature enters its back stretch, TMA is hoping to persuade lawmakers to delay that mandate until March 2020 to allow for a widespread rollout of PMP-EHR integration.
Early returns on integration are promising. Troy Fiesinger, MD, (pictured left) of Village Family Practice in the Houston area, says he and his colleagues also have done it successfully with their EHR. Dr. Fiesinger says Village, which now prescribes all its controlled substances electronically, had already been paying a great deal of attention to opioid use in the practice before undergoing the integration a few months ago.
The workflow contrast has been stark, Dr. Fiesinger says. Previously, he had to have a patient’s chart open in the EHR and have a second tab in his browser open for the PMP. He would have to log in each time he accessed the drug database; enter the patient’s first and last name and date of birth without any mistakes; and click on the checkbox attesting that he would use the PMP properly before the patient’s profile would appear.
“That would take easily 30 seconds, and if you mistyped a name, if the name was misspelled, it won’t come up, and you have to start getting creative. Whereas with [the integration], when I look at the screen, if I open the medication list, the top item in the medication list is the PMP query. So I click on that, and within 6 seconds, it pulls up the patient’s Texas PMP file. I don’t enter a name, I don’t enter a date of birth, I don’t have to attest that I’m going to follow the rules.
“It pulls it up almost identical to what you see in the PMP. It’s not quite as detailed, but it’s all the scrips, all the days, all the doctors’ names. So it makes it very easy to do a very quick check, and then it also date-stamps that I did it.”
TMA fought against the 2017 legislature imposing the mandate on physicians, arguing that technology would prove to be the best ally in the battle against opioid misuse, but more time was needed for that technology to mature. Today, Dr. Fiesinger says integration makes a PMP check “far less of a burden than it was before,” with faster use and fewer clicks.
“Given that it’s going to happen … we might as well make compliance as easy as possible,” he said. “This type of integration, which to me exemplifies TMA’s position, makes it as easy as possible.”
But Dr. Fleeger, who will become TMA’s president next month at TexMed 2019, is concerned about whether integration will be easily available to all physicians. He and Dr. Fiesinger both have the advantage of using an EHR from Athena, a large, nationwide system with hundreds of thousands of participating physicians.
Dr. Fleeger’s concerns speak to why TMA is trying to convince the legislature to push the mandate back another six months. Meanwhile, the Board of Pharmacy is working with lawmakers to secure funding for mass PMP-EHR integration.
“What I worry about are the doctors who are on smaller-company, specialty-specific, non-cloud-based [EHRs], and I worry about, even though it is possible, to have that degree of integration … happen in a timely manner,” Dr. Fleeger said. “So I would say the onus needs to be on the [EHR vendors] and on the Board of Pharmacy to make sure that integration has occurred before they make it mandatory.”