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Curbside Consult with Dr. Jayne 5/6/13

May 6, 2013 Dr. Jayne 2 Comments


I think many of us in the healthcare IT trenches have simply become beaten down. There are dozens of different initiatives, regulations, and “incentives” causing daily pressure to change how our systems deliver care and how we interact with patients.

Some days I feel like I’m barely able to keep my head above water. There are so many competing priorities you can’t afford to get too worked up over any one issue or you might be sucked under.

In my informatics role, I’m exposed to a lot of different venues for care delivery. This week I served as a locum tenens in a primary care office and again had to confront something that has bothered me for years: pharmacies sending electronic requests for refills on controlled substances when they cannot be refilled electronically. Not only is this bothersome, but it wastes significant time in the practice.

Yes, I’m aware that the DEA issued rules that allow electronic prescribing of controlled substances. However, for this to be legal, the physician has to use certified e-prescribing software and two-factor authentication. Additionally, the pharmacy has to upgrade their systems to receive and process the prescriptions.

My state was one of the last to clarify its requirements for these transmissions, so adoption has lagged. Practices aren’t going to go through the credentialing process if the pharmacies aren’t ready, and our informatics team checks with the pharmacies monthly to see if they’re prepared to accept these scripts.

Our region has several major pharmacy chains that have spent the last decade sending refill requests for drugs that physicians cannot prescribe electronically. The physician (or his/her designee) has to deny the prescription electronically (otherwise be marked as “unresponsive” by the pharmacy intermediary system) then either call the script in if that’s permissible, or print and sign a prescription to mail to the patient or for the patient to pick up. These chains are still not enabled to receive DEA-compliant controlled substance prescriptions, yet they continue to send these refill requests that cannot be processed.

When I first saw this years ago, I called the pharmacy and asked why this was happening. I was told that the prescription management software couldn’t tell the difference between controlled and non-controlled substances, so they couldn’t block the inappropriate refill requests. They didn’t think their vendor would be willing to make a change. Flash forward and it’s still happening. I have to wonder why. Have systems not evolved in nearly a decade? Can vendors really not fix this?

It makes me wonder — where are the Meaningful Use requirements for all the other software systems with which my EHR has to interact? Why aren’t the pharmacies required to document the numerator and denominator for “percentage of refill requests sent that are actually legal to refill?” Why are only the providers and hospitals eligible for penalties?

If we’re going to have de facto regulation, let’s treat everyone the same – from the pharmacy to home health to post-acute care. When only some of the players are jumping through hoops and we’re just passing the meaningless work from one part of the industry to another, we’re not transforming medicine — we’re just being wasteful.


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Currently there are "2 comments" on this Article:

  1. Meaningful use is really only about getting government money. If you want to treat everyone the same, then shouldn’t the pharmacies get incentive money from the government? At least they took initiative to get somewhat computerized years ago, not relying on the government to pay for their technology.

  2. Regarding electronic refills for controlled substance prescriptions, it’s an interesting double standard. Following DEA rules, SureScripts, the primary electronic prescription data interchange (EDI) network, requires that the prescribing systems and prescribers be certified for Electronic Prescribing of Controlled Substances (EPCS). If the prescribing system isn’t certified, the prescribing system is required to block prescriptions for controlled substances because SureScripts isn’t allowed to transmit EPCS for prescribers or via systems which aren’t certified. Pharmacies and pharmacy systems which are connected to SureScripts evidently have no such restriction. The pharmacies can (and do) send refill requests for controlled substance prescriptions. Dr. Jayne’s frustration is quite common in the EHR & ePrescribing world because unless you are one of the less than 2,000 prescribers who are certified today for EPCS, you have no way to respond electronically to a refill request for a controlled substance. I too am dubious that pharmacy system software can’t manage this situation… EHR’s are able to do it, why shouldn’t pharmacy systems.

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