The article about Pediatric Associates in CA has a nugget with a potentially outsized impact: the implication that VFC vaccines…
News 2/13/17
Top News
As expected, Rep. Tom Price, MD (R-GA) is confirmed as HHS Secretary. Vice President Pence, who administered the oath of office, wasted no time in highlighting what will likely be at the top of Price’s to-do list: “President Trump has made it the top priority of this new Congress to repeal and replace the Affordable Care Act with healthcare reform that will lower the cost of health insurance without growing the size of government. And finding someone to lead Health and Human Services who brings a background in medicine, a background in healthcare, a background in budgetary issues in the Congress of the United States, who understands the unique challenges of state officials in programs like Medicaid was easily met when he made the decision to name Dr. Tom Price as the new Secretary of Health and Human Services.”
MGMA President and CEO Halee Fischer-Wright, MD pens a congratulatory note to the new secretary, asking that he be sure to work with physicians on reducing the administratively burdensome complexities surrounding HIPAA, reducing the cost and reporting burden of MIPS, developing APMs that better dovetail with the needs and abilities of physician practices, and providing greater flexibility in EHR certification standards.
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Announcements and Implementations
The Colorado Association of Addiction Professionals will implement EnSoftek’s DrCloudEHR behavioral health software across its member agencies.
MedicalMine adds a mobile app publishing tool to its Charm EHR/PM/RCM suite of solutions, giving independent physicians the ability to customize their own branded app with features including scheduling, messaging, and bill payment; and to publish it to various app stores.
Metropolitan Center for Mental Health (NY) moves 170 end users at its three locations in Manhattan from paper documentation to TenEleven Group’s Electronic Clinical Record.
The State of Oregon’s Washington County Dept. of Health and Human Services selects EnSoftek’s DrCloudEHR to help improve its countywide behavioral health, addictions, and developmental disabilities programs.
Government and Politics
The local news takes a retrospective look at the State of New York’s e-prescribing law, which went into effect last March in an attempt to help curb the state’s opioid abuse rates. (It is the first state to penalize physicians who fail to e-prescribe and use the associated registry.) At first, physicians were leery of the extra work e-prescribing and checking the registry would entail, but now some seem to be softening. “The prescriptions are legible,” says pediatrician Edward Lewis, MD. “You have control over it. You can follow the electronic trail log in terms of where the prescription was sent and when it was sent.” Lewis and several of his colleagues believe the legislation has indeed helped keep controlled substances in hand. “Before I write a prescription for a controlled substance, like an ADHD medicine,” he says, “I have to go on to the NYS registry and see when the last time the prescription was written.”
Telemedicine
Senator Mike Shirkey (R-MI) and Rep. Eric Leutheuser (R-MI) tour the Community Health Center of Branch County’s Cardinal Connect clinic to gain a better understanding of how school-based virtual clinics in three Michigan counties are helping students access primary care from CHC’s Pediatric and Adolescent Center. “One of the most important aspects of our job is to get the word out about the School Tele-health program,” said Program Manager Theresa Gillette during the tour. “Every day we touch the lives of students in Branch County, but we have to remember that our model has the opportunity to impact the lives of students across Michigan. We don’t take that responsibility lightly.” According to the American Telemedicine Association’s latest stat-by-state report card, Michigan
The West Virginia Public Employees Insurance Agency rolls out telemedicine services from ISelectMD to its 180,000 beneficiaries. The Hilton Head, SC-based company entered the West Virginia market four years ago when it offered similar services to Harrison County employees.
The local business paper digs a little deeper into the progress Texas stakeholders finally seem to be making in crafting telemedicine legislation that everyone can agree on. Texas Medical Association President Don Read, MD confirms the key issue of the latest proposed bill is the definition of the doctor-patient relationship. TMA members want to ensure that any legislation passed doesn’t skip over this crucial element. “We think that it should meet the same standards of care as if I see somebody in my office,” Read explained. “We’re on board, as long as we can have that. The model that led to all this problem, they [presumably vendors like Teladoc] didn’t want a doctor-patient relationship. They just wanted to say, give us a call, we’ll prescribe and charge you $65, and we’ll keep going.”
Other
The New Yorker fantasizes about what new healthcare plans might look like under the Trump administration:
Platinum
For a monthly premium of two hundred and fifty thousand dollars, this plan gives you prime access to all health-care options—no referrals or medical ailments required! If you’d like an MRI just for the fun of it, you’ll be slid into the very next available magnetic scanning tube. All prescription medication is free, plus the pharmacist has to say, “I love you; you are my moral superior,” when you pick it up.Gold
The same as the Platinum Plan, but only available to people who own a gold mine.Silver
For the incredible price of just $49.99 a month, you’ll receive a five-hundred-milliliter bottle of an unbelievable liquid miracle cure containing nanoparticle colloidal silver! Just one tablespoon daily will boost immune-system strength, make skin look decades younger, and improve your performance in the boardroom and the bedroom.Bronze
You can see any doctor in your network for only a ten-dollar co-pay. Your deductible is forty million dollars.
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I’m not quite sure why the article on NY State e-prescribing was newsworthy enough to highlight.
It’s true that e-prescribing works relatively well most of the time and has some definite advantages over paper scripts. Nevertheless, it still is problematic in multiple respects:
1. It’s costly for people with part time solo practices to purchase the software
2. There is no way to cancel a script that’s accidentally submitted for the wrong dose or person whereas with paper you can just void it or rip it up
3. The pharmacies continue to bother people with faxes about med refills rather than using a centralized electronic approach. Prior authorizations for meds remain a discrete nightmare and need to be integrated into the EMR workflow (if not eliminated for inexpensive meds).
4. The pharmacy software is still not configured correctly for handling prescriptions (especially controlled substances or Medicaid scripts) from academic medical centers that are written by residents. CVS is the worst in this regard although Walgreens apparently has issues as well. These problems didn’t occur with paper but are chronic with the change to e-prescribing and result in a lot of hassle for clinicians and mixed up medications (and hassle) for patients.
5. It is not straightforward to deal with medication refills, etc if you don’t have ready access to a computer. Our EHR has an iPhone app that allows placing e-prescriptions but it won’t work for controlled substances. Previously you could phone in a script for several days and send in a covering paper prescription. And scripts for regular meds were a simple phone call, not logging in, finding the right patient, etc.
6. The external prescribing history can be very helpful but it can also be very misleading because there is no way to annotate it to show when or why a particular medication has been discontinued. Consequently some meds keep getting resurrected when they would have (appropriately) faded from awareness in the paper world.
7. When adjusting doses in between visits, the medication information in the patient chart is now inaccurate because the EHR software aligns dosing and prescribing info to the prescription that has been placed. When a patient calls and a dose increase is indicated (e.g. Start taking two pills rather than one at bedtime), there is no way to note that without issuing more pills except as free text. But free text is not included in later med reconciliations. At least with my hospital’s EMR (Cerner), you can’t just adjust the “script” without giving more pills or implying that you gave more pills.
8. The maintenance of e-prescribing is very time consuming for large organizations, especially because each location within a health system requires a different SPI number and manual configuration. Before, we just took our paper pad of scripts and off we went.
9. Last, but certainly not least, the NY Health Commerce website (which one logs into to check to prescription monitoring data) epitomizes poor security practices and horrible user interface design. The usernames are a mix of letters and numbers that are not easy to recall and the passwords have to be changed frequently wirhout recycling any portion and with multiple requirements. Suffice it to say that this means people either have to put a stickie note in their desk drawer or computer or write their current info on a sticker on the back of their ID. Often one has an easily recalled login name and just records a password but in this case neither is memorable so you have to write down both. This makes it that much easier to compromise. The site design is cumbersome and there is no way to save your patient list as favorites, so you have to enter the patient name and date of birth manually each time, then click that the patient concurs with accessing the info, then click again to get the full view. To give a controlled substance script can take several minutes overall, which can add up even if you are prescribing appropriately.
The bottom line is that it’s good to have the option of e-prescribing but these problems with NY e-prescribing are just the tip of the iceberg. it would be much more efficient to be able to use paper when needed. It would also be a big plus If the pharmacies (yes, CVS, this means you) would fix their software and if New York State would fix their web site to enhance usability. Also the EHR vendors (yes, Cerner, this means you) need to fix their software to handle outpatient medications safely and correctly.
I commend NY MD for the above comment. Despite the stress imposed by obvious flaws of workflow design he took the time to write a cogent, highly detailed and specific bill of particulars. As frustrating as situations like this are, his sort of approach is what’s needed.