Thursday, January 5, 2012

WA Rx Monitoring Program Flawed

First thing yesterday morning two messages appear in my inbox. A few minutes later I am searching the controlled substance records for the patients on my schedule for the next few days. Health Information Designs provides the service via a Web interface that looks like a throwback to the 1990's and features data entry windows that do not line up with their labels. The "practitioner/pharmacist query" page features a check box for "Prescriber Search by DEA." Does HID intend that DEA agents should be able to use this to search for providers like me? Or did they mean "Prescriber Search by DEA Number?"

Undaunted by the amateurish interface I conduct my first queries. Bingo. I discover more than one non-physician has prescribed controlled substances I consider contraindicated for a patient I treat for addiction without contacting me to coordinate care. I strike more pay dirt:

  • One buprenorphine maintenance patient had already told me his dentist had prescribed a -codone for a dental procedure.
  • I discovered another physician had prescribed zolpidem to a buprenorphine patient without consulting me.
  • I discovered another physician had prescribed eszopiclone unbeknownst to me.

Now what? Should I test each patient by asking if there's anything they want to tell me? Should I discharge the filthy liars? And how often should I check the database?

I am inclined to avoid the drama, but let each patient know that I can now discover what other docs (and non-docs) prescribe. Since these other providers also have access to the records there will exist no illusion that the patient can keep them in the dark.

Out of a total of 18 patients I was unable to find any record of 7 patients. In one case I had entered the wrong birth date, but in several cases I myself have prescribed controlled substances regularly for months. This means that a negative query can result from entering the name or birth date incorrectly, but it could also result when no controlled substances were prescribed. So a positive result tells you something, and a negative tells you nothing. This flaw merits urgent attention.

I inquired about the problem via email to HID. The response:

Your search may be too narrow and will only pull specified information. I am able to help you with a search if you are available. Also your search should be used as a tool in addition, to the information you know is true and it allows the prescriber/pharmacist to make a better decision about health care. When used this will prove a very useful tool when used in conjunction with good sense and caring health providers like you.
Ayana Lewis
Technical Support Specialist
Prescription Drug Monitoring Program
Health Information Designs, Inc.

If anyone out there can interpret that for me, please comment.

When I called HID for that promised help I predictably encountered Ayana's voice mail, so I called back to navigate the menus. The states are divided alphabetically with menu choices, but I waited in vain for Washington. I guess I could have extrapolated from Vermont (8), but I chose to call once more and try my luck with an operator. With minimal hold time I spoke with a representative who ultimately did not seem to grasp the gravity of the problem or offer any hope for correction. I have since contacted the State of WA and am expecting a return call.

On the positive side for the interface: security. Not only must I use a username and password to access my account, but I must register the devices (computers) I intend to use.

An unexpected positive consequence: Patients in the past have refused to allow me to coordinate care with other providers for fear I will reveal their addiction history. Since this strategy will no longer keep the secret I can expect more cooperation in the future.

The patient I "caught" above (or I could more accurately say I caught the providers of the prescriptions) admitted to the problem, allowing us to develop a new plan, including giving me permission to contact those providers and read them the riot act. Overall this program will likely help a lot of people and save more than a few lives.

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