When I woke up this morning mulling over a complicated case a significant fact occurred to me: When I had first used my state's online prescription monitoring program (PMP) I discovered that two other prescribers had ordered benzodiazepines for this patient with addiction problems without contacting me. I confronted the patient and the prescribers, all of whom agreed to shape up, but now I realize that I have not checked this particular patient's record in a few months, and with the patient facing increasing medical challenges I plan to access the database today.
But I should not have to.
I have written about this program's limitations before here and here, but the problem I have encountered in the case above begs for another technologically easy solution. To state the problem in general terms, busy physicians will never check the PMP often enough to catch everyone's transgressions. It takes too much time. How often must we do this? Monthly? Weekly? Daily?
Two solutions occur to me. First, instead of requiring me to check patients one by one, entering name and birth date each time, the program should allow me to build a list of patients of interest. Every time I access the PMP it would generate a list of all such patients and any prescriptions filled since I last accessed the records. Better yet I could opt for email or text notification for each new prescription, or my electronic health record might alert me. The program could also allow me to opt out of notifications for prescriptions I deem appropriate.
Come to think of it I need to check the PMP for a new patient I examined yesterday. While I'm at it I will check the patient above:
New patient: Negative! I did not use the exclamation point just because the report showed no controlled substance prescriptions, but because this is the first time ever that the PMP actually confirmed finding that patient even though no prescriptions showed up. Maybe they fixed one of those problems I wrote about before! (Or maybe in all prior cases I entered the wrong name or birth date, but let me think positively.)
Complicated patient: No inappropriate prescriptions.
Total time: about 8 minutes, almost enough time to do one of those 15 minute med checks. ;) Imagine how much time it would take to check every patient in a busy practice.
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Or better yet, how about a regularly produced report of: patients filling controlled substance prescriptions from your practice who have also filled another controlled substance prescription from another prescriber within a specified time interval, sorted by quantity? Ideally, there would be a way to exclude the DEA #s of other practitioners in your own office, if any.
ReplyDeleteThen just add a checkbox to remove certain prescriptions from future lists (e.g. you prescribe benzodiazepines for a patient, but are aware that he/she sees a specialist who handles pain meds and there's no need for further regular review) and you're golden.