Please write 100 words response to each of this post on last two discussion topic.
1) Hello Class,
In this week’s lecture we looked at electronic prescriiptions for controlled substances (EPCS) and personally I think this is an important step in the reduction of handwritten facsimile scriipts or scriipts being misinterpreted. There are many benefits to the EPCS system. As mentioned in the lecture and probably the two biggest benefits would be that there is an audit trail, and it can support patients and providers by providing patients scriipts during non-office hours. For example, if a provider is out of office but a patient requires a scriipt, the provider can simply signoff on the scriipt remotely. This functionality became crucial during the course of the 2020 pandemic where some providers switched to zoom visits to see and care for their patients. One benefit mentioned that I also find a concern, however, is automatic refills. This has become very useful for patients that must take certain medications daily to maintain their health. The issue with automatic refills and what makes this my first concern when implementing an EPCS system is unintentionally overdosing the patients. Setting up automatic refills can be at the convenience for both the patient and the provider, but patients may lose sight of their responsibilities in taking the medication accurately and according to the medication administration schedule. I have personally seen patients who require a specific medication either incorrectly dose or lose their medication thereby requiring another set of medication due to automatic refills. When this happens, it can be difficult for the care team to determine if the patient is taking the medication appropriately and provides extra hoops for the provider to jump through to prescribe the patient another set of medication if before the designated refill date. The providers may also feel with automatic refills they won’t have to see their patients as often. This too is a double-edged sword because it does provide convenience and reduction in cost for frequency of patient visits but does result in less oversight, which for elderly patients can be fatal. The second biggest concern with this type of system is that it will be very costly. As the lecture mentions, it requires a double authentication system for security purposes, which this alone is extremely costly. This does not even include the general upfront and ongoing costs required for supporting a EPCS system within the EHR. Dependent on which type of EPCS and EHR is chosen, it can cost thousands of dollars per provider (Health Current, 2018). These would be my two biggest concerns when setting up an EPCS system. The best way to mitigate these would ensure that providers are maintaining proper oversite of patient scriipting and to perform a costs vs return on investment analysis when choosing a EHR/EPCS system.
Sincerely,
Matthew
Reference:
EHR vendor cost sheet – health current. (2018). Retrieved October 27, 2021, from https://healthcurrent.org/wp-content/uploads/2018/09/EPCS-Cost-Sheet_FINAL_09-21-18.pdf.
2) atricia Gaffen
Oct 28, 2021 at 7:30 PM
This week we are summarizing our general thoughts and reflecting on EPCS. Since my trade is in Occupational Therapy, I really don’t have any idea or experience behind electronic prescribing. I also did not know the history of it or the benefits of E prescribing in healthcare technology so I decided to really dig deep into reading several different resources so that I could really understand what the purpose of electronic prescribing is. Basically, electronic prescribing or E prescribing allows health care professionals such as pharmacists or physicians to use a digital prescriiption software and transmit a new prescriiption to a new community to basically reduce the risk associated with scriiptwriting ( ). eRX platforms like Surescriipts began building electronic connections in 1999 and Electronic Prescribing became legal shortly after in 2007 then by 2003, eRx took off with the Medicare Modernization act ( ).
There are many benefits of electronic prescribing. As everyone is aware over the years technology is constantly changing. There are several benefits to physicians and patients to electronic prescribing. Some benefits of E prescribing include the prevention of drug errors they are mainly due to handwritten prescriiptions, it enhances the medication reconciliation process where physicians can readily view the patient’s medication history and won’t have to memorize all the drugs that the patient is taking. A third benefit is that it shares instant notification of drug interaction allergies if there are any. So, with E prescribing, doctors have full access to patients’ information. This system would allow for notifications about allergies or other issues that would be contraindicated to dispense a med. E prescribing would be a preventative tool to reconsider giving a certain medication to the patient otherwise to reduce a fatal injury to the patient. A fourth benefit is that it would allow for better monitoring of controlled substances in less time. A typical authorization now is just a few seconds ( ).
The top two greatest concerns when setting up a hospital-wide program are making sure to take the time to really invest in training because you want the providers to have the education and support required to adopt prescribing. Second, it’s very important that the system within the hospital has hardware and software that has excellent firewalls to really protect the transmission of data that presents privacy concerns.
References:
The history of electronic prescribing (eRx) and its benefits in Healthcare Tech. The History of Electronic Prescribing (eRx) and its Benefits in Healthcare Tech | Covetus Technologies Pvt Ltd. (n.d.). Retrieved October 28, 2021, from https://www.covetus.com/blog/the-history-of-electronic-prescribing-erx-and-its-benefits-in-healthcare-tech.
Salmon, J. W., & Jiang, R. (2012). E-prescribing: History, issues, and potentials. Online journal of public health informatics. Retrieved October 28, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615836/.
3) E-FORCSE is Florida’s PDMP used for those who dispense medications to report the release of controlled substances that are scheduled II-V. Practitioners are then able to check the database to ensure a patient has not already received these medications from a different provider before prescribing and can provide a dispensing history for practitioners. This initiative was developed in 2009 to combat drug abuse and diversion (Florida Health, n.d.).
Missouri was the only state that did not have a statewide PDMP, legislators have offered resistance due to concerns about data breaches and privacy. Just this past year the governor signed PDMP legislation into law (Hauswirth, 2021, June 6). St. Louis County does have a PDMP which only covers 80% of the state population, by creating a state program, supporters are looking for increased oversight (Weinberg-Gannett, 2021, April 8).
The PDMPs have similar such as early substance abuse prevention and investigation, promote awareness, and provide information for public health initiatives (IIR, 2021). However, they are not uniform across the states, variations are seen in which substances are monitored, responsible agency, who has access, registration and use requirements, and reporting style. The reporting style can either be proactive (generates unsolicited reports) or reactive (generates reports only when requested) (Prevention Solutions@EDC, n.d.). The names also differ, for example Ohio Automated Rx Reporting System (OARRS).
Another difference is the sharing of interstate data. In the U.S. there are 54 active PDMPs which includes states, territories, and districts. Another difference among states is the sharing of data between states. California, Guam, and Northern Mariana Islands do not participate in interstates sharing, though they are working to resolve this. Most states are at least sharing with other bordering states. Regarding access, all PDMPs allow intrastate access for prescribers and dispensers, while interstate 52 allow access for providers and 45 for dispenser. Within the state 50 allow access for federal law enforcement, 51 state law, 49 local law, and 34 prosecutorial authorities. Researchers can access 52 intrastate. Patients can access their own records for 45 PDMPs. Public health departments, drug counselors, Medicare, and Medicaid are all entities that have access to some PDMPs but not all (IIR, 2021).
As far as which medications are monitored, Nebraska and Northern Mariana Islands monitor everything, 43 others monitor Schedule II-V, 9 monitor schedules II-IV. In addition, 28 of these programs monitor medications which are not considered controlled but have seen an increase in abuse such as gabapentin (IIR, 2021).
References
Florida Health. (n.d.). Prescriiption drug monitoring program. https://www.flhealthsource.gov/FloridaTakeControl/pdmp
Hauswirth, B. (2021, June 6). Missouri’s governor to sign PDMP on capital lawn in Jefferson City on Monday. Missourinet. https://www.missourinet.com/2021/06/06/missouris-governor-to-sign-pdmp-on-capitol-lawn-in-jefferson-city-on-monday/
IIR. (2021). Interstate PDMP access and data sharing alignment. https://www.pdmpassist.org/pdf/resources/Interstate_PDMP_Access_and_Data_Sharing_Alignment_20210125.pdf
Prevention Solutions@EDC. (n.d.). Prescriiption drug monitoring programs. https://preventionsolutions.edc.org/services/resources/prescriiption-drug-monitoring-programs
Weinberg-Gannett, T. (2021, April 8). Missouri steps closer to state prescriiption drug monitoring program. Lake News Online. https://www.lakenewsonline.com/story/news/2021/04/08/missouri-steps-closer-state-prescriiption-drug-monitoring-program/7152503002/
4) Hi Everyone,
A prescriiption drug monitoring program is now in place in Florida (PDMP). The “Electronic-Florida Online Reporting of Controlled Substances Evaluation,” or “E-FORCSE,” is the name of the program. Florida doctors refer to it as the “prescriiption medication database” more frequently. Most quite, it was not the plan of the Legislature for any state or government organization to utilize the information from the E-FORCSE framework basically as proof to make a licensure or disciplinary move against doctors, dental specialists, drug specialists or other authorized wellbeing experts.
Information from E-FORCSE has been discussed for a situation against an authorized wellbeing proficient to act as an illustration of “inadequate execution,” “falling underneath the norm of care,” or expert “carelessness.” Additionally, doctors have been educated regarding the supposed utilization of the E-FORCSE framework by state and government law requirement experts in criminal examinations and indictments of authorized wellbeing experts. E-FORCSE will take in controlled substance administering information from drug stores and medical services specialists, and will make the data accessible to all medical services experts who would then be able to utilize the data set to direct their choices while endorsing and apportioning specific profoundly manhandled physician recommended drugs. With this data, medical services experts might have the option to distinguish patients who are “specialist shopping”- getting different solutions for similar controlled substance from various medical services professionals. Specialist shopping is a lawful offense in Florida. It permits the medical services professionals to pick and recommend controlled substances that won’t adversely communicate with prescriiptions endorsed by other medical care experts. Pharmacists can decide for their patients if their medical services professionals have recommended controlled substances that may adversely communicate when utilized together. Health care professionals can decide whether their patient has had different solutions for similar medications from numerous medical services experts. This distinguishes those patients possibly occupied with the wrongdoing of specialist shopping. At the point when medical services specialists intercede, they can help their patients find therapy. In addition to meeting the federal HIPAA requirements, E-FORCSE will meet all required DOH security requirements.
There are two goals of E-FORCE which are;
Provision of support to enable proactive use of prescriiption Drug Monitoring Program by medical care practitioners and health policymakers to ensure timely information on prescriiptions and patient behaviors to health authorities, this monitoring aims to improve health safety and improve health outcomes. The second goal is to minimize the abuse of opioid abuse and also minimize the number of deaths caused by opioids abuse- in four thousand, six hundred and ninety-eight drug overdose deaths in Florida 68% of them were caused by opioid overdose this called for action which attributed for creation of E-FORCE.
Currently, 49 states that have functioning PDMPs, in addition to the District of Columbia and the US territory of Guam, and these programs vary from state to state. Missouri is the only state lacking a statewide PDMP, however St. Louis County has implemented its own PDMP and has welcomed other counties and cities in Missouri to join. Although similar in nature, each state’s PDMP varies by how it is administered and who is granted access. Only 28 states need dispenser (pharmacist) enrollment as of April 2018, while 25 states require both pharmacists and prescribers to participate. Indiana, North Carolina, Oregon, and Guam require only pharmacists to enroll. Currently, neither party requires required enrollment in 14 states. 5 Enrollment of pharmacists and physicians would be a critical step forward in the development of PDMPs to combat medication diversion. De-identified data can be used for study in some states, including Georgia, Louisiana, and New York. Oklahoma is the only state that requires data to be reported to the PDMP at the point of sale. New York State adopted the first PDMP program in 1918, which was used to track prescriiptions for cocaine, codeine, heroin, morphine, and opium. Pharmacists were required to report copies of prescriiptions to the health department within 24 hours under this program.
Reference:
(1)Scott, R., Philip, C., General, S., & Poston, S. R. (2016). E-FORCSE®.
(2)Haffajee, R. L., Jena, A. B., & Weiner, S. G. (2015). Mandatory use of prescriiption drug monitoring programs. Jama, 313(9), 891-892.