Mandatory e-prescribing comes into its own

With help from Darius Tahir and Mohana Ravindranath

WHY THE OPIOID CRISIS IS GOOD FOR HEALTH IT, CHAPTER TWO: Our sector is starting to look like Exhibit A in the lecture about how crisis can lead to technological innovation. We’ve already described how the legislative struggle with opioid overdoses has led to expansion of telemedicine. Well here’s a second area of our beat that’s been chivvied along by fear of opioids: electronic prescribing of controlled substances.

... With state legislators, some pharmacies and health systems leading the way, and Congress following in the slipstream, the move to e-prescribing is accelerating nationwide.

... Such digital transmissions have only been legally possible since 2010, but with the opioid crisis continuing to batter the country, policymakers and the health care sector have become increasingly intrigued by routing prescriptions through electronic pathways, our Darius Tahir reports this morning. Only 21 percent of controlled substance prescriptions were delivered electronically in 2017, according to Surescripts, a national e-prescription network, but that’s up from 11 percent just one year earlier.

... It’s easier and cheaper to control prescriptions sent digitally rather than by paper, says Geisinger’s chief pharmacy officer, Mike Evans. His hospital system has mandated e-prescriptions for controlled substances, and is preparing to expand that to all pharmaceuticals, controlled or otherwise, by the summer.

... The mandating of e-prescriptions received a kickstart from the New York legislature in 2016, and Arizona, Iowa and North Carolina have since passed mandates scheduled to take effect in the coming years. Walmart announced May 7 that it would require e-prescriptions for opioids by 2020.

... Both chambers of Congress have introduced the Every Prescription Conveyed Securely Act of 2018 (hr3528), which requires e-prescriptions for controlled substances in Medicare Part D by January 1, 2020; the House version was approved by voice vote in the Energy and Commerce Committee May 9. The Senate version is still in committee. Read the details in Darius’ story here.

Tweets of the Day:

Mark Friedberg @MWFriedberg. We need better #EHRs. But it’s hard to solve safety & usability problems that stay secret. Post your #EHRbuglist Here’s mine.

Adrian Gropper @agropper My 40th medical school reunion talk is about why our profession must own the artificial intelligence and patients must control the records the AI needs #HealthIT @PatientPrivacy

Welcome to bloomin’ Monday morning eHealth, where we hadn’t been in the D of C for 24 hours, after a glorious week in London — it was mostly sunny there, for Pete’s sake! — when our house reminded us how much it needs our love and attention by admitting copious precipitation into its nether regions. No Sunday roast for us (or time to think about the British NHS’s critical need of a 4 percent budget hike): it’s wet feet and the drone of the Shop-Vac. Lovely to be back. No, really. Send tips to [email protected], or tweet @ravindranize, @AthurAllen202, @dariustahir, @POLITICOPro, @Morning_eHealth.

FDA EXEMPTS GENETIC RISK TESTS FROM 510(k): Tests measuring a consumer’s genetic risk for health conditions officially won’t need 510(k) clearance from FDA, the agency announced Friday. The exemption frees companies from getting that clearance, which the agency generally requires for devices that aren’t of a new type. The announcement doesn’t mean the genetic tests will be entirely free of agency scrutiny, however. FDA is proposing a number of special requirements for companies to fulfill if they want to launch a product in this category. Companies will have to conduct a user comprehension study, to be sure participants understand the test and its results, including their potential limitations.

... The decision, prompted by the 21st Century Cures Act, is another victory for direct-to-consumer genetic testing firms like 23andMe. The agency at first took a combative approachtoward the startup, but has gradually relaxed its posture.

ICYMI: EPIC VICTORY: Illinois’ Procurement and Policy Board last week found no violation in University of Illinois Health’s contracting process for a $62 million EHR deal with Epic. Cerner had filed a protest against the arrangement, saying its bid was $1.5 million lower than Epic’s, and that the process was tainted by a possible conflict of interest.

DOES INCREASED DATA EXCHANGE WITHIN THE HOSPITAL SYSTEM MEAN LESS WITH OTHERS? That’s the conclusion of this study in the Journal of the American Medical Informatics Association by Indiana University researchers who examined hospital surveys back to 2010. The prevalence of data sharing increased over time, but sharing between hospital systems — as opposed to within them — progressed more slowly (no surprise there). On average, the scholars found, hospitals could share 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange. Hospitals are prioritizing exchange of information within their organizations, the authors found, and “if increasing inter-system exchanges is a desired goal, current market incentives and government policies may be insufficient to overcome hospitals’ motivations for pursuing an intra-system-information-exchange-first strategy.”

HOW THE LEOPARD REGAINED HIS SPOTS: A 5-month-old, dehydrated leopard cub found in the forest in Madhya Pradesh state was treated successfully through telemedicine, according to the Times of India. The cub was brought to the district police and seen by a veterinarian who was stumped by its illness and contacted experts at Van Vihar National Park in Bhopal, many hours away, via telemedicine. A week after receiving medication for an infection, the cub was back on its regular diet of a half pound of raw meat twice a day, the Times reports. Another triumph of telemedicine — and a first for wild animals in India.

DESALVO TO OPENNOTES: Karen DeSalvo has joined the advisory board for OpenNotes, which seeks to disseminate the sharing of doctors’ notes and decision-making with patients. DeSalvo, the former ONC head and assistant secretary of health, teaches medicine and population health at the University of Texas Dell Medical School.

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