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Editorial: Prescription abuse

Florida‘s medical examiners recently reported that prescription medicines caused more deaths in 2008 than illicit drugs. The medical examiners also reported sharp increases in deaths caused by prescription tranquilizers and painkillers, such as Oxycodone and hydrocodone.

The results of the year-end report weren’t surprising. Since the middle of last year, physicians, pharmacists and law enforcement officials have warned of a near-epidemic of deadly prescription medicine abuse. In 2005, the Medical Examiners Commission began reporting the drugs discovered in bodies subject to autopsies. The percentage of decedents with at least one drug in their bodies has increased each year; to 53 percent last year.

“The vast majority” (4,924) of the 8,556 drug-related deaths studied last year by the state’s medical examiners involved the presence of more than one drug, according to the 2008 report. The presence of at least one prescription drug caused the death of 2,184 people last year.

To put the scale of those numbers in perspective, consider: There were 2,983 deaths on Florida’s roads last year; 1,169 of those fatalities were alcohol-related. Prescription drugs caused more deaths than alcohol-related crashes in Florida.

Of particular concern: Death-related occurrences of both benzodiazepines and oxycodone were up by more than 20 percent in 2008 compared with 2007. The drugs that caused the most deaths in Florida: oxycodone (941), benzodiazepines (929), methadone (693), cocaine (648), alcohol (489), morphine (300), hydrocodone (270).

This year, the Legislature finally passed a law that calls for creating an electronic database to monitor the prescription and sale of certain painkillers and tranquilizers. The database should help investigators track the worst offenders once it is operational next year, but even proponents of the law concede it was watered down.

Other initiatives are likely to be necessary because the personal and societal problems associated with the misuse of prescription drugs aren’t getting better.

AMA Unveils Enhanced ePrescribing Learning Center to Provide Physicians Tools to Make Informed Decisions About Electronic Prescribing

Earlier this year the American Medical Association (AMA) launched a new online learning center to provide physicians with the information and tools they need to make informed decisions about electronic prescribing (ePrescribing). Today, the AMA unveils enhanced tools for ePrescribing and opens the site and all its resources to all physicians.

“A recent survey found about 30 percent of physician participants use an ePrescribing system in their practice. This is a sizable increase from the 13 percent who said the same at the end of last year,” said AMA Board Member Joseph M. Heyman, MD.

“With the current Medicare ePrescribing incentive and the promise of increased patient safety and practice efficiency, physician interest in adopting new technologies is increasing. We are glad to be able to offer physicians guidance on ePrescribing.”

The learning center includes a variety of tools and resources to help physicians, including calculators to estimate time savings and eligibility for incentive payments and planning tools to help determine practice readiness for and ease implementation of new technologies. Some of the new tools include:

• A system finder tool that selects three systems for a user based on their responses to a brief questionnaire
• Side-by-side comparisons of up to three ePrescribing vendors at one time
• The ability to read vendor feedback and ratings from other users, and provide your own vendor feedback
• Automated contact a vendor capability for when a decision is reached.

“Health information technology continues to be a hot issue in health care, and electronic prescribing can be a physician’s first step into health IT,” said Dr. Heyman. “Incorporating an ePrescribing system into your practice can help reduce medication errors and drug interactions and also help prepare the practice for future technologies like electronic health records.”

Standards Panel Backs Quality Measures for ‘Meaningful Use’

On Tuesday, the Health IT Standards Committee approved quality measures and standards for how health care providers can demonstrate “meaningful use” of electronic health records by 2011, Government Health IT reports.

Under the federal economic stimulus package, hospitals and physicians who demonstrate meaningful use of EHRs will qualify for Medicaid and Medicare incentive payments.

The standards panel endorsed a matrix of 27 quality measures and 12 standards that build on each other to improve patient outcomes. The standards call for health care providers to use health IT tools for transmitting:

• Continuity of care documents;
• Discharge summaries;
• Inpatient and outpatient prescriptions;
• Laboratory test results; and
• Other structured health data.

The committee said health providers who have not yet adopted EHR technology could use certain unstructured data for 2011, provided that they work to eventually meet structured data standards.

John Halamka, co-chair of the Standards Committee, said the panel attempted to provide “comfort levels” to encourage physician compliance with the standards and quality measures. He said future criteria will require health care providers to meet stricter standards.

Stimulus Package Steps Up Health Data Privacy, Security

Health care providers are gearing up to meet the privacy and security provisions of the federal economic stimulus law, Healthcare Informatics reports.

Under the health IT provisions of the federal stimulus package, all entities that handle protected health information must comply with HIPAA privacy regulations. In addition, the stimulus law calls for health care providers to:

• Notify all affected patients within 60 days of a security breach;
• Report security breaches to the HHS secretary and prominent media outlets if the incident affects more than 500 individuals;
• Track all personal health information disclosures; and
• Upon patient request, provide an account of every disclosure for the previous three years.

Experts say health care facilities could face serious penalties if they fail to comply with the new security provisions of the federal stimulus package.

Lisa Gallagher, senior director of privacy and security for the Healthcare Information and Management Systems Society, said health care facilities have focused on the funding aspects of the stimulus law instead of the security provisions. She said health care executives “need to devote time to creating additional policies, procedures and processes for meeting these requirements.”

E-prescribing gains traction in Michigan

He gave up the paper pad four years ago and now only writes prescriptions for patients electronically.

While Dr. Richard Smith can’t specifically quantify the results, he knows without any doubt that e-prescribing has generated efficiencies in his medical practice.

“As you accept it in your practice, it’s a phenomenal tool,” said Smith, an obstetrician with the Henry Ford Medical Group and president of the Michigan State Medical Society. Smith, who’s been in practice for nearly 30 years, is among a growing number of physicians in Michigan and nationwide who now use e-prescribing, as health care rushes to catch up with other industries in the use of information technology. A June report shows Michigan is one of the leading states in e-prescribing rates, ranking third behind Rhode Island and Massachusetts. It moved up from fifth in 2007 and three spots from two years earlier.

In 2008, doctors in Michigan ordered 9.03 percent of all prescriptions electronically – 4.2 million new prescriptions and more than 603,000 refills – more than twice that of 2007 and more than quadruple the 2006 rate, according to Surescripts, a national provider of electronic access to health information that issues the annual Safe-Rx Awards to the top 10 states. The use of e-prescribing in other leading states has grown by similar rates since 2007. The rate in Massachusetts, for instance, grew to 20.5 percent in 2008 from 13.43 percent the year before and 8.80 percent in 2006.

Advocates of e-prescribing suspect Michigan’s 2009 rate is now in the mid-teens and say it will continue to rise rapidly. “We’re on a continuum right now,” Smith said. “We’ll see more and more.” At Grand Rapids-based health plan Priority Health, the e-prescribing rate by participating doctors was 14 percent as of May, up from just 3 percent at the end of 2008, pharmacy administrator Steve Marciniak said. Despite the strong growth in Michigan’s e-prescribing rate the past two years, Health Alliance Plan’s Denice Asbell says advocates need to maintain the push to go much further.

“Nine percent leaves a lot of room for growth and improvement,” said Asbell, project manager of purchasing initiatives at HAP, a unit of Henry Ford Health System.

A 20 percent e-prescribing rate is a “realistic goal” for 2009, Asbell said. “We’ve had a significant number of physicians come on board and start using the technology just since December,” she said. “Physicians are recognizing this is the way the world is going and they have to get on board. Patients are expecting it now.”

Helping to drive the rate higher is a 2 percent incentive payment for 2009 that doctors can receive from the federal Center for Medicare and Medicaid Services for e-prescribing when writing prescriptions for Medicaid and Medicare recipients.

In Michigan, Surescripts credits the February 2005 formation of the Southeast Michigan e-prescribing Initiative, or SEMI, with the growing adoption of e-prescribing technology by physicians. The group consists of representatives from Ford Motor Co., Chrysler and General Motors, Blue Cross Blue Shield of Michigan, Health Alliance Plan, the Henry Ford Medical Group, Medco Health Solutions and CVS Caremark Corp.

E-prescribing advocates cite its ability to improve the operating efficiency of physician practices and reduce potentially dangerous drug interactions in patients.

Since 2005, the use of e-prescribing in Southeast Michigan has generated a 24 percent reduction in the incidence of adverse drug reactions, according to SEMI.

Between 2005 and 2008, some 2.75 million prescriptions for patients were changed or canceled because the electronic network alerted participating doctors to a potential drug-to-drug adverse reaction, according to a SEMI analysis of 9.5 million prescriptions that were ordered electronically.

Doctors changed or canceled another 260,000 prescriptions because a drug allergy warning. A HAP survey of physicians found 77 percent agree that e-prescribing improves patient safety. Physicians also cited a reduction in staff time for handling prescription renewals, reduced pharmacy call backs and faster patient transactions at the pharmacy. The 500,000-member HAP estimates the collective administrative savings for Henry Ford Medical Group physicians at $560,000 annually. Another $540,00 a year is saved by reduced ER visits and hospital admissions resulting from prevented adverse reactions.

EHR adopters could face series of tighter standards

A work group of that committee delivered its first draft of recommended definitions of “meaningful use” of EHRs, a standard that providers must meet to qualify for subsidy payments estimated at $34 billion to be handed out by Medicare and Medicaid. The work group recommended instituting a series of increasingly complex meaningful-use requirements between 2011, the first “payment year” of the subsidy program, and 2015, the final year payments will be made before financial penalties for not adopting begin.

During those discussions, Anthony Trenkle, director of the CMS’ office of e-Health Standards and Services, said the requirements will not be “tiered” based on when the provider adopts an EHR after 2011. Instead, whatever meaningful use standards are applicable for the year the provider applies for an EHR subsidy are the standards that provider must meet, regardless of whether it is the provider’s first year of EHR implementation.

A 10-day public comment period opens today on the work group’s initial recommendations. Trenkle said the CMS hopes to have a final definition of “meaningful use” to put out for a 60-day comment period later this year, with final rulemaking not expected until early next year.