How e-prescribing stops doctor shopping

By | January 28, 2010, 10:36am PST

Summary: There are times when the refresh was just jaw-dropping. It radically changed what I did.

Doctor shopping is part of the dark underbelly of medicine.

Addicts go from doctor-to-doctor, describing phony symptoms, and getting real prescriptions for dangerous painkillers or stimulants.

Doctors feel helpless. They are taught to trust. They’re not cops.

Now, thanks to e-prescribing software, they don’t have to be.

Dr. Matt Weyenberg (right) found this out the hard way. He’s in family practice with a Plano clinic called Village Health Partners. They’re big believers in automation. They’ve been given awards for it. And they’ve gotten the chance to beta test the latest stuff.

The practice’s main vendor is GE Centricity, but they also use Kryptiq for e-prescribing. It was in testing the latest version of that software that Dr. Weyenberg learned some of his patients have been telling him sweet little lies.

“I click a button and it goes back to the SureScripts network, through Kryptiq, so if the patient had anything filled at SureScripts pharmacies it shows up. You see the doctor’s name, quantity and dose. The medical history is just viewed – it doesn’t go into the chart.

“There are times when the refresh was just jaw-dropping. It radically changed what I did.”  Some of these were patients he had been seeing for years.

He confronted them gently. He explained what he knew, offered the help of pain clinics, psychiatrists, addiction centers. Some took him up on it. Most didn’t. But the trust level was gone. Dr. Weyenberg dismissed them from the practice.

“I had an example last fall of someone getting Ritalin from 16 doctors. I spent a half hour on the phone with him, that day,” convincing them to get help, “and I then called a psychiatrist from whom he’d brought the letter saying he had ADHD symptoms.

“The doctor asked how I figured it out. I said with my Electronic Medical Record (EMR), and he said what’s an EMR.”

There are insurers who police this doctor shopping. But addict-patients are smart. They pay cash and keep going. Maybe now some of them will know to avoid the doctors who have fancy software, but with the HITECH stimulus and its penalties kicking-in later this decade, those are going to be fewer-and-fewer.

Maybe then doctor shopping will end. It can end with the insurer, or with the doctor, or the pharmacist. But it needs to end. And e-prescribing software can help end it.

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Disclosure

Dana Blankenhorn

Dana Blankenhorn has been a journalist, writer and part-time futurist for over 30 years. At the present moment I run only a personal blog in addition to my ZDNet open source blog. DanaBlankenhorn.Com has the subtitle The War Against Oil. In the past I have used it to write about political history, e-commerce, personal matters, some ideas related to open source, and The World of Always On, which is the idea of using sensors, motes and RFID to turn WiFi links into platforms for applications which live in the air. My IRA account at Schwab holds a few tech shares, most notably some Intel and Applied Materials, but there are no open source companies in it. I don’t even own any CBS stock.

Biography

Dana Blankenhorn

Dana Blankenhorn has been a business journalist since 1978, and has covered technology since 1982. He launched the Interactive Age Daily, the first daily coverage of the Internet to launch with a magazine, in September 1994.

Talkback Most Recent of 11 Talkback(s)

  • Not that it shouldn't be done...
    ...but does this software go to show us the the privacy parts of the HIPAA is just one of those sad little jokes?
    ZDNet Gravatar
    Bill4
    28th Jan 2010
  • Pharmacy records exchanged by doctors?
    That's what we're talking about, pharmacy records being exchanged among doctors. You think that violates HIPAA? Really? Really.
    ZDNet Gravatar
    DanaBlankenhorn
    28th Jan 2010
  • Heil Blankenthorn!
    You know, Dana, that authoritarianism just seeps out of your pores. Now you're on the hunt for druggies, as if our hundreds of thousands of drug cops had overlooked one or two dopers. Anyway, I'll bet ZDNet doesn't give you the kind of money our government pays its army of drug sniffers. But then you'd do it for nothing, because you love to rule. What I see in you is nothing but a stalking horse for that beloved "nanny state" of yours.
    ZDNet Gravatar
    nikacat
    29th Jan 2010
  • Right on
    Doctor shopping will end when just about every drug can be bought over the counter. Or when a "prescription" is not the same as a "legal license", and it's the pharmacist who gives the advice. There are better ways to do this then men-with-guns-imposing-rules-and-penalties.
    ZDNet Gravatar
    vikingnyc@...
    29th Jan 2010
  • You funny
    You don't like cops? You do like crime? Why is
    support of law enforcement deemed "nanny state"
    when it's aimed at you, but failure to support
    jail is called "soft on crime" when it's someone
    else?

    I don't expect you think about that, but I hope
    others do.
    ZDNet Gravatar
    DanaBlankenhorn
    30th Jan 2010
  • RE: How e-prescribing stops doctor shopping
    Good article Dana that sheds light on some of the benefits of eRecords/digital medicine. While it remains to be seen how effective HITECH will be (EHR adoption) eRx will proceed forward and even that small step is an improvement over what we have today.
    ZDNet Gravatar
    John-Chilmark
    29th Jan 2010
  • Note the pushback, John
    Take a look at some of the comments. Lots of our
    readers don't like law enforcement. Some don't
    like the law limiting access to such drugs as
    oxycontin, Ritalin and dexedrine.
    ZDNet Gravatar
    DanaBlankenhorn
    30th Jan 2010
  • Doctor-shopping IS Ridiculous...
    ...Because really all this effort to prevent people from taking the drugs they want is folly. It's the Drug War in a different guise. Do you really think that something like this will prevent addicts from getting their drugs of choice? No. It will merely push them away from professional medical supervision, thereby feeding the black market, starving the legitimate market, and potentially harming the patient. It will no more stop the flow of drugs than the Drug War has stopped marijuana from getting to those who want it.
    ZDNet Gravatar
    buzzl
    29th Jan 2010
  • So take all you want, we'll make more?
    Really? Take all the oxycontin you want? Take
    all the morphine?

    I support decriminalization of marijuana, by the
    way. I think people can live with a pot habit. I
    think we need a cost-benefit analysis of all
    drug laws.

    But speed and powerful painkillers will kill
    you, man. And while you're addicted you're not
    worth much to an employer, or your family.

    So what do we do about those losses? Is it then
    OK for employers to fire you if they see your
    productivity dropping to zero due to drug abuse?
    You can't say "it's none of their business" --
    productivity is their business.

    We've just gotten new rules that treat problems
    like addiction just like physical problems. The
    stigma should ease.

    But if you would rather be unemployable, that's
    your look out.
    ZDNet Gravatar
    DanaBlankenhorn
    30th Jan 2010
  • RE: How e-prescribing stops doctor shopping
    Dear Mr. Blankenhorn:

    In my state (Virginia) the way that they have helped decrease the access to narcotic prescriptions is to have a centralized database that is easily accessible by any provider, in "real time," for free to gain access to a patient's purchase of controlled drugs along with the names of physicians that have written the prescriptions. You don't need to go through the e-prescribing process to do this.

    Let's go over why e-prescribing will eventually fail to get widespread acceptance:

    -- It's a workflow killer- usually involves a cumbersome multi-click method of getting the prescription out to the pharmacy, which may or may not take the prescription and which may not be the pharmacy that your patient decides to buy the prescription at.
    -- E-prescribing is not free. Even the supposedly "free" Allscripts standalone e-prescribing software forces the physician to double entry all prescriptions into the EMR that they currently have, which is costly and makes that process useless. Of course, the physician can decide to pay royalties to integrate it into their current EMR (if that's at all possible).
    -- The physician will need to purchase a "certified" EHR, which nowadays average approximately $34000.00 per license with $1800.00 per month ongoing fees.

    Currently the level of e-prescribed medications stands at about 3% and growing slowly. Unless the software becomes freely accessible, easy to use it will eventually plateau and ignored by physicians.

    >>> "?but with the HITECH stimulus and its penalties kicking-in later this decade, those are going to be fewer-and-fewer."

    I wouldn't be so sure- the current level of HITECH-ready physicians as per the CDC (published 3 weeks ago) is about 6%, even after the first year of the HITECH stimulus push. Physicians know that "certified" EHR systems are costly, cumbersome, have an approximately 50% disenrollment rate, and have never been proven to actually decrease errors, increase quality, and/or decrease cost as has been stated by President Obama and the various EHR vendorlobbyists that surround him. I've counted 6 lobbyists so far, including GE (Blumenthal), Allscripts (Tullman), and Cerner (DeParle), Partners HealthCare System (John Glaser), eCW (Thomas Frieden, MD), Todd Park (AthenaHealth).

    What will become "fewer-and-fewer" are the doctors willing to see Medicare patients due to this increased beaurocracy now with HITECH threats of penalties and the forced "meaningful use" which will turn physicians into secretaries, forcing them to send in data about patients to third party governmental statistician pinheads. President Obama really believes that this HITECH poorly funded mandate will save the increasingly expensive Medicare program. How wrong he is (again). Medicare was scheduled to go bankrupt by 2017- now it'll probably go much, much earlier.

    Al Borges MD
    ZDNet Gravatar
    alborgmd@...
    3rd Feb 2010
  • RE: How e-prescribing stops doctor shopping
    I completely agree with Dr. Weyenberg. The insurance companies can only police those that use them, and most addicts do not have proper insurance. There needs to be another form of help that doctors can use to prevent multiple prescriptions to addicts. E-Prescribing seems to be the perfect answer. It allows doctors to act on behalf of the patients best interest and prescribe drugs or a support system appropriate to the patients condition.
    ZDNet Gravatar
    DrFirst
    8th Feb 2010

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