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All Things HIT

Jun 15 2012   3:32AM GMT

New York’s new e-Pre Act, has one problem!



Posted by: AllinHIT
E-prescribing, EHR, eRx, I-Stop, Mt. Sinai, workflow

If you read my last blog you are aware I am in NYC working at Mt. Sinai hospital. Hence, I’ve been sort of “checking out” the health IT scene here, and so far, I must say I am impressed.

Previously, I wrote about Mt. Sinai and their participation in the Image Share project, in conjunction with the RSNA. Now, I’ve read within three (3) years physicians will be required to send prescriptions electronically for pain narcotics under the Internet System for Tracking Over-Prescribing Act (I-Stop). Yes, you heard it right. In the State of NY, physicians will electronically send schedule II, III, and IV drugs!

At first, I thought this was great news. As a former advisor to ePrescribeFlorida, a nonprofit organization promoting the use of e-prescribe in the State of Florida, we worked tirelessly on trying to get the State of Florida on this same path. Our efforts, although less ambitious, were to be less disruptive. Hence, there is a huge problem with this legislation, as it puts unnecessary burden on the physician and the pharmacist! 

The problem with I-Stop is it requires the physician to review a patient’s prescription history, on a yet to be built real-time database, hence effecting workflows! I-Stop, however, is an equal opportunity workflow disrupter (is that a word?), as it requires the pharmacist to report when such prescriptions are being filled! The I-Stop database is separate from the physicians EHR and the pharmacist’s back-end pharmacology system, hence, will require both offices to access yet another system in their workflow! I continue to be an advocate for e-prescribing controlled substances, however, I believe there is a better way to accomplish it and still attain the goals of the I-Stop Act (reducing drug abuse and identifying those that need help with substance abuse).

What is a better way? It requires collaboration between software vendors, network aggregators, and of course, the stakeholder State.  The solution begins with having the pharmacist’s system, which is certainly tied to SureScripts, automatically update these prescriptions to a database which is tied to the physicians’ EHR. When the prescription is written in the EHR for those drugs, it will automatically check the pharmacist database (SureScripts), then creates an alert to the physician if abuse is suspected! This solution will not require a drastic change in their workflow, but requires systems to do what they do — talk to each other!

I applaud New York in allowing schedule drugs to be electronically sent. However, I would like a more system approach, as described above. The physicians’ workflow is already going through changes considering the implementation of EHRs due to HITECH. I-Stop is a perfect example of good intentions gone disarray, but it deserves a reprieve with changes!

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