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About pkaufman:

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).

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Aug
26
2014

Several years ago, we embarked on a journey that no other health IT company had taken to date: we participated in a study that dramatically shifted the e-prescribing landscape by adding controlled substances as a capability. I am happy to share that the Agency for Healthcare Research and Quality (AHRQ) released a video about the three-year project.

I’ve talked about our work to bring e-prescribing of controlled substances to market and the current state of the industry in previous blog posts and videos, but I wanted to get into some of the details that surrounded our AHRQ-funded study in Berkshire County, Massachusetts in this post.

Study Background

The DEA issued its Interim Final Rule on electronic prescribing of controlled substances in 2010. Several years before the ruling, we laid the groundwork for electronic prescribing of controlled substances in Berkshire County through an AHRQ-funded study. I had met Donald Burt, MD, a physician at Berkshire Health Systems (BHS), who highlighted some of his grievances with the inability to send controlled substance electronically, which included:

  • Using two systems for prescribing was nonsensical and resulted in disrupted workflow
  • Not only were handwritten prescriptions time consuming, they also put him and other physicians at risk for tampering and diversion
  • Berkshire County had a huge prescription drug abuse problem, exacerbated by an inability to track medications sent. In fact, BHS was funding its own program to monitor all controlled prescriptions

His grievances were not uncommon for physicians then, and today.

The project started to come together when I got Grant Carrow PhD on board. I approached Dr. Carrow, who became the Principal Investigator, to participate in the study because I was impressed with his understanding of the issue as well as his academic background.

At the time of the study, Dr. Carrow was also Director of the Drug Control Program for the Massachusetts Department of Public Health (MDPH). When Dr. Carrow and MDPH agreed to get involved, they put together a high-quality, academically complete project. Dr. Carrow was also instrumental in bringing both BHS and Brandeis University into the study. I am thankful to Dr. Carrow, as his work helped us get AHRQ funding. Other partners included pharmacies, the DEA (who provided a waiver), AHRQ, and Emdeon, the e-prescribing network that transmitted prescriptions between DrFirst and the pharmacies.

Spearheading Industry Transformation

Some people might want to know why we chose Berkshire County to do a pilot study. What better place to do a study on e-prescribing controlled substances than somewhere with a prescription drug abuse problem? Since DrFirst was already communicating with the DEA about possible solutions to e-prescribing of controlled substances, I received the green light from the DrFirst executive team. I then began gathering a team to participate in the study. You can learn more about the project by watching the AHRQ’s video:


 VIDEO: AHRQ Highlights Pioneer Electronic Prescribing of Controlled Substances Study

I hope you enjoy the video, and please feel free to share your thoughts in the comments section.

Where We Stand: E-prescribing of Controlled Substances Today

We’ve come a long way, but we’re still not at 100% of providers sending, and pharmacies accepting, controlled substances. So, where do we stand now?

  • Over 40% of pharmacies nationwide accept controlled substance e-prescriptions
  • 49 U.S. states have now legalized controlled substance e-prescribing
  • New York’s I-STOP deadline March 27, 2015; The law mandates controlled substance e-prescribing

For more information on controlled substances e-prescribing read our The Evolving Landscape for Electronic Prescribing of Controlled Substances white paper.

The AHRQ’s video reminds me, at a time when controlled substance e-prescribing is gaining momentum, of the real transformation we spearheaded and continue to foster.

About Peter Kaufman:

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).

Find all posts by Peter Kaufman | Visit Website

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Sep
27
2013

Perhaps because DrFirst is located in the Washington, DC area, and perhaps because we have a strong belief in standards and therefore participate in multiple workgroups tackling national issues, I’ve gotten to know the four individuals who have held the position as National Coordinator of Health Information Technology (ONCHIT) during their tenures–some more than others.

Since the creation of this relatively new federal agency in May 2004, each of the National Coordinators has brought a special flavor to the office. Each of these individuals has left a legacy, whether through setting up the office, bringing in VA healthcare experience, advocating for and receiving a significant budget, or driving Meaningful Use measures (MU) towards the difficult task of being, well, meaningful.

Dr. Farzad Mostashari is a unique individual in his interest and ability to canvas others and listen to their opinions. As such, MU has moved steadily forward. Although the pace of progress toward the Stage II adoption deadline has been controversial, it is due in large part not just to the ONC issues, but to the increasing number of mandatory, competing obligations, rules and deadlines originating from other divisions within HHS, as well as other federal agencies.

Examples include the ICD-10 deadline and the 10+ years of uncertainty and congressional brinkmanship in Medicare payment reform and the Sustainable Growth Rate (SGR). Speaking as a physician, the healthcare industry feels “under siege” resulting from the revolutionary changes coming with the implementation of the ACA law on top of the rapid strides forward in information technology.

Farzad has tried hard to establish a balance between incentivizing positive change more rapidly in health IT, but not at so fast a pace that providers felt they were just hanging on for the ride.  And progression of MU measure adoption through the next phases has been a thoughtful process, with an interest in gaining insight into the early stages before moving on to complete the design of the third stage. Whatever revisions may or may not be made to the ONC deadlines, the loss of Farzad Mostashari will be felt hard by DrFirst, the Physicians EHR Coalition (www.PEHRC.org), and I believe by the many practicing physicians (though not all) who are successfully managing the IT transition and may not yet even realize the impact he has had.

From my personal perspective, in addition to being reasonable and reachable, Farzad is a heck of a nice guy. He always has a smile for a familiar face, and is happy to discuss just about any topic related to healthcare IT.  He will be missed as both a leader and a friend.

The departure of Dr. Mostashari will leave a hole, but certainly not a vacuum. And I’m also sorry to hear about the departure of David Muntz, Principal Deputy National Coordinator.  But ONC is rife with very bright people, including the Acting National Coordinator, Dr. Jacob Reider.  Dr. Reider has a strong interest in usability—if he can help improve that feature in EMR applications, providers will be in a much better position to use those programs happily.

About Peter Kaufman:

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).

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Sep
20
2013

For a big picture view on how controlled substance e-prescribing (EPCS) and Prescription Drug Monitoring Programs (PDMPs) will help stem the epidemic of controlled substance abuse, please see the series of blogs by my colleague Thomas Sullivan, MD. In context with that series, I thought it would be helpful to describe certain key requirements for providers pursuing controlled substance e-prescribing as mandated by the DEA.

This entry assumes that you are either:

  1. a provider who has decided to participate in EPCS, and that adequate pharmacies in your area are also participating, OR
  2. a vendor with providers who are in the group above, or that has more than a trivial number of providers in NY State where prescribers will be required to send controlled drug prescriptions electronically by the end of 2014

The DEA’s requirements for an application to send EPCS include several critical areas outlined in their Interim Final Rule (IFR).

First, the EPCS application’s user interface must contain certain features and show them to the prescriber at the point of electronically “signing” the prescription. These include (1) specific patient, (2) prescriber, (3) prescription and (4) pharmacy information, as well as a (5) “signing statement.”

EPCS screen What’s Needed for EPCS: Critical Requirements for Providers and Vendors

Second, prescribers must undergo identity proofing (IDP) specified in the IFR, based on NIST requirements.* This IDP, which is used to identify the prescriber with more certainty than just a username and password, ties the prescriber to a two-factor authentication credential. These “factors” are:

  • (6) who you are (a biometric)
  • (7) what you know (a password), and/or
  • (8) what you have (a token)

DEA requires authentication with two of the three above factors. Most systems currently use a token and password because they require the least amount of additional hardware and drivers. In future, biometrics may be more widely used.

Third, once a provider has a two-factor authentication set up, their e-prescribing system must be able to grant them “access control.” That process involves two people (one can be the prescriber but doesn’t need to be, and one must have a two-factor authentication that works with the system – again, this can be the prescriber). This process tells the e-prescribing (or EHR) system that this prescriber is approved to use it for EPCS.

The final requirement I will cover here is that the e-prescribing system or EHR must undergo an extensive audit to make sure each of the requirements described above – usability and appropriate screens, IDP and access-control – are addressed as required by the DEA. The e-prescribing system or EHR vendor must make a copy of the resulting opinion letter and/or audit report from the 3rd party auditor available to practices that are using their system for EPCS.

There are plenty of other specific requirements, such as regarding re-sending or printing of EPCS prescriptions, but those above are the most serious, overriding and complicated.

As Chief Medical Officer of DrFirst, I feel the need to add that we developed our controlled substance e-prescribing system – EPCS Gold℠ 2.0 – specifically as a module so our partners and our competitors could use it to add EPCS to their systems. We believe strongly that this is good for both patients and physician practices and want to see it adopted by the industry. In areas where pharmacies that accept EPCS are limited, a common comment is that they are waiting for more EPCS prescribers – but many prescribers complain there are not enough pharmacies. Please feel free to contact your vendor and ask them about their plans to implement EPCS, or if you are a vendor, contact DrFirst and we can help you quickly add EPCS functionality to your system.

* Since the credentialing process used by hospitals is, in and of itself, an intense form of IDP, the recently released NIST Publication  800-63-2, “Electronic Authentication Guide”, allows such institutions to perform their own identity-proofing process.

About Peter Kaufman:

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).

Find all posts by Peter Kaufman | Visit Website

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Nov
21
2012

 Prescription Abandonment: It’s Not What the Doctor Ordered

Prescription abandonment is a growing concern in the medical community. With more and more doctors having digital access to patient medication history data through e-prescribing and electronic health record systems, it is becoming increasingly clear that patients never pick up prescribed medications.

Research shows that there is a direct correlation between prescription abandonment and  an increase in out-of-pocket patient costs. In addition, other factors — such as intolerable side effects and lack of patient understanding of the necessity of the drug — all result in medication non-adherence. These factors frequently result in unnecessary office visits and hospitalization, high re-admission rates, therapeutic failure, unnecessary deterioration in health, and the subsequent increase in the cost of health care.

Further research has shown that prescription abandonment causes up to 125,000 avoidable deaths per year and adds roughly $2,000 in additional healthcare costs per person in the U.S. When all the associated costs are combined, a 2011 study calculated that the cost of medication non-adherence — simply put: patients not taking their medications as prescribed by their physician — is almost $300 billion each year, more than 7% of all U.S. government spending on healthcare.

Physicians are no longer limited to interpreting medication history results. Now physicians can offer  patients financial assistance to combat the strain on their wallets. With Patient Advisor services offered by DrFirst through Rcopia, Rcopia-MU, as well as through its EHR/EMR partners, physicians can now quickly view a patient report that provides instant insight into the level of medication adherence and prescription fill rates of patients. This way physicians can identify any gaps in care and effectively consult with the patient about the importance of sticking to their treatment. Providers can also provide clinical, financial, and behavior support such as patient education , prescription and co-pay savings, patient care plans, and lifestyle engagement programs. Patient Advisor is designed to help providers assist patients in overcoming any obstacles in taking their medications.

DrFirst allows physicians the capability to extend the care provided to the patient beyond the office visit and ensure that patient’s stick to “Just what the doctor ordered”.

 Prescription Abandonment: It’s Not What the Doctor Ordered

You can download a free copy of our prescription abandonment infographic here.

About Peter Kaufman:

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).

Find all posts by Peter Kaufman | Visit Website

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Sep
26
2012

Back in 2001 when DrFirst first developed e-prescribing, we spent a lot of time educating providers about the benefits and patient safety advantages of utilizing technology in their practices. We spent years “Crossing the Chasm” from early adopters to broader adoption. For years, the industry believed the inability to e-prescribe controlled substances (Schedule II – Schedule V), combined with DEA restrictions, was the single greatest barrier to the broad adoption of e-prescribing. Many practices that prescribe large numbers of controlled substances avoided e-prescribing altogether because it fragmented their workflows.

DrFirst spent years working with the DEA and AHRQ in the research, development, and pilot phase of meeting the DEA requirements, in order to remove this obstacle so providers could all benefit from e-prescribing. (http://blog.drfirst.com/drfirst/congratulations-ahrq-grantee-team/). After we successfully went through the difficult process of certification, we hit a lull.

What we didn’t anticipate was that EPCS would have its own “chasm” to cross.

After reading Dr. John Halamka’s blog on where the industry stands on EPCS, we realized that the industry wasn’t aware that many of the barriers have already been removed! (http://geekdoctor.blogspot.com/2012/09/an-update-on-controlled-substance-e.html).

“The primary barriers in my view have been:  the development time and effort the vendors and pharmacies needed to come into compliance with the Interim Final Rule (IFR); the third party-audit (this is a reference to the section required IFR Section 1311 audit, not the Surescripts certification), which is both costly and time-consuming; an incorrect perception that no pharmacies can accept EPCS; vendors’ competing development priorities (Meaningful Use Stage 2, ICD-10, etc.); and having all the docs ID proofed and authenticated in conformance with the Drug Enforcement Agency IFR.”

1) DrFirst experienced first-hand the many hurdles in getting to market with EPCS. In an effort to help the overall industry finally remove THIS barrier to e-prescribing adoption, we created EPCS Gold™ as a platform accessible to any EHR or HIS vendor. With EPCS Gold™, we have removed those obstacles allowing EHRs of all sizes and technical capabilities to offer their physicians a high-quality, scalable, DEA-compliant, fully certified, audited, and low cost solution.

2) Since June, we’ve seen a 25% increase in the number of pharmacies enabled to accept EPCS. This includes over 12,000 pharmacies in 38 states, including several major national chains such as Walgreens, CVS, RiteAid, and Osco. Interestingly, some states have begun adopting legislation requiring real-time prescription monitoring in order to combat prescription drug abuse, such as New York State’s recent I-STOP law, which will make EPCS required by the end of 2014.

3) Vendors no longer have to choose between competing development priorities because EPCS Gold allows them to greatly reduce development costs and effort, and eliminate the effort for audits, certification, and avoid day-to-day system operations, ID proofing and authentication of providers and ongoing security and compliance for constructing and operating a controlled substance e-prescribing system that meets DEA requirements so they can get to market quickly.

DrFirst has removed these barriers to lower the bar because at the end of the day, we recognize that doctors will benefit from this technology and we believe in patient safety, so we’re doing our part to build a bridge across the chasm for the benefit of the entire industry! For more information about DrFirst’s EPCS product, EPCS Gold 2.0, please visit http://www.drfirst.com/e-prescribing-for-controlled-substances.jsp.

About Peter Kaufman:

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).

Find all posts by Peter Kaufman | Visit Website

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Apr
18
2012

Adverse drug reactions (ADRs) are serious threats in nursing home and assisted living facilities where the advanced age and poor health of most patients make them more vulnerable than the general population. This effect is compounded by many patients taking multiple medications significantly increasing the possibility of an adverse event.

According to a study by Warwick Medical School in England, the typical nursing home patient takes an average of nine medications. The same study found 90% of patients were exposed to some kind of medication error, and 52% were exposed to serious errors. A recent study by the School of Pharmacy at Belfast University in Ireland found that during a 16 week period, nursing home patients with dementia (who are more vulnerable because of the inability to advocate for themselves), 40% were prescribed at least one potentially inappropriate medication.

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About Peter Kaufman:

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).

Find all posts by Peter Kaufman | Visit Website

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