The introduction of technology into healthcare has been life-altering for physicians - in ways both welcome and not so welcome. The exponential growth in available computing power and high tech devices have allowed for diagnostics and treatments that were once the realm of science fiction. These technologies have had a profound impact on the practice of medicine and the ability of physicians to extend life and minimize suffering. Bringing this computing revolution into the front and back office of physician practices has not always fared as well and created such unalloyed positives. In particular, the growth of Electronic Health Records (EHRs) have been fraught for doctors across the US.
Recent research from Stanford shows that 4 in 10 physicians “believe there are more challenges with EHRs than benefits,” and less than 2 in 10 report being “very satisfied” with their current system. The mandate that physician practices and hospitals adopt EHRs was undertaken with great fanfare. Optimistic regulators and technologists pointed to the ability of EHRs to promote the portability of health information for patients and facilitate mining and utilizing data more meaningfully. The hope was that this digital solution would eliminate not only cumbersome paper charts but also the need to fax or photocopy reams of patient information.
Anyone who has recently worked in a doctor’s office or hospital knows that the fax machine is still a fixture, and true portability is still far from a reality. The origin of EHR technology is partly to blame. These systems were built for billing purposes and to house the accompanying required documentation, not for supporting workflows or fostering interoperability. The dream of true interoperability among clinical data systems, including EHRs, took a major step forward with the recent push for SMART in FHIR technology. This innovation also represents a tremendous opportunity for non-EHR software to serve as an enabler of physician and staff workflows.
Controlled substance prescribing is a case study in an area that is ripe for disruption. Prescribing controlled substances in highly regulated by state and federal agencies, and necessitates extensive documentation and information gathering on the part of the prescriber. Prescribing these substances incorrectly or based on poor information puts patients at risk. It also presents a danger to prescriber licensure or reputation if not handled appropriately.
As one example, providers must access their local Prescription Drug Monitoring Program (PDMP) database when prescribing a controlled substance. As the U.S. Centers for Disease Control and Prevention (CDC) points out: “PDMPs can provide health authorities timely information about prescribing and patient behaviors that contribute to the [opioid] epidemic and facilitate a nimble and targeted response.” Prescribers and pharmacies can access PDMPs via Web-based portals, which is an excellent start in harnessing technologies like the internet. However, there is still room for improvement by incorporating PDMP-based data and other sources.
Using workflow support and enablement that leverages the latest technologies could revolutionize the cumbersome process of controlled substance prescribing. Tapping into multiple sources for patient-level data will allow prescribers to make more informed decisions. Leveraging a secure, cloud-based platform would provide the opportunity to engage with patients in new and meaningful ways, such as encounter-linked checklists and digitally created and stored pain contacts. Even accessing PDMPs can be automated and the data included can be presented in a more intuitive and user-friendly manner.
This suite of capabilities is the future and will allow physicians who prescribe controlled substances to finally realize the promise of the computing revolution in a way that complements the evolving world of EHRs.