This news item on NPR station caught my attention. North Carolina Attorney General is worried that the doctors and pharmacists are not using the state built controlled substance registry as much as they should. Further, DHHS has commissioned a study to understand the reasons for low adoptions.
This medical registry was introduced to prevent people from abusing drugs. The news and discussion is about overdose. They are related, but not connected.
Regardless, there is a simple answer. EHR and SureScripts database. With Meaningful Use guidelines, EHRs must support drug-drug, drug-allergy interactions. With e-prescriptions, most EHRs also perform dose checks and warn doctors about wrong dosage. SureScripts database connects doctors and pharmacists. Doctors can pull up all the medications a patient has been taking, regardless of who prescribed them. So, if the patient was prescribed Oxycontin or Amoxicillin in California, a doctor in Reidsville, NC can still look it up. Since the doctors are already using the EHR, they know this information in the context of their note writing. Then write a new e-prescription for the patient.
The state registry, while good, requires doctors to log in to a different website. Then search for the patient using a bunch of parameters. If they find the right patient, they may be able to tell the meds this patient was taking.
Pharmacists are connected to SureScripts, from where they are also able to access the medication history of the patient. There is no need for either the doctor or the pharmacist to connect to the registry and do extra work.
There are 2 distinct issues here and they are being mixed in the news articles.
1. Drug overdose:
Doctors are performing this step using EHRs. So, patients should not be prescribed more than recommended dose. Pharmacists can additionally check doseage, but I don't know why they need to look into state built registry instead of pharmacy databases. This is a more serious issue that includes patient and care taker education. It cannot be solved by a state registry.
2. Doctor shopping:
Unfortunately this is common. Patients will go to different doctors to be prescribed pain medications. Doctors using e-prescription have the medication history built-in. I know cases where doctors identified these patients using the EHR. Of course they refused more prescriptions for these patients.
EHRs currently don't track meds that are written on paper and paid in cash. This meds history is sometimes available only in the state registry. Doctors have asked for this to be included in the EHR. But the state application has no interfaces. EHRs or any other automated system cannot pull this data.
Doctors and pharmacists are already overburdened. Having them log into one more disconnected system is asking for too much. The state registry needs to integrate with applications doctors are already using. State legislators need to talk to the customers (doctors and pharmacists) instead of adding one more study.