The Domino Effect of Bad Physician Data

Miranda Rochol
Miranda Rochol

Guest post by Miranda Rochol, vice president of product and strategy at Healthcare Data Solutions.

The recent DEA schedule change of hydrocodone prescription drugs has critical implications for prescribers, pharmacies and patients – not only for patients who are taking hydrocodone medications for chronic pain, but also for patients who experience new injuries that require short-term pain treatment.

The following scenario depicts how the hydrocodone schedule change can impact all of these stakeholders:

A patient goes to see her primary care physician because she twisted her knee in an exercise class and can barely walk. During the examination, the physician determines that the patient has torn her ACL and will need a referral to an orthopedic surgeon for further examination and treatment. In the meantime, however, the physician is going to prescribe the patient Vicodin, a common pain medication, which has recently been reclassified as a Class II drug under the DEA’s schedule change.

Sounds like a pretty common story, right? But as simple as this scenario sounds, there are multiple challenges that can arise when physicians don’t have the right tools to do their jobs efficiently.

The first potential problem has to do with the referral. The method a physician uses to refer patients to specialists matters – a lot. Paper-based referrals can cause a number of problems, from insufficient information provided to specialists, to lack of timely feedback to referring physicians, to inefficient referral tracking.

Electronic referral management through the use of electronic health records (EHR) solves potential issues with timeliness and tracking. But whom a physician selects to refer a patient to is also critical. In today’s value-based model of healthcare, careful selection and management of physician referrals is integral to improving patient outcomes and reducing healthcare costs. And one of the best ways to maximize physician referrals is to use an accurate physician directory, or database, that contains vital information like location, ZIP code detail, affiliations, areas of specialty, and organizational capabilities.

The next potential problem has to do with prescriber validation. Not all prescriber credentials are alike; some physicians can write prescriptions for some drugs and not others. With the DEA schedule change of hydrocodone drugs, many physicians are now legally ineligible to write prescriptions for drugs like Vicodin.

In this scenario, if the physician’s credentials limit him from prescribing Vicodin and the EHR doesn’t validate his credentials, the physician could find himself in a whole lot of trouble.

According to the Controlled Substances Act, any person who knowingly or intentionally distributes or dispenses a Schedule II drug could be subject to $1 million to $10 million in fines and up to 30 years in prison. The same consequences apply to pharmacies. If the pharmacy receives the prescription and fills it without validating the prescribing physician’s credentials, the pharmacist and pharmacy could face serious charges.

Now let’s look at the same scenario from a different angle. Let’s say the EHR does verify the referring physician’s DEA credentials and finds them invalid. Now what? Will another prescriber in the office have to write the prescription? Will the patient have to go to another physician altogether? How can the physician get the proper credentials to prescribe Schedule II drugs?

What happens is a serious disruption to the workflow in the office, impacting everyone from the physician to the clinical coordinator (who usually processes the referrals) to the patient. As a result, time and money has been wasted, and the patient may have to wait to get the treatment she needs.

Fortunately, scenarios like these can be avoided. Simple, effective data solutions are available to ensure that physicians can do their jobs efficiently – and that patients can get the care they need.

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