Physicians at Affiliated Oral and Maxillofacial Surgeons of Maryland now have a better handle on opioid prescribing as they try to combat the ongoing crisis.
The orthopedic surgeons at Affiliated Oral and Maxillofacial Surgeons of Maryland have recently adopted a mobile medication management application to better handle the prescribing and workflow processes of a practice where each doctor writes about 30 prescriptions per day for controlled substances, including opioids for pain management.
It is easier for patients who just had surgery to get their prescriptions electronically sent to the pharmacy rather than having to physically drop off the prescription.
This also is timely with Maryland’s mandate, which went into effect July 1, for prescribers to be able to check the state’s prescription drug monitoring program before prescribing controlled substances. For example, a patient may claim to have lost a prescription, but the PDMP may show that the prescription was filled. Access to this information within the prescribing workflow is seen by many as essential to complying with the mandate.
Affiliated Oral and Maxillofacial Surgeons recently made the decision to begin prescribing fewer opioid tablets when appropriate because mobile prescribing makes it easier to send refills. Leftover pills in the cabinet leaves open the door for other people, including children, to access remaining opioids – something all sides want to avoid.
This practice has also long used secure communications software to communicate among the three offices because it’s much quicker and easier than making phone calls or sending emails.
“As an oral and maxillofacial surgeon, I treat patients with surgical procedures,” said Kevin Schwartz, DMD, a surgeon at Affiliated Oral and Maxillofacial Surgeons. “In my specialty, patients tend to be in a fair amount of discomfort following their procedure. Typically, this dental specialty has managed post-operative pain of surgical patients with opioids as a standard of care.”
“With the mobile medication management application, I can be more confident in prescribing because I have access to more information.”
Kevin Schwartz, DMD, Affiliated Oral and Maxillofacial Surgeons.
There is so much more awareness around overprescribing opioids as well as the need to check the PDMP, which was a cumbersome process involving separate logins, he added. Schwartz was looking for a way that he could check the PDMP easily to make sure he was prescribing the right pain relief for his patients and not creating a bigger problem.
That’s when the practice began using the iPrescribe application from DrFirst to see what patient have already been prescribed by other providers in the state, according to Schwartz.
“The Maryland PDMP site is not always easy to use when I have to go to it directly. I have to log into a separate system and re-enter patient information to access the medication history,” he said.
Using an e-prescribing system means clinicians can access the PDMP data in the app, rather than having to log into a separate system.
DrFirst is not alone among such tools. A wide variety of e-prescribing systems on the market, many of which can handle EPCS, the electronic prescribing of controlled substances. These vendors include athenahealth, Ayva, drchrono, DxScript eRx, eClinicalWorks, Imprivata, Kareo and MDToolbox.
At Affiliated Oral and Maxillofacial Surgeons of Maryland, the mobile medication management application enables Schwartz to take care of his patients’ pain needs and still prescribe less based on more information. When he prescribes, he starts with a three-day prescription then sees how the patient does. If the patient needs more to manage their pain, he can refill their prescription.
When it comes to results, the practice now writes about 90 prescriptions for controlled substances each month. The mobile medication management application has made it very quick and easy for physicians to prescribe in small unit batches and to check the PDMP.
The standard opioid prescription was for 20 to 30 tablets in the past where now physicians write for six to 12 tablets. With one click, a physician can access a patient’s medication information from the PDMP and can see immediately whether the patient has an opioid issue.
“I never write an opioid prescription for more than three days anymore,” Schwartz said. “Prior to a surgical procedure, I give my patients a pep talk that they may not even need to take any pain medication after surgery. But I want to make sure to help them in the way they need pain support.”
Now, he sends them home with a prescription for a non-opioid drug like ibuprofen so they have something for baseline pain management if they need it. He adds a limited prescription for an opioid to augment this baseline medication. He doesn’t know if they will even need to take it, but it gives them peace of mind that if the pain gets too bad, they have something stronger to take.
“Then I ask the patient to call me in two or three days to let me know how they are doing,” he said. “If they need a refill for pain, it’s very easy for me to prescribe the refill. From wherever I am, I just open iPrescribe on my mobile phone and electronically send the prescription refill to the patient’s pharmacy.
Automation is critically important to prescribing any medication, Schwartz added. For opioid prescribing, automation gives a check-and-balance system so physicians can know the whole history of how much medication and what kind of drugs a patient has taken before physicians write a new prescription.
“For instance, in metro areas, we are more likely to see medication ‘shoppers,’” he explained. “Based on our experience, we have a gut feel of who these people are. Now, we can check to make sure we have accurate information. With the mobile medication management application, I can be more confident in prescribing because I have access to more information.”
Electronic prescribing also helps with fraud. Prescription pads can fall into other people’s hands and pads can go missing. With electronic prescribing, physicians don’t have to worry about forged prescriptions. It basically eliminates that whole area of concern.