Hospitals and other health facilities will face harsh new penalties if their employees snoop in the medical records of patients, under legislation signed by California Gov. Arnold Schwarzenegger. The governor approved two bills creating a state office to police patient privacy and to allow the state to issue fines as high as $250,000 for multiple violations. Schwarzenegger rejected most other major healthcare legislation aimed at protecting average Californians who face significant medical bills or inadequate insurance.
Think the new tamper-proof prescription rules don't affect e-prescribers? Think again.
Tomorrow is the deadline by which all written Medicaid prescriptions must be on tamper resistant pads. Although proponents of e-prescribing have added the new guidelines to the laundry list of benefits of switching from paper to computer (since the rules don't apply to electronic, faxed, or telephone prescriptions), in most cases e-prescribers and electronic health record-users will still have to make some adjustments to their prescribing practices.
While it's true that the Centers for Medicare and Medicaid guidelines do not apply to electronic prescriptions sent via fax or computer directly to the pharmacy, there are still a good number of instances in which an e-prescribing physician will need to print the prescription out and hand it to the patient, says Peter Basch, MD, medical director of ambulatory clinical systems at MedStar Health.
"Physicians still must print prescriptions for controlled substances, and there are those patients who would prefer a paper printout rather than the prescription being sent electronically to their pharmacy, or those who do not know the exact pharmacy where their prescription will be sent. And you can't post-date an e-prescription, so those patients that need their prescriptions filled at a later date will need a printout," he says.
Unlike their prescription pad-using counterparts, who can replace the old pads with new tamper-resistant pads from vendors, medical providers who e-prescribe would likely be forced to invest in expensive tamper-proof paper (standard printing paper costs—on average—less than a dollar per sheet, while tamper-proof paper can cost several dollars per sheet), and laser printers capable of printing to multiple trays at a high resolution. For an eight-hospital system like MedStar, Basch estimates that process would have cost $1.5 million upfront to become compliant, with ongoing costs of about $200,000 annually.
Basch, an early adopter of e-prescribing and a proponent of electronic health records, says he foresaw those costs becoming a barrier to adoption of e-prescribing and EHRs and decided to form a coalition to push for revised anti-tampering requirements that focus on using new print technologies, rather than using expensive tamper-proof paper, as originally mandated by Medicaid. "We are all for this change, but we want to do it in a way that works and a way that is consistent with the federal mandate by the president to encourage adoption of EMRs and e-prescribing. Our concern was, if you create a new barrier by adding tens of thousands of dollars to a physician's budget, you are sending the opposite message," says Basch.
The first, called a digital void pantograph, incorporates a hidden security word or image into the background of a computer printed prescription. The image will show up if the prescription is copied or scanned. The second, called microprinting uses a strip of minute type that can be read with a 5X magnifying glass or loupe. The type will appear smeared when photocopied on most machines. Neither of these technologies requires special paper or printers, says Bausch, eliminating the need for that potentially large upfront investment.
While Bausch says he's pleased that CMS and the NCPDP were able to come up with a less expensive, effective alternative to the government's original plan, the group's work is not done. He says within a short time-frame (read months, not years) the prescription information itself will become tamper-proof. "What we will do is make the information tamper resistant. The physician will send that information electronically to a network and print a receipt for the patient. The pharmacist can then check the patient's receipt against the stored information, if the two match, the prescription is filled."
Hopefully by now providers have already figured how to become compliant with the new guidelines, but if you're considering the move to e-prescribing or implementing an electronic health record, now might be a good time to talk to your suppliers about the latest print technology options.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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ENSR's International Audit Protocol Consortium has joined forces with Citation Technologies to create a compliance assurance and regulatory research tool "IAPC Interactive."
The Healthcare Information and Management Systems Society will host its fourth Virtual Conference & Expo on Nov. 19-20 that features added education sessions, exclusive concurrent sessions, and opportunities to gain product knowledge and network, according to HIMSS representatives.
The emerging Nationwide Health Information Network was put through its paces on September 23 as live operations were demonstrated before a large audience at the Health and Human Services Department and via a Webcast. The demonstration involved records created for the test but stored in actual health systems. The exercise showed that a healthcare provider could easily use a Web browser to obtain basic records on a patient stored by another healthcare system. The next step is to prepare to go live by the end of the year, said Ginger Price, NHIN program coordinator at HHS' Office of the National Coordinator for Health Information Technology.
At least three-quarters of all Internet users look for health information online, according to the Pew Internet and American Life Project. Of those with a high-speed connection, 1 in 9 do health research on a typical day. And 75% of online patients with a chronic problem told the researchers that “their last health search affected a decision about how to treat an illness or condition,” according to a Pew Report released in August. Reliance on the Internet is so prevalent, said the report’s author, Susannah Fox, the associate director at Pew, that "Google is the de facto second opinion" for patients seeking further information after a diagnosis.