POCP Blog

By Connie Sinclair, Director, Regulatory Resource Center

Massachusetts recently enacted comprehensive legislation to help combat opioid abuse deaths, which have reached crisis proportions in the Bay State and around the country.[1] The state’s new mandates, to be phased in during the 4^th quarter of 2016, will have significant impacts on electronic health records (EHR) and pharmacy systems.

The new legislation was enacted to address Massachusetts’ growing problem of drug overdose and diversion. According to state health officials, more than 1,000 people died from opioid-related overdoses in Massachusetts in 2014 — an increase of 33% from 2012 and part of an epidemic of deaths blamed on prescription drug and heroin abuse. Nationwide, drug overdoses are the main cause of accidental deaths for Americans 25 to 64 years old, surpassing even traffic deaths.

Massachusetts’ new law limits the quantities of “opiates” prescribed to 7 days’ supply under certain circumstances, and allows pharmacists to dispense a lesser quantity than prescribed. It mandates that “opiate prescriptions” must include specific language stating that patient can request lesser amount. If less is dispensed, the remainder is void, and the pharmacy must “notify the prescriber via an interoperable EHR.”

EHR and pharmacy system vendors should take note of these requirements. Most pharmacies do not have the ability to send messages of this type to the prescriber’s EHR. This notation is similar to the biosimilar substitution notice required by several states, and will require a different type of interoperability between pharmacy systems and EHRs than what exists in common practice today.

The new law also provides patients with a “Non-Opiate Directive Form,” which they may complete to indicate that they do not want to be prescribed those drugs.  Rules will be promulgated to describe how this information can be “recorded in the interoperable electronic health record.”  As a result, changes will be needed in EHRs as to how this information is recorded and exchanged—both with EHRs in other physician offices and integrated delivery networks as well as with pharmacies.

In a related development, Massachusetts is expected to promulgate new rules to require prescribers to view the state’s prescription drug monitoring program (PDMP) database before prescribing any Schedule II or III controlled substance. PDMPs collect data from dispensers such as pharmacies, outpatient hospital pharmacies, outpatient clinics and others submitters regarding quantities of and to whom controlled substance medications have been dispensed. Many states already encourage prescribers to check the PDMP before prescribing most controlled substances, but do not impose a penalty for non-compliance. Some states, such as New York, require prescribers to check the database in advance before prescribing most—or all–controlled substances. The number of these mandates is growing.

Point-of-Care Partners can help you keep up with current events regarding state mandates and what needs to be done to integrate EHRs and PDMPs.  For starters, check out our (complimentary) regulatory resource center, which makes it easy for you to keep up with state and federal regulatory actions.

[1] Opiates are derived directly from the opium poppy by departing and purifying the various chemicals in the poppy. Opioids include all opiates but also chemicals that have been synthesized in some way. Heroin is an opioid but not an opiate. Morphine is an opiate and also an opioid.

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