Last year, agency officials told TMA it had “plans in place to automate the ap- plication process in the future, including an online pay function, but as with any state agency, we must prioritize based on limited funds and resources provided.” At press time, according to the DPS
website, the agency offered to email doc- tors a renewal application form, but they still have to mail the paperwork and fees.
Improving PAT In August, DPS launched a new online prescription drug-monitoring database called Prescription Access in Texas (PAT). Physicians say it can be an important clinical and risk-management tool but needs some tweaking. TMA, through its red-tape reduction bill, wants to ensure protections that give doctors the flexibil- ity to use it in ways suitable to their in- dividual practices and that guard against mandatory use of the database. Several years in the making, PAT is designed to rein in trafficking and abuse of prescription drugs. It allows physi- cians, police, and others to check in real time patients’ controlled substance pre- scription history for the last 12 months. “This is a very good first step. But we need to keep improving the database as we go forward, and we need some safeguards,” said C.M. Schade, MD. The Garland pain management specialist is a past president of the Texas Pain Soci- ety and represents the organization on TMA’s Interspecialty Society Committee. Physicians can use the database, for example, to educate patients on their medications and appropriately treat them based on what prescriptions they’ve already received from other practitioners. The tool can be especial- ly helpful in emergency departments, where patients often come in with pain complaints but without a medical record. Emergency departments and practices specializing in pain medicine, in particu- lar, also remain susceptible to attempts by those trying to fool the system to ob- tain narcotics for illegal purposes, and the database could help identify suspi- cious behaviors. On the other hand, most patients have legitimate complaints, and because they often forget the names or types of
their medications, they may unwittingly be double-dipping, Dr. Schade says. The percentage of “bad apples” abusing the system is so small that requiring physi- cians to check the database 100 percent of the time for 100 percent of patients is impractical. “Why check the majority of patients who are doing nothing wrong? All you are going to do is overload the system and bog it down,” said Dr. Schade, who pilot-tested PAT before its launch. “I do want to know when a patient is suspect- ed of doctor-shopping. But other than that, I want to be able to use my clinical judgment.”
The sheer size of the database also
raises the potential for unintended priva- cy and safety concerns, physicians warn. As many as 150,000 users — physicians, pharmacists, police, board investiga- tors, midlevel practitioners, podiatrists, dentists, and veterinarians — can query the system. The volume of prescription data entered could range in the millions. Therein lies the potential for errors that could adversely affect patients. To date, there is no way for patients to correct their reports, Dr. Schade says. Nor can physicians incorporate patients’ prescrip- tion information in the online database into their chart or electronic medical re- cord. Physicians can print it out, but they must store the report separately. “That’s a problem for me as a practic- ing physician,” Dr. Schade said, espe- cially if doctors are supposed to readily make use of the information or if inves-
tigators come knocking for medical re- cords and that information is missing. State regulations also bar physicians
from delegating their authority to re- search the database and from sharing their log-in information with anyone, even a staff member. Doing so would constitute a violation of the Health In- surance Portability and Accountability Act (HIPAA). Dr. Schade acknowledges potential privacy concerns with such delegation. But HIPAA rules already apply to similar patient activities that doctors entrust to their staff. “There are only so many hours in a
day, and all of this red tape cuts into that,” he said. “For doctors to adopt the database on a widespread basis, we have to make it practical.”
A balanced approach
The Senate Committee on Criminal Jus- tice in late October heard public testi- mony on recommendations to enhance ongoing efforts to crack down on pre- scription drug abuse, including the new online monitoring database. State health officials, law enforcement representa- tives, physicians, patient advocates, and others testified on a range of solutions: increased funding for DPS programs, a multiagency prescription drug manage- ment strategy workgroup, and improved educational programs for patients and health care professionals. Some health and law enforcement of- ficials suggested a more “standardized”
Red-tape hotline
TMA wants to hear from you as part of its red-tape reduction effort. Where are you experiencing administrative hassles? Where does the red tape need to be cut and how? Visit
www.texmed.org/redtape to share your complaints and
suggested solutions. Or light up the phones of the TMA Knowl- edge Center at (800) 880-7955.
December 2012 TEXAS MEDICINE 43
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