Opioid Prescriptions in the Age of EMR – Why Physicians Must be Ultra-Vigilant

Opioid addiction and abuse is a national health crisis, with the over-prescription of narcotics such as Oxycontin, Oxycodone and Fentanyl at the foundation of this growing problem. According to the CDC, overdose deaths involving prescription opioids have quadrupled since 1999 along with sales of these prescription drugs. From 1999 to 2015, more than 183,000 people in the U.S. died from overdoses related to prescription opioids.

With the recent increased scrutiny on opioid prescribing comes the burden of documentation for physicians who prescribe opioids. Aside from weighing the risk-benefit factor for each patient’s pain relief, doctors must also meticulously document medical care in compliance with increased regulatory oversight, or risk sanctions against their medical license.

Compliance and regulatory matters bring an increased need for thorough patient examinations and rigorous documentation of medical care by way of thorough and contemporaneous notes. Any physician who writes opioid prescriptions must first do a patient evaluation and include the name, strength, and quantity of the narcotic in the medical record (as well as on the written prescription).

While the use of electronic medical records (EMR) should make proper documentation easier, medical practices must also ensure their EMR system’s reliability and upkeep to avoid any impediments to compliance.

Two cases come to mind that illustrate the ramifications of not using and maintaining an EMR system properly.

A doctor in a three-physician practice was suddenly faced with working alone due to various circumstances. During that time, the practice’s EMR system wasn’t working properly and this physician had only worked with paper records in the past. Although he’d obtained complete patient histories and conducted thorough examinations, critical information was excluded from those patients’ EMRs because he was not familiar with the EMR system. Much of that missing information was about opioid prescriptions he’d written to manage patients’ pain. Exacerbating the problem was that he was not a practice owner who could allocate funds towards the system’s repair. The EMR’s malfunction led to cascading problems: Because this information had not been entered into the EMR system, the practice came under the scrutiny of the state licensing authority and patient records were subpoenaed. The physician had to appear before an investigating committee and answer to the practice partners regarding the wide gaps in the medical records.

Another pain management physician was in the process of changing his EMR system vendor and had prescribed a significant amount of opioids for pain management. The quantity of opioid prescriptions caught the attention of his state licensing authority, which subpoenaed patient records. However, this doctor was unable to produce the complete charts because during the EMR vendor transition, many progress notes and other medical record components had vanished. This and other factors resulted in the physician’s license being temporarily suspended pending a full hearing.

While EMR has vastly improved medical recordkeeping, the burden is still on the physician to ensure that scrupulous documentation occurs and that the medical records are entered into the system properly. The physician is responsible for any breakdowns in the process. Therefore, it is critical for every practitioner and practice to:

• Continually monitor patient records and the EMR system to assure its proper function and use.
• Don’t allow system problems to linger; immediately remediate issues to ensure thorough, timely documentation.
• Educate himself or herself about state licensing authority regulations regarding narcotics to ensure prescription and documentation compliance. Regulations will likely dictate appropriate dosage, strength, and quantity of the medication; circumstances that permit multiple prescriptions and the necessity of treatment plans; guidance on what constitutes a thorough medical history and whether the physician must access a state prescription monitoring program.
• Audit the office’s billing procedures to ensure appropriate billing practices are followed.

Given the country’s opioid crisis and the current regulatory environment, physicians must be vigilant about their patients’ medical records as well as the proper implementation and maintenance of their EMR systems. To do otherwise could put them and their medical practice at risk.