Patient Safety-A Root Cause Solution Is Now Available
And A Follow-up On The Frustration With Third Party Payers
Prescribing Errors Are Rampant
If the industry really cared about safety and quality, the solution finally available would have been a priority early into the Electronic Health Records transition. The EHR process was thwarted upon us with the Obamacare legislation. The legislation mostly had forced provider deadlines and huge financial costs to bear. For motivation there were financial penalties/payment clawbacks in the legislation for falling behind. The obsession with HIPAA (Health Insurance Portability and Accountability Act) compliance was a priority over system design. For general public information, HIPAA is a total joke. HIPAA is another source of potential fines to providers who don’t hide your reception signature from others in the waiting area. It is a total illusion of information protection to help pull of an open health care record system through digital information integration.
The Safety Issue:
Every day, in any typical medical practice and IN NEARLY EVERY HOSPITAL ADMISSION AND DISCHARGE transition, there is a broken patient care communication link. This is, by far the largest source of patient care and safety error in the healthcare field. I am speaking about patient prescription management.
In 2014, while serving as a Lee County Delegate for the Florida Medical Association this issue was brought to the “house of medicine”. The referendum in debate was referred to the governing board. The board chose not to pursue the project.
* Resolution 14-102 Electronic Prescribing Accuracy Fix Lee County Medical Society; Ray Kordonowy, M.D., Delegate House Action: Referred to the FMA Board of Governors Board Referral: Council on Medical Services & HC Delivery
RESOLVED, That the FMA bring this glaring root cause error source for present prescribing habits to the attention of the physicians; and be it further RESOLVED, That the FMA seek a seamless solution be built into the current procedures for electronic prescribing by initiating a productive dialogue with Surescripts and other involved vendors; and be it further RESOLVED, That the FMA hold the industry to a specific timeline/deadline to resolving this very important issue; and be it further RESOLVED, That the solution arrived at is tested and validated as effective in functioning to the stated goal of automatic notification of prescription discontinuation to the pharmacy on record for an individual patient’s chart; and be it further RESOLVED, That there be a documentation trail to be discoverable for such changes made, documented and signed in the patient’s electronic medical record. This documentation trail should be evident to the prescriber, the software vendor and the pharmacy on record.
In 2014/15, The FMA board upon review, chose the following action:
Innovation Board Action:: The Board approved recommendation to not adopt this resolution. The directives are unclear and unnecessary and the Board supports monitoring for issues related to e-prescribing and updating the Board as needed
I will let the public decide. Was the board correct in stating the directive was unclear and unnecessary?
Eleven Years Later, Just Today April 29th, 2025, Elation Health EHR Has Developed the Solution For Our Practice Patients
Last evening, I sent a request to the Elation Health development team inquiring about automating prescription discontinuation notices to the dispensing pharmacy. Within hours of my inquiry the Elation team replied.
Thank you for reaching out about sending prescription cancellation requests when discontinuing prescriptions. This is fortuitous timing because an updated prescription workflow has been released today to your practice. As part of this update, you can send a prescription cancellation request (CancelRx) while discontinuing the prescription in the same workflow. You can see this new workflow now by selecting Actions > Discontinue or Actions > Document Discontinue on a prescription.
As a note, only ePrescriptions sent from your practice and to pharmacies that support electronic cancellation are eligible for a prescription cancellation request. You will see a note in the Discontinue dialog if a prescription cannot be canceled. You can learn more about the updated workflow via link. Please let me know if you have any questions!
Today I have been monitoring this feature and it appears to be working for CVS and Publix pharmacies. One of the Walgreens pharmacies was not able to “receive” this notice. Within our own dispensing location (MD Scripts) it is also working. I wanted to let the public know that the pieces are in place for bidirectional communication for documenting physician discontinued prescriptions is finally here. I encourage you to ask your pharmacy if their company has activated this interface for your prescription safety. It took 11 years, but… “mission accomplished”.
It will be interesting to see how the Hospital System’s EPIC EHR and Lee Healths’ internal pharmacies activate this feature. Stay Tuned.
Tipping Windmills At The Prescription Benefits Process!
It appears it will take more than Superman and the Caped Crusader to break the mindmeld of the prescription central planners. This whole process is just a big game to the payer players. My latest example once demonstrates the disconnect within the “rule book” of insurance prescription coverage.
As I wrote earlier this past month, the generic version of the FDA approved weight loss drug called Saxenda is now available. The generic compound is called liraglutide and is a daily injection. A month of the highest dose regimen retails presently for $480. This compares to $1080 (this is a discount from a year ago) for one month of Mounjaro the name branded Lilly product.
Mounjaro IS NOT FDA approved for weight loss. The patented protected version of the same molecule is sold as Zepbound. This week I attempted to prescribe the MOST COST EFFECTIVE, FDA approved Glp agonist, liraglutide for weight loss for a patient. This individual does not yet have diabetes.
Within hours, the patient was informed by his pharmacy, my prescription was not a covered product within his plan, regardless of indication. Further, neither the Zepbound nor Wegovey (both patented and approved for weight loss) brands are on the formulary.
The pharmacist reported the Mounjaro or Ozempic (the name branded molecules approved for diabetes as Zepbound or Wegovy respectfully) ARE on the formulary. So essentially the message is: Don’t prescribe the most cost effective product for the indicated approved use. Instead prescribe the more expensive alternative approved for a different indication.
So at this point, the question becomes, in order to help this individual, is the doctor OR IS THE Prescription Benefit Manager/insurance plan engaged in fraudulent prescribing? The phrase “you can’t win for losing” comes to mind.
