Practice Fuse-Up?

There was an anonymous comment on my post, E-Rx Update and Review (thanks, BTW), that linked to a concerning article in Forbes about Practice Fusion.

For those who haven't been following, Practice Fusion is a free electronic medical record system. I signed up for it because it allows me to e-prescribe, which I and every other doctor in the country will be required to do starting in March of 2015,and I don't want a last minute scramble-the I-STOP deadline had to be postponed because many prescribers didn't have an HCS account, although I'm not sure how they were getting their rx pads before that. I don't use Practice Fusion for patient records, mainly because the data is stored in the cloud and it's not clear who owns it.

However, the Forbes article is not about storage of patient data, or even security of patient data. At least, not through the health record maintained by the doctor. According to the article, Practice Fusion has set up a Yelp-like site, Patient Fusion, where patients can have access to their health records, if they agree to this with their doctors. They can also schedule appointments, and read and write reviews about doctors. The writing reviews is where the problem came in.

Apparently, patients were writing reviews and including personal information about themselves, sometimes very intimate information (the article calls them, "Burning Sensation [Down There]' Reviews"). And these patients were not aware that their comments, and sometimes names, would be posted publicly.

This is a screenshot of what I could find of the review page:

It's not clear to me if this is the same form that these patients filled out, or if it's been revised since the company realized personal information was being presented publicly. The fine print under "please leave a review for your provider" reads: for your protection, do not include any personal information.

And the fine print under "Patient Authorization" reads:

I authorize my provider and Practice Fusion, Inc. to publish my review on the Practice Fusion website, together with my first name (subject to my unchecking of the "Keep this Review Anonymous" box above). The purpose of publishing my review is to make it available to patients and prospective patients of my provider, and other members of the public. I understand that my provider and Practice fusion will not publish any personal information about me, except my first name (subject to my unchecking of the "Keep this Review...

That's where the screenshot ends. I tried to find myself as a provider so I could set up a Patient Fusion account and get more information, but I wasn't listed. I guess I have to fill out or set up something special to be listed as a doctor.

Here's the thing. Practice Fusion clearly needs to take some responsibility in this. There should be a popup window with a reminder: Please be sure not to include personal information. Or something like that.

But in the age of Facebook, and the era of complete absence of privacy that it ushered in, don't the people who wrote the reviews need to have some responsibility? Everything was filled out online, so you can't say they're not tech-savvy at all.  Do people really not know what it means to write a review? Don't people buy stuff from Amazon?

I don't mean to "blame the victim" here. And the Forbes article was waving around some sensationalism to get read. But I'm very uncomfortable with the whole paternalistic approach, like where government tries to dictate how much soda a person can drink, or how much salt a chef can cook with (this was proposed but thank goodness shot down several years ago).

Maybe the whole idea is that people want to believe a greater power or authority figure is taking care of them and making decisions for them, so they don't need to think and feel responsible, and so they can feel protected. And maybe the price of this protection is privacy. If you want mommy and daddy to make sure you're safe, then they have to know everything you're up to.

Is that a good thing?

E-Rx F/U and Confession

This is a practical follow-up to my recent post, Erx Me.

I went through the E-Rx validation process at Practice Fusion. It involved submitting a very simple form, along with my medical license and government issued ID. The instructions were a little confusing, because it asked for a valid medical license, so I wasn't sure if that meant a copy of the license, or the registration, which has the valid dates. I live-chatted with them, and they were immediately responsive, and told me I could use either, and they would verify the dates.

It was a bit difficult to find the right place to submit it, but I got there, eventually. I apologize but I don't remember exactly how I found it.

The instructions said it could take 7 business days to complete the validation process, or more if they were particularly busy. I got confirmation the same day.

So, thus far, overall, Yay! for Practice Fusion.


I also tried to register for I-STOP. But I have a confession to make. I terminated my membership in the APA a year ago. I felt that they were just extorting money for CME, and that my money was better spent on something like UpToDate. Also, they implemented the MOC PIP program, which I find unacceptable.

But I still seem to get emails from the NYSPA, which is how I found out about I-STOP. Of course, since my membership expired, I can't log in. So I wasn't able to register through the NYSPA site for I-STOP.

Well, after some fumpfing around online and fuming at the idea that I might have to rejoin the APA for something that is required by law, I discovered that I didn't need to register through their site. In fact, I didn't need to register at all, since the Prescription Monitoring Program can be accessed through the NYS DOH portal. And I already have an account there, since that's how I order my prescriptions.

The instructions  for finding it were moderately helpful. You log in, click on the "Applications" tab at the top, click on the letter "P", and then scroll down to the PMP Registry. That part was easy, once I found the right instructions. As a bonus, the link to order new prescription pads is right below it.

I was then instructed to click on the green "+" sign to the right of the link, to add this to my favorites. I did so, several times, and my favorites still says it has nothing in it.

Summary: It's pretty easy to get started with E-prescribing through Practice Fusion, and you don't need to register for the Rx monitoring program through NYSPA.

Just FYI.

Erx Me

In case you thought you were done with big practice changes, s/p CPT, DSM-5, think again.

"Starting August 27, 2013, all physicians who prescribe Schedule II, III and IV controlled substances will be required to consult a new online state registry designed to track the prescription and dispensing of controlled substances."

This is from the NYSPA's comment on the new I-STOP law.

Here's a good I-STOP resource, from the Medical Society of the State of NY.

From what I can tell, starting on August 27th of this year, when we write prescriptions for controlled substances, we will have to open up our laptops or ipads or whatever, right there with the patient, and check that the patient is not up to any funny business with his meds.

I'm assuming this because of the phrase, "real time", which is supposed to be defined in regulation.

So, here you are, in your office, and you look up the patient on the registry, and you say, "Mr. Patient, it seems you've been diverting your meds, so I can't write that prescription for you. Have a nice day."

I don't know. The level of monitoring is getting out of control. It's like legislative OCD. And it carries such righteous indignation. We're going to purge the country of the evil of prescription drug abuse. Yeah, okay. It's a problem. But it doesn't have to be the Spanish Inquisition.

And it's one more way the government is insinuating itself into the room with the patient. Others include implying the psychiatrist is not doing a good job unless the patient is filling out checklists, and requiring patient reviews (see this post).

But that's not all. Starting on December 31, 2014, ALL prescriptions will need to be submitted electronically.  I was trying to figure out how to implement this, and I know, from risk management classes, that electronic medical records are a no-no, since, even if you can guarantee security (and really, you never can), if the data is stored in the cloud, you don't know who owns it. So I figured there're going to be some problems with e-rx's, and I called my carrier to find out if they have any advice about potential pitfalls, etc. They didn't have a lot of information, but referred me to the AMA's website, for  A Clinician's Guide to Electronic Prescribing, which was actually not that easy to find through the site, and I ended up googling it.

What WAS relatively easy to find was their e-prescribing learning center, where you can learn about how great e-rx is, and how it will solve the age-old problem of illegible prescriptions. You can also learn about how much it will cost you to implement and maintain your e-rx system. In fact, it'll walk you through a series of questions to help you determine which system is best for your practice. And then it will give you a list of e-rx systems that meet your needs.

I tried it, and I answered all questions on the "no frills" end, i.e., I don't want any advanced features, I don't want an EMR to go with it, etc. It came up with 3 recommended systems:

Relayhealth Escript at $600, no demo available
Care360 Physician Portal 2008.3, at $240, no demo available, and
InfoScriber, version 115, at $600, no demo available

Now, I didn't try to look this up, but I'm willing to bet that the AMA has financial connections with all these systems, and any others it spits out. It certainly didn't refer me to Practice Fusion, which is free, comes with an, also free, EMR which you don't have to use if you don't want to, and is ranked #1 for both e-rx vendors, and EHR based e-rx vendors, by the Black Book Rankings.

Bottom line: I signed up for Practice Fusion (no, they're not paying me to write this), and I'm in the process of being verified for the e-rx (apparently, you have to do that). I'll let you know how it goes.

As I was writing this, it occurred to me that once we start e-prescribing controlled substances, we'll be taking diversion of these substances out of the hands of individuals who have to hustle to get hold of a one-month supply of meds, and placing it in the hands of anyone savvy enough to hack the system. Who could do that? Oh, I don't know, maybe a large scale crime organization, or your average computer science major at MIT. Goodbye, diversion in dribs and drabs, hello big-time diversion.