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Pain - Coordination of Information

Many Berkshire County healthcare providers are aware of patients who have sought prescription pain medications from multiple providers at the same time. Sometimes those patients are simply changing providers or have had difficulty securing an appointment with their customary provider. Oftentimes, however, patients simultaneously seeking prescription pain medication from multiple providers are abusing or diverting those drugs. Some prescription pain medications currently sell on Berkshire County streets for as much as $80 a tablet so that, with a $20 deductible and a 30-day supply, a patient who is willing to harm others and break the law can realize a substantial financial profit.

The various hospital departments, physician offices and other service sites through which patients can obtain controlled substances have not historically had a means to easily or quickly share information about patients they are jointly treating and this deficiency sometimes leads to a lack of coordinated care in pain management and either the accidental or purposeful (on the part of the patient) over-prescription of medication and the risk of drug diversion.

One impediment to the sharing of information comes from an appropriate sensitivity to the confidentiality of patient information, both under traditional standards and the more recent HIPAA Privacy Rule. However, the legal constraints against disclosure include exceptions that allow exchange of information in treatment contexts and in situations where the patient is seeking pain medication for inappropriate purposes (such as abuse or diversion).

A second impediment to the sharing of such information has been the technological limitations of the existing information systems at Berkshire Health Systems and with other Berkshire County healthcare providers. With the advent of the outpatient component of the Berkshire Health Systems electronic medical record through Meditech, the appropriate exchange and monitoring of critical information is being greatly eased. 

Prescribers of pain medication with access to the Meditech system can arrange to have a flag added to the patient’s electronic medical record that identifies the patient as a participant in an existing pain management regimen and provides that important information to subsequent providers who may be considering a course of treatment that includes what would become additional controlled substances. This information is important, of course, to the provider co-managing the patient (even unwittingly), so that the patient is not harmed by excessive or conflicting medications. Similarly, a patient who is reasonably believed to have a history of misuse or diversion of pain medication can be identified in the electronic medical record, so that subsequent providers can be mindful of that risk when considering the prescription of controlled substances or alternative therapies. A provider who is considering a course of pain management drug therapy can consult the patient’s electronic medical record in order to determine whether the proposed therapy will conflict with or otherwise create risk to the patient.

The pain medication information within Meditech will be maintained in as secure and confidential a manner as is possible, with both access and content limited to that which is the minimally necessary information to keep the patient (and in the case of diverters, the community) safe from harm.  

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