Changes in Florida’s Prescribing Medication Laws

In their ultimate wisdom, the Florida Legislature has decided that all medication prescribing shall be done electronically by computer beginning in January 2020.  As of November 1st, the Florida Medical Association has not informed its members of this but it was discussed briefly at a hospital staff meeting.

We were told that most pharmacies will no longer honor paper written prescriptions.  My office electronic health record system, which slows down seeing patients remarkably, has had electronic prescribing software which we have used for several years now.  The big change is that we will now be required to order controlled substances online electronically when in the past it was not permitted.

Since the opioid crisis struck Florida, physicians have been required to create an account with the State’s narcotics hotline named E-Forsce and check out the recipient prior to prescribing controlled substances for pain.  We then issued a written prescription.

It never made sense to me why if one is trying to track narcotic prescribing it wasn’t being done on computers from the beginning?  Nonetheless, this is a change which will require prescribers to download additional software and use two methods of identification as the legitimate prescriber before you can actually prescribe for your patients.

It will give you the freedom to prescribe from your phone or tablet when out of your office which is a convenience not available in the last few years. It will however mean more time in front of the computer screen, more user names and passwords to remember and less time actually listening, talking and communicating with patients.

Bureaucracy, High-tech and a Day Rounding at the Hospital

We have a new electronic medical health record system at our hospital. It was introduced with what I believe is a short and ineffective training program for physicians followed by a far too short on-location use of experts to help the doctors and nurses learn the new system. It is frankly a pain in the neck to access the computer from outside the hospital due to the multiple layers of security and passwords you must use. It is simpler and less complicated at the hospital but the request for frequent change of the password for security purposes makes remembering the password problematic for me especially when I am sitting in the ER at 2:00 a.m. sleep deprived and wanting to get home.

On an average day the computer adds a minimum of 10 minutes of work per patient seen. We have electronic health records to comply with the massive number of Federal mandates requiring it and; to avoid the financial penalties for not complying. The Feds offered each hospital an 11 million dollar incentive for putting in these systems which made their decision to computerize far simpler.

Recently, when I made rounds and attempted to access the computer, a brand new screen greeted me. On the left-hand side it instructed me to tap my ID badge against the screen for an automatic log in access. On the right-hand side was the traditional log in screen.

I must be fair and admit the hospital did notify staff to stop by the Medical Staff Office to be issued a new ID badge which would provide easy access to the system. Since that office opens at 8:00 a.m., and I am usually there earlier than that, I had not yet picked up my new badge. So I used the right-hand side of the screen and accessed it the traditional way typing in my User ID and current password. A swirling circle appeared and swirled for three minutes. Then another screen appeared for two minutes. By this time I was annoyed and frustrated.  A kind nurse noticed my frustration and told me that when you attempt to log into the new screen the first time, it takes about 10 minutes to be logged onto the system. I sat patiently until finally I was let in.

The delay in access pushed me back 10 minutes.  By the time I finished rounds it was 8:00 a.m. I stopped by the Medical Staff Office on the way to my office and asked for my new ID card. I also asked if I could keep my old ID card as well because over the last 40 years I had become attached to it. We needed that ID card to swipe our way into the parking lot, into the building and onto the elevators and certain hospital floors and units.

I was told I needed to keep my old ID card as my new card was to be used only for computer access. It would not get me into the parking lot or the building or special floors and units. They gave me a fancy new ID card holder that accommodates two ID cards.

That’s the high-tech world’s idea of efficiency and progress – I suppose!

We Need Your Patience – Thank You

EHROur office is converting from electronic health record software created by vendor All Scripts to a program created by Greenway called Prime Suite.   Prime Suite contains a very easy to use practice management component for billing and scheduling that will replace our current proprietary system known as Innovations.  Why would I possibly change systems again?   All Scripts made certain decisions that it will result in it no longer keeping its software working. We need an electronic health record system that meets the Medicare and federal government’s requirements and we chose software that communicates with the software at Boca Raton Regional Hospital and the Tenet facilities.

The training and switch from one computer system to another is both tedious and stressful for the office staff and the physicians. It is tedious and stressful because we not only need to carry on business as usual, but we must make sure we record our visits accurately and that the previous medical records are transferred into this system accurately and completely.  For this reason staff will be asking you to reconfirm your personal data including address in Florida and elsewhere, phone numbers including mobile phones, home phones, fax numbers, email addresses and your preferred method of being contacted.  We will be checking your primary insurance and secondary plans as well as confirming your emergency contacts names and phone numbers. As part of the process we will be re-examining whether you have indicated that you have a living will or any end of life plans and make sure we have a copy of those documents on file.

As we move forward we apologize for asking you to provide the information we already have and that has not changed but hope that by being complete and thorough we will eventually make all operations work at a higher level for you the patient. Thank you. Feel free to call if you wish to discuss this.