The five orthopedic surgeons at the Schwartz, Funari & Poshni practice in Montgomery County, Maryland, have long used secure texting software from DrFirst to communicate among the three offices because it’s much quicker and easier than making phone calls or sending emails.

In February, however, the practice adopted the vendor’s iPrescribe software to better handle the prescribing and workflow processes of a practice writing 90 controlled substance medications a day, including opioids for pain management, while making it easier for patients who just had surgery to get their prescriptions electronically sent to the pharmacy, rather than having to physically drop off the prescription.

Not only is e-prescribing a convenience to patients, but it also may compel patients to stay with the practice, says Kevin Schwartz, MD, a oral surgeon.

Kevin Schwartz, MD
Kevin Schwartz, MD

As the use of opioids continues to rise, however, the practice knows it needs to do a better job monitoring patients using the drugs, Schwartz acknowledges. The doctors are working with the Maryland Board of Pharmacy to check patient visit profiles through the state’s prescription drug monitoring program (PDMP) and identify patients who may be hoarding opioids and other controlled substances.

A patient, for example, may say they lost a prescription, but the PDMP may show that the prescription was filled.

The practice recently made the decision to begin prescribing fewer opioid tablets when appropriate. If a patient has been prescribed 20 tablets, now he or she may get five or 10, and the doctors will monitor how the patient does on the lower level. Schwartz himself has decided to start at bottom with only five tablets and monitor results. “We don’t want scripts left in the patient cabinet,” he explains. “We want to eliminate kids taking them.”

The big problem with managing opioids, Schwartz believes, is that with the medications available, patients now expect to have a higher level of pain relief. And, perhaps unwittingly, the Joint Commission, which places a high value on adequate pain relief, “hits hospitals if doctors don’t control pain,” he adds. Still, Schwartz sees cutting down the supply of opioids while adequately controlling pain as a solvable problem.

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