James S. Gessner, M.D., a Norfolk physician with Anaesthesia Associates of Massachusetts and president of the Massachusetts Medical Society, has been deeply involved in the group’s response to the opioid epidemic. He led its Task Force on Opioid Therapy and Physician Communication, which produced new physician guidelines that have been incorporated into the Board of Registration in Medicine’s recommendations for opioid use.
He was also very active in helping the 25,000-member doctors’ organization advocate for a much-needed update to the state’s aging prescription monitoring program. Here, he talks with Patient Safety Beat about the new Massachusetts Prescription Awareness Tool, or MassPAT, launched last month, and the Society’s work on other patient safety issues.
1. Betsy Lehman Center: Are you and the Massachusetts Medical Society pleased with the new prescription monitoring tool?
Gessner: This story has a happy ending. The old system dated from 1992. It was clunky, slow and updated irregularly, and we told the governor’s Opioid Working Group last year that it needed to be improved because of the significant potential for patient safety. So Gov. [Charlie] Baker stepped up to the plate, found the $6 million that was needed, and initiated the contract. The vendor they chose operates PMPs [prescription monitoring programs] in 25 other states, which means it includes data from neighboring states. You can enroll in under 10 minutes. And the data goes into the system in real-time from electronic prescriptions and pharmacies. So this has everything we wanted.
2. Betsy Lehman Center: Has it been easy to persuade physicians to enroll?
Gessner: There was some concern for a week or two after MassPAT launched that registrations weren’t going fast enough, so the society issued a media alert and sent repeated messages to our members. That resulted in a huge increase in sign-ups within a few days. We now have more than 80 percent of Massachusetts physicians who write controlled-substance prescriptions in the system. Currently, they only need to go into MassPAT when they write new prescriptions. But starting Oct. 15, the system must be checked every time you prescribe any Schedule II or III narcotic, as well as first prescriptions for benzodiazepines.
3. Betsy Lehman Center: In our work, we’ve noted that it takes a lot of hard work, including promotions, incentives, email alerts, and other outreach, for new medical practices to be adopted. What can the Society do to promote other advances in patient care and safety?
Gessner: As one of the leading state medical societies, we advocate for any change that would help physicians improve practice, access or health care in general. But it doesn’t take much pushing. Physicians want to use the best practices. I just came from a meeting this weekend where people were practically cheering about advances in transfusion technology. The issue is one of communications—getting doctors enough data to warrant a change. With opioids, we decided last year to make our 18 continuing medical education modules on pain management available free of charge. Since then, some 6,500 individuals—82 percent of them physicians—have completed over 18,000 courses. And this summer, AthenaHealth reported that Massachusetts doctors prescribed 14 percent fewer opioids in the second quarter of this year than in the first quarter. That was a much larger drop than the 8 percent decline nationwide. And was doubly remarkable since this state already ranked in the bottom quartile of all states for opioid prescriptions.
4. Betsy Lehman Center: One advance that’s had mixed reviews is electronic health records (EHRs). The Annals of Internal Medicine said recently that doctors now spend half their time updating EHR records and other desk work, and only one-quarter seeing patients. How can a doctor do a good job of patient care when he or she is hidden behind a screen?
Gessner: Physicians in Massachusetts were among the earliest proponents of EHRs, and I don’t know a single one who’s very happy with the outcome. EHRs have hit a home run for patient safety with things like collating medical records and integrated pharmacy management, such as the MassPAT system. On the down side, they can be incredibly expensive and interfere with the physician-patient relationship. It’s gotten so bad that some practices are now investigating using scribes, where a trained person sits in the room and takes notes while the physician pushes her computer screen aside. I was joking with one of my colleagues yesterday that the most dreaded message that can appear on your screen is the one that says, “Check your orders please, as the system is very slow today.” That happened to my colleague just last Saturday, so it’s not that infrequent.
5. Betsy Lehman Center: So what can be done to make EHRs more effective?
Gessner: They’ve got to be fast and easy to use, of course. But the most important thing is to make sure they have all the data you need for the patient who’s right in front of you. Often, the patient sees providers in several different systems, and that can make it hard to access the data. But things are getting better. Massachusetts will soon be trying try out a new system where emergency rooms share patient data with each other. The system has been tested in Colorado and other places and people who use it have liked it. In Massachusetts, it should help us spot drug-seeking patients, or those who have behavioral issues or a history of violence, as well as take better care of patients who might be seen in more than one ER over a short period of time.