By Heather Somand, Pharm.D., BCPS, manager medication use informatics, Michigan Medicine, Sinai Grace Hospital, Ann Arbor
During the last week of 2017, Lt. Gov. Calley signed into law a number of bills addressing opioid prescribing, monitoring, education and consent. As clinical informatics pharmacists, we will be asked to develop functionality within our electronic health records (EHR) to address the new requirements and/or capture data for auditing purposes to assist providers in complying with the new requirements. In the following paragraphs, a description of each law, the date it goes into effect and potential implications to the EHR are described.
Senate Bill 166 (Public Act 248) is significant for prescribers and those that support the EHR. Effective Friday, June 1, 2018:
- All licensed prescribers in Michigan must be registered with the Michigan Automated Prescription System (MAPS) before prescribing or dispensing a controlled substance
- Prescribers will be required to run and review a MAPS report on all patients who receive a controlled substance prescription for greater than a three-day supply.
As a result, IT teams across the state may be asked to help facilitate compliance with these requirements by integrating the MAPS vendor, Appriss, into your EHR . This will make it easier for providers to check MAPS and/or develop a way to capture a MAPS check either automatically or through an attestation statement. Appriss is able to integrate within certain EHRs and provide single-sign on functionality. Of note, the latter requirement to check MAPS prior to prescribing a controlled substance does not apply to hospital inpatient orders, freestanding surgical clinic orders or veterinary prescriptions filled by a pharmacist.
Senate Bill 274 (Public Act 251) is also significant in that it limits a prescription containing an opioid for treatment of acute pain to a seven-day supply in a seven-day period. The bill does define “acute pain” and goes into effect July 1, 2018. IT teams should start brainstorming options to remind prescribers of this limitation. Options that may be considered include pop-up alerts to the providers during the prescribing process, education built into the short-acting opioid prescription orders, defaulting the sig and quantity in the orders to a seven-day supply, if possible, or limiting the prescription fields.
Some additional details about schedule II controlled substance prescriptions were mentioned in the bill including permitting a pharmacist to do partial fills for CII prescriptions in certain situations.
Senate Bill 47 (Public Act 252) requires prescribers to obtain and review a MAPS report before prescribing or dispensing buprenorphine, a buprenorphine containing medication or methadone to a patient in a substance use disorder program. Any actions taken to enhance your EHR to comply with Senate Bill 166 above should be followed here as well.
House Bill 4408 (Public Act 246) requires education and signed informed consent documents when prescribing an opioid to an adult or minor. In the case of minors, a specific form called the “Start Talking Consent Form” for parental consent is required before prescribing the first prescription in a single course of treatment for a controlled substance containing an opioid. This form must be a separate document from any other informed consent documents a prescriber may use. To see an example of the “Start Talking” document, see Ohio’s version here. The state of Michigan has indicated it will release the Michigan version by May, just in time for the June 1, 2018, due date. IT teams across the state should engage their Health Information Management teams now, since initially, this consent document will need to be uploaded into the EHR and easily accessible.
The bill does outline certain exceptions to parental consent of a minor’s treatment if related to a medical emergency, surgery, hospice or oncologic treatment. See the full bill here.
The second part of House Bill 4408 addresses education to all other patients prior to prescribing an opioid containing prescription and obtaining their signature indicating they received the education. The consent form will also be specific; although, the bill only indicates it will come from the Department of Health and Human Services. This document will also need to reside within the patient’s EHR.
Senate Bill 273 (Public Act 250) requires a licensee or registrant who treats a patient for opioid related overdose to provide information on substance abuse disorder services. Conveniently, the MAPS vendor Appriss provides some resources on their website by zip code, so the need to develop something home grown may not be necessary until the state further defines what information must be provided. This requirement goes into effect March 27, 2018.
Lastly, Senate Bill 167 (Public Act 249) and SB 270 (Public Act 247) both speak to the requirement of a bona fide prescriber-patient relationship. Although this may not directly affect IT teams, details are included incase you receive questions. Some providers initially questioned what this meant in relation to ambulatory clinic visits where a patient may see multiple providers within the practice. However, a bona fide relationship is defined as a prescriber who has all of the following:
- Reviewed the patient's relevant medical or clinical records and completed a full assessment of the patient's medical history and current medical condition, including a relevant medical evaluation of the patient conducted in person or via telehealth.
- Created and maintained records of the patient's condition in accordance with medically accepted standards.
If you would like to read the full bills, you can find them at www.Legislature.mi.gov/. Collectively as a state, we should identify the best methods within the EHR to address the legislative requirements from a technology perspective. I encourage you to get involved in the MSHP Informatics and Technology Committee. If you have questions about the Committee, feel free to reach out to me at firstname.lastname@example.org. Our next meeting is Thursday, May 3, 2018, in Okemos, Mich. We also have a Google group to post questions, benchmark with your colleagues and share experiences. If you’re interested, request membership by visiting groups.Google.com/forum/#!forum/mshp-informatics.