Electronic Health Records Bill Seeks To Protect Against Drug Diversion Concerns

Lawmakers want healthcare technologies to include measures to avoid drug abuse, but some providers concerned about conflict with NJ’s new telemedicine law

Garden State lawmakers are seeking to ensure that new healthcare technologies can appropriately process — and protect — prescriptions for opioids and other controlled substances in an effort to reduce drug diversion and the potential for abuse.

But the Senate health committee withheld action Monday on a Democratic proposal to strengthen how electronic health records address these drugs to allow for clarifications requested by telemedicine providers and other physicians. Representatives of these groups said, as drafted, the measure could conflict with New Jersey’s new telemedicine law, which greatly restricts doctors from remotely prescribing highly addictive, Schedule II drugs.

The proposal (S3592), sponsored by Senate Majority Leader Loretta Weinberg (D-Bergen) — which passed an Assembly committee in June and is slated for consideration by the full body on Thursday — would require the owners or administrators of electronic medical records to ensure these systems can accept, process, and transmit Schedule II prescriptions. These technologies would also be required to meet all federal standards related to communicating and protecting these prescriptions.

Most hospitals and providers nationwide now use some form of electronic health record, or EHR, and all Garden State acute-care facilities are participating in a federal incentive program to develop these systems, according to the Office of the National Coordinator for Health Information Technology.

New Jersey lags behind other states

Other studies suggest New Jersey is lagging behind other states in implementing these systems, with three in four hospitals now using EHR systems and more than 60 percent of doctors’ offices. The New Jersey Innovation Institute is now working with state officials to create a database to individually identify each Garden State resident to avoid patient mix-ups.

At the Senate health committee hearing Monday, several speakers praised the proposal to strengthen these EHR systems when it comes to transmitting opioid prescriptions. But they also said tweaks were needed to avoid confusion or contradictions with other state laws.

Attorney Matt Greller, who represents Teladoc — one of a number of national telemedicine providers now working in New Jersey — praised the call for greater records security, especially given the opioid epidemic, which has been fueled in part by prescription drugs that are diverted for illicit use. But Teladoc providers, who don’t prescribe Schedule II medications, should not be forced to upgrade their system, he said.

“We would be required to make a significant investment in our national platform to track something we don’t do,” Greller said. According to the company’s estimates, the work would take at least three full-time staff members six months and cost Teladoc $500,000, he added, “With no benefit that patients will see.”

Teladoc’s prescribing practices in New Jersey are shaped by the state’s telemedicine law, signed last summer, which requires physicians to conduct an in-person patient visit before using remote technology to issue prescriptions for a Schedule II drug. It also requires face-to-face follow-up appointments every three months if the patient is continued on these controlled substances.

Physicians not responsible for compliance

Greller said that Teladoc’s protocol here is also shaped by its practice; the company generally focuses on non-emergent illnesses like pink eye and sinusitis — conditions for which Schedule II drugs would be inappropriate.

As a solution, Greller urged lawmakers to amend the bill to make clear it did not apply to telemedicine or telehealth providers. He said he is working with the Assembly sponsors, Health Committee chairman Herb Conaway (D-Burlington), a physician, and Nancy Pinkin (D-Middlesex), to incorporate the changes.

Mishael Azam, chief operating officer for the New Jersey Medical Society, also urged sponsors to clarify that the vendors of electronic health records systems are responsible for ensuring compliance, not the physicians using the system. “This doesn’t apply to prescribers at all,” she said.

Sen. Joseph Vitale (D-Middlesex), the chair of the Senate health committee, agreed the concerns raised by these parties deserved attention. “But I don’t want to amend this bill on the fly,” he said.

Vitale urged Greller and Azam to continue to work with the sponsors of the legislation to modify the bill before it is up for a vote in the Assembly Thursday. He said there will still be time to move the bill in the Senate before the legislative session ends mid-January.