It seems that the people discussing this rule are hesitant to give their true opinions on how they feel about it.  Isn’t this a great opportunity to involve patients in the discussion to share their need for adequate pain control, and the community’s need for protected prescribing without diversion?  Here’s John Halamka’s discussion of this ruling, and the linked video provides more clues. Maybe, with patient involvement, a workable solution could be developed that allows these substances to be dispensed safely using electronic systems.

The State Alliance members will continue their discussions from their May 2008 meeting on ways that state policymakers can help facilitate electronic prescribing. A representative from DEA will present the proposed rule issued in June to allow electronic prescribing of controlled substances. A CMS representative will share information on current and future activities to support electronic prescribing in Medicare. The Alliance will provide NGA staff guidance on how the organization should implement the statement adopted in May by the State Alliance.
•Tony Trenkle, Director, Center for Medicare and Medicaid Services Office of E-Health Standards and Services
•Mark Caverly, Chief, Liaison and Policy Section, Drug Enforcement Administration Office of Diversion Control (Invited)

AMCP.org – Comments on Standard SIG – The NCPDP was working on the standard for Med Sigs – a little background

In the air, health emergencies rise quietly – USATODAY.com

I have been on several flights in the last 2 years with medical emergencies on them. On the last one, there were so many doctors on the flight, that the flight attendants actually turned people away from assisting. On two I have been on, I was the only physician on the flight, but not the only allied health professional (nurses are as important as physicians in these situations).

I’m glad this is being reported on, because I think that this issue should be recognized and there are some opportunities for us to do some things:

1. Establish helpful guides for patients deciding whether to fly or not. For example, a person recently discharged from a hospital with a new medication regimen may be at risk on a transcontinental flight
2. Establish helpful guides for airline personnel for working with in-flight physicians and nurses. This includes seeking out the right expertise, and maybe a 30 second coaching session on procedures like using the air to ground radio and what is available and not available on board (and there’s usually a medical kit with a lot of useful things on board).
3. A guideline about intervening on a flight plan. One thing that was confusing for me in the times I assisted surrounded landing a plane in an emergency – this is the kind of thing I don’t want anyone to be guessing about. If a patient is critically ill, there should be an option to order a plane down to get help, and maybe scripting that goes with this. What’s possible though – how long does it take to land a plane and is it better to continue on and bring medics on board? Sometimes, it’s the humane thing to do to get help quicker.
4. A guideline for medical providers to prepare documentation and work with flight crew to maximize their talents in an emergency. Maybe an introduction as to who has medical experience and what they can do (perhaps as part of the 30 second orientation I spoke of).
5. Maybe, a guideline for patients and providers. In an in the air emergency, people encounter very intense moments and form something of a bond. I think it is therapeutic in some cases for the provider to connect with the patient/family after the incident is over, or with the patient’s regular provider in some cases. I did this with one family and it was really special.

I also have to make a broader societal call for our profession to engage in making medication reconciliation a norm in all parts of care, and in involving patients in their care by giving them access to all of their medical information (as I did in this blog post about a medical emergency I attended to on the ground). Informing and empowering patients throughout the process of care prevents a devastating outcome in these situations. None of us wants a family member in distress in a situation where they do not have accurate information about their health care regimen that they can either tell someone or have written down from their physician.

An in-air medical emergency is both an intense time and a time when people come together to do the best they can to help another person. I am a big fan of creating a process where everyone can maximize their talent and minimize their anxiety during a life or death situation.

If anyone else has attended on an emergency or seen one in the air, let me know your thoughts. Comments are open.

• New E-primer ? The Need to Know: Addressing Concerns about Privacy and Personal Health Records – Quote:”Project HealthDesign teams have found that while confidentiality is important to end users, they are often willing to share personal information in exchange for specific benefits and functions? “
• eCWusers.com :: An Independent Users Group for eClinicalWorks – A user forum that is publicly hosted by users of the eClinicalWorks EHR
• Create a personal MedActionPlan? for every patient – Interesting approach to guiding patients on medication regimens
• EMR – Electronic Medical Records and Practice Management for Clinical Practices by eClinicalWorks – eClinicalWorks Patient Portal information
• HIMSS – National Capital Area – Forum on focusing on the consumer in health care, January 17, 2008