Philadelphia Malingering?

[whopper]

While I did residency in Atlantic City someone told me that in Philadelphia (about 1 hour away from A.C.) Had a system where the psych units called each other up concerning problem patients because one malingering being discharged would literally go to the other psych unit within the hour.

I thought such a practice violated HIPAA. It doesn't. It's not a HIPAA violation to share medical information so long as both parties are involved with treatment. A big problem with hospitals sharing information is when one person calls from hospital A to B the person at hospital B doesn't know if the person at Hospital A truly is a medical professional.

So if an alliance were put into place, say there was a way to readily ID one professional (say the social workers) information would be more liquid.

First-is anyone here in Philly? Does such a system exist? I am considering writing an article on proposing such a system to localities with clusters of hospitals.

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[OldPsychDoc]

In our metro area the majority of major hospitals use some version of Epic, and there is an information-sharing system in place allowing us to get a very simple signed consent from the patient to view records at the other hospitals, and <ding> they're right there on our screen. Handy. That, plus the state controlled prescription database, makes it a little tougher to pull the proverbial wool over our eyes.

 

[whopper]

Yeah, terrible Missouri is the only state in the country without some type of central pharmacy so if a guy is getting benzos from 6 different doctors I can't tell. Hey I guess it's all about "FREEDOM MAN!" The freedom to get as much benzos as you want without the man watching you.

Sometimes malingering patients refuse to sign the form. That's why I think local hospitals pooling together data could be a good thing.

 

[Doctor Bagel]

In our metro area the majority of major hospitals use some version of Epic, and there is an information-sharing system in place allowing us to get a very simple signed consent from the patient to view records at the other hospitals, and <ding> they're right there on our screen. Handy. That, plus the state controlled prescription database, makes it a little tougher to pull the proverbial wool over our eyes.

Here, too. We have CareEverywhere through Epic that I think all the hospitals use. We also have a crisis database for the county that includes information about people who have been flagged as being high utilizers. That's where the social workers in the ED are magic -- they can access all this information that I can't.

Don't get me started on the prescription database here. It requires a notarized form, which means I still haven't signed up. My current employer has a notary, but they're at a work site about 20 miles away from my work site. Bad excuse, I know, but shouldn't they try to make these things easy for us? In the state where I went to medical school, they're actually going to start mandating that you check the database before prescribing scheduled substances.

 

[birchswing]

Here, too. We have CareEverywhere through Epic that I think all the hospitals use. We also have a crisis database for the county that includes information about people who have been flagged as being high utilizers. That's where the social workers in the ED are magic -- they can access all this information that I can't.

Don't get me started on the prescription database here. It requires a notarized form, which means I still haven't signed up. My current employer has a notary, but they're at a work site about 20 miles away from my work site. Bad excuse, I know, but shouldn't they try to make these things easy for us? In the state where I went to medical school, they're actually going to start mandating that you check the database before prescribing scheduled substances.

I think there should be a requirement on the prescriber in which for certain medications they have to give a reason why that medication is necessary and what other treatments have been attempted first. It wouldn't necessarily have to be approved by any particular agency, but I think putting one more step in place in order to prescribe benzodiazepines, in particular, would be a good practice so that some of the mindless prescribing might stop. If you are forced to give a rationale and a state agency can see that the rationale doesn't make sense, they might be more aware of prescribing problems.

I say this because there's a lot of talk about drug-seeking patients, but the drugs these patients are on and want more of originated somewhere.

 

[OldPsychDoc]

I think there should be a requirement on the prescriber in which for certain medications they have to give a reason why that medication is necessary and what other treatments have been attempted first. It wouldn't necessarily have to be approved by any particular agency, but I think putting one more step in place in order to prescribe benzodiazepines, in particular, would be a good practice so that some of the mindless prescribing might stop. If you are forced to give a rationale and a state agency can see that the rationale doesn't make sense, they might be more aware of prescribing problems.

I say this because there's a lot of talk about drug-seeking patients, but the drugs these patients are on and want more of originated somewhere.

We already have this: it's called Prior Authorization, and it makes physicians want to jump out of windows because it's such a major pain in the coccyx. Unfortunately, it's applied only to expensive drugs by insurance companies, not to dangerous and addictive drugs.
I'm sympathetic with what you're saying, but we really don't want to go there. Still the best way to get someone off of opiates and benzos is to not start them in the first place, and I do think that we as a profession are gradually getting better about this.

 

[WingedOx]

Honestly, where I'm at most of our patients end up well known enough that there's no real need to call.