The quirks of Maine’s prescription monitoring program, from an ER doc’s perspective

Dr. Charles Pattavina became chief of the Department of Emergency Medicine at St. Joseph Hospital 6½ years ago. He hadn’t been at the Bangor facility more than a couple weeks when a man sent by the Maine office of substance abuse knocked on his door to talk about why he should use the state’s prescription monitoring program.

The online database allows doctors to search for patients’ prescription histories, so they know whether patients are “shopping” around at multiple medical practices to get addictive painkillers. At the time, Pattavina said he appreciated the concept of the program but didn’t really use it. Logging in could be difficult; it didn’t have real-time data; and, because of federal law, it omitted certain patient populations, such as veterans.

It wasn’t until this spring that the state made what might seem like a small change — but could have major implications. Instead of requiring prescribers to log in to the prescription database separately, they can now access it through the statewide computer system HealthInfoNet, which contains patients’ electronic medical records.

It shows how something as simple as user friendliness can have a significant change on behavior — and how the state can continue to operate with an eye toward improvement.

Providers use HealthInfoNet much more frequently than the prescription database, and now the two are connected. Prescribers don’t have to sign in separately.

“It’s sort of revolutionized my use of it,” Pattavina said.

Previously, Pattavina went through what many other providers also experienced: Because he used the system infrequently, he often forgot his password. Instead of offering a prompt to jog his memory or reminding him what the basic password requirements are, the system requires him to call customer service to get a new password. Each password must be different, so they become increasingly harder to remember.

What’s more, customer service is not available at night or on weekends — the exact time people might consider going to the hospital since their primary care doctor’s office is closed.

Even though Pattavina and other prescribers can now access the database through HealthInfoNet, the password retrieval process should still be improved, he said. Several weeks ago, on a weekend, the HealthInfoNet link wasn’t working, so he tried to log in directly to the prescription monitoring database. The passwords he tried were incorrect.

He called the support line, and a representative did call back — but not until Monday when it was of no help.

The system is set to improve even more next year when pharmacies start updating the database with prescription information daily instead of weekly. And in September, for the first time, veterans’ prescription information is supposed to be searchable in Maine’s prescription database as the Department of Veterans Affairs begins contributing to the monitoring program.

Pattavina also looks forward to the day when states will share information about prescriptions.

He recalled a case where he knew the hospital had ordered a prescription for someone, but it never showed up in the database. What was he supposed to do when the person returned, seeking more medication? From the information Pattavina had, the prescription had never been filled; but there was no reason to think the patient hadn’t filled it.

Was the patient filling the prescription out of state? Or did the patient have the ability to fill it through the VA? There’s no way for Pattavina to know.

Though the monitoring program has needed improvements, it’s a valuable tool, he said. It has helped open the door to conversations with patients about treatment.

“If people are open to getting help, that’s enough. Because that’s what you really want, is for them to get better,” he said.

Erin Rhoda

About Erin Rhoda

Erin Rhoda is editor of Maine Focus, a journalism and community engagement initiative by the Bangor Daily News.