System to let county doctors track patients' prescription records

As an emergency room physician, Whitcomb has prescribed painkillers and worried about patients going to another hospital or clinic for more pills and then abusing or selling them. Last year, a close friend's son mixed beer with the painkiller Percocet, lay down for a nap and never woke up.

"For your own safety and for patient safety, we need a way of checking to see where these patients are getting drugs," Whitcomb said. "Patients can take these prescriptions and sell them on the street, and we have no way of tracking who's doing it."

Whitcomb, now the medical director of patient access at Aurora Sinai Medical Center, hopes an effort he has spearheaded within the Medical Society of Milwaukee County will soon change all that. Within about six months, the group hopes to launch a database that will allow area doctors to check whether their patients have gotten prescriptions for potentially addictive painkillers from anyone else. In time, the medical society wants to bring pharmacies on board to flag doctors who prescribe large amounts of the drugs.

A Journal Sentinel investigation published a week ago found that area physicians are almost never criminally prosecuted for incorrectly prescribing potentially dangerous drugs and that several doctors have been allowed to keep their licenses despite repeated investigations by the state's Medical Examining Board.

Some doctors simply have not been well-educated on how to effectively treat pain, and they make mistakes, adding to the problem.

"The only thing we find in the legal system is the tip of the iceberg," Whitcomb said.

Bruce Kruger, executive vice president of the medical society, said the group's effort is a way to help bridge the gaps.

"As a community, we are trying to come up with a solution for what's been identified as a major public health issue," he said. "This isn't the home run, but it's certainly way beyond where we are today. It's a start."

At first, the database would cover only Milwaukee County, where its use would be voluntary for doctors. Patients could still abuse the system by visiting doctors in other parts of the state.

Within a year or so, the medical society plans to solve that problem by seeking legislation that would mandate a statewide system, Kruger said.

"If we can make it work, which I'm confident we can, we're not going to stop with just Milwaukee County," he said. "If it's a model that works, other providers will want to embrace it. Most providers want to do the right thing."
Preventing abuses

A society task force convened in April and chaired by Whitcomb is nearing its final draft of a written plan to curtail prescription drug abuse in the county. It includes a list of guidelines to help doctors differentiate potential drug abusers from patients with legitimate pain. Some of the warning signs include asking for refills early; getting prescriptions from several doctors and having them filled at different pharmacies; and complaining of conditions that are hard for doctors to assess, such as headaches and back pain.

If a patient exhibits the warning signs, or if a doctor plans long-term treatment with narcotics, the patient would have to sign a medication management agreement promising not to sell the medications or to use illegal drugs or alcohol, under the guidelines.

Although many doctors already use such agreements, the medical society's plan would standardize them across the county. In signing a new agreement, a patient would agree to its posting on the database, where other doctors would have access to it. Access to the database would be limited to protect patients' privacy. Doctors, in turn, would agree not to prescribe potentially addictive painkillers to someone who already has entered into an agreement with another doctor.

"This way, doctors are no longer practicing in isolation, and they're observed," Whitcomb said.

If a patient violates the agreement, a doctor can stop seeing him or her. The medical society's draft policy discourages abruptly cutting off patients from their medications, which could lead to withdrawal symptoms or to the use of illegal drugs. Instead, doctors should help the patient taper off the drugs or arrange for inpatient drug treatment.
Combining databases

Whitcomb and Kruger are optimistic that the medical society could combine its database with another effort, already under way, to electronically link patients' medical information throughout the county.

Several groups have worked for years toward setting up that computer network, which is receiving software and technical support from Microsoft and could be operational within weeks, Whitcomb said.

Microsoft has invested about $5 million in the pilot program, Kruger said. According to the company, Milwaukee is one of several test sites to see how well its new data-processing technology works and how it can be adapted to other health care systems nationwide.

Additional funding came from area health care systems and from a federal grant. Adding the medication management agreements to the system would cost about $50,000, which the medical society plans to pay for, Kruger said.