An issue was recently brought to my attention regarding the potential risk of prescription drug fraud in Electronic Medical Records. Is this a real or imagined problem? How prevalent is prescription drug fraud currently and what could be done to reduce the risk?
Common drugs fraudulently obtained include the benzodiazepines (e.g. Valium, Xanax and Ativan), the narcotics (e.g. Oxycodone) and stimulants such as the Amphetamines. All of these drugs have addictive potential and have psychoactive (mood or conciousness altering) properties. They can be obtained by walking into a physician office or walk-in clinic and requesting a prescription for the drugs or by fraudulently preparing a prescription that looks legitimate but is in fact a forgery. The majority of physicians are generally savvy to drug seekers and will rarely provide prescriptions on demand, however occasionally prescription pads are stolen from Doctor's offices or fraudulently copied and printed. Some protections against fraudulent prescriptions in a purely paper world include the need to write a prescription and forge a physician's signature, the indentation of ink on the paper and the watchful eye of the pharmacist dispensing the drug. I am not aware of the actual prevalence of prescription drug fraud in Canada, but I imagine that it is a problem particularly in certain jurisdictions.
When using an EMR, there are number of ways that a prescription can be generated and delivered to a pharmacy. In an ideal world, the physician would generate a prescription in the EMR, it would be digitally signed and transmitted into an electronic queue and the patient could present identification at a pharmacy of choice and the medication would be dispensed. This is a future vision and does not currently exist in Canada to the best of my knowledge. An alternative is the ability for the EMR to generate a prescription which is then faxed directly from the EMR to a pre-selected pharmacy using a unique identifier to confirm the legitimacy of the prescription. In both of these situations, the prescription is delivered directly to the pharmacy. However, most physicians who currently use an EMR print and hand the printed prescription directly to the patient, who then takes it to the nearest pharmacy. These are generated using standard printers and white 8.5x11 sheets of paper. With a photocopier or scanner and inexpensive publishing software it is quite easy to duplicate prescriptions prepared in this way potentially paving the way for extensive prescription drug fraud.
An alternative is to use 8.5X11 counterfeit-resistant prescription paper. A sample of such paper was sent to me by RxSecurity in Nova Scotia. This is a thoughtful solution and something that I would like to bring to the attention of the readers of CanadianEMR. Click on the image at left to see a more detailed view of the standard prescription pad sized pads. The larger sheets are prepared in the same manner and have a watermark that is resistant to photocopying.
In locations where you may be facing problems with prescription fraud, an important step in using the 8.5x11 sheets is to notify your commonly used pharmacies that they should only accept your prescriptions on the counterfeit-resistant paper.
Am I painting too dismal a picture when it comes to the prevalence of prescription drug fraud and the ease with which prescriptions can be duplicated using whit paper and an inkjet printer or photocopier? Have you had experience with this issue in your practice? Are there other solutions to this problem?
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