How Technology Can Help Us Ensure Safe and Effective Drug Use

| | Technology & Integration

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A claimant who suffers a serious injury may concurrently take multiple medications to treat various aspects of the injury. His doctors may have prescribed pain killers, muscle relaxers, sleep aids, and possibly other drugs. How can utilization review (UR) track the patient’s usage of these drugs over a long period of time? And how does a UR reviewer track the patient’s weaning process when so many drugs are involved? In a situation like this, technology can help. Software can provide the capability to track prior requests for drugs and ensure that the requests are appropriate. It is important to see the historical picture of the claim, the claimant’s treatments, medical records, etc. Drug-tracking technology can also aid UR reviewers oversee a successful weaning process.

Tracking Software Guides an Appropriate Process for Tapering off Medication

The goal of UR is to give patients get the appropriate treatment to ensure success in their recovery and return to their former productive lifestyle. Doctors should apply evidence-based guidelines to ensure that treatment conforms to industry standards and safety concerns. The concerns for pharmaceutical requests include misuse or overuse of drugs. Treatment standards outline the period of time drugs should be needed, concerns regarding misuse, etc. If a UR reviewer sees repeated requests for the above-mentioned mix of drugs, he may need to have a discussion with the treating physician regarding a weaning protocol for the patient to avoid addiction. For example, if a reviewer determines that the weaning protocol for a pain medication requires reducing the patient’s medical dependency, they may promote tapering from four tablets a day to three. The reviewer then needs to be able to track that process such that if a request comes in later for four tablets a day, the reviewer can take the appropriate action to continue the tapering process based on the established protocol. It is challenging to ensure that a physician reviewer follows through with the weaning process recommended by another physician reviewer. Having the historical drug information readily available in a software solution helps ensure successful protocols are managed appropriately. It allows reviewers to see previous requests and outcomes to determine whether an established tapering process is being followed. If the plan is not being followed, the reviewer can contact the requesting physician and discuss whether the patient’s condition has changed or whether the weaning process should be continued. Over the past few years, it has become more common for patients to take multiple medications concurrently. The ability of software to track the history of approved medications, as well as any advanced drug treatment plans, helps reviewers balance a patient’s prescriptions and establish/monitor a successful weaning protocol to ensure the patient’s safety and the efficacy of the prescribed drugs.

Karen Atkins

Karen Atkins, Chief Operating Officer with UniMed Direct, is leading the conversation, and the industry, on how to make the utilization review process more efficient for all stakeholders: physicians, insurance companies and, most importantly, patients.