MAT / OTP
A MAT program that stopped running its medication list in two places
Controlled prescribing in one system, the clinical record in another, and a reconciliation problem that only showed up when someone asked for the whole picture.
- Level of care
- Office-based MAT
- Size
- 180 active patients
- Payer mix
- Medicaid, commercial
- Focus
- Prescribing, retention and outcomes
The situation
The program prescribed buprenorphine through a standalone e-prescribing product because their EHR did not support EPCS. That meant the medication list existed twice — once where it was prescribed, once where it was documented — and neither copy was authoritative.
PDMP checks were performed and recorded on paper. Retention was tracked in a spreadsheet that nobody trusted enough to bring to a payer conversation.
What changed
- Controlled prescribing moved onto the chartEPCS with identity proofing, PDMP lookup and two-factor signing, against the same medication list the clinical team maintains.
- Every prescription wrote to the activity logPrescriber, timestamp, PDMP result and destination pharmacy, in the same immutable log as chart access.
- Assessments went out on a schedule and scored themselvesRetention and outcome measures stopped depending on someone remembering.
- Program-level outcomes became exportableBaseline against latest across the cohort, in a format a payer will read.
Results
Three measures, before and after.
Reconciliation stopped being a task because there is nothing to reconcile.
Recorded on the chart at the moment of the check.
Now a number the program can bring to a rate conversation.
This is a composite scenario, modelled on the workflows this product was designed against with a clinic director and a revenue cycle management firm. It is not a named customer engagement, and we will replace it with one when a program is ready to publish under its own name.
The takeaway
A program whose core clinical model is controlled prescribing cannot run on a system that stops at non-controlled medications.
If that describes your program, the fastest way to find out whether this holds is thirty minutes with your own workflows rather than a slide deck.
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