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April 3, 2017
One man has been arrested in connection to a series of PharmaNet breaches that may have compromised the personal medical information of about 20,500 British Columbians.
Vancouver police executed a search warrant at a home in Richmond on March 23 and arrested a suspect. Investigators believe the man gained unauthorized access to the provincial online prescription-medication information system and used patients’ personal data for fraudulent purposes.
The man, who hasn’t been identified, faces a number of identity-theft-related charges, said police. Charges haven’t been laid.
The Health Ministry characterized the breach as a product of “cybercrime” that targeted doctor and medical clinic offices and PharmaNet service vendors.
“Through forensic analysis, we have learned that several breaches, which have occurred since July 2016, are connected,” said spokeswoman Lori Cascaden.
In February, the Health Ministry sent out letters to about 7,500 people affected by the breach, which officials became aware about after users and vendors reported incidents of “suspicious access.”
Since then, another 13,000 people may have had their PharmaNet information accessed, said the ministry Monday.
In the majority of cases, the suspect is believed to have accessed patients’ profiles, which contain their name, address, gender, date of birth and personal health number. In some cases, information such as the patient’s medication history for the last 14 months was also viewed.
To mitigate the risk of identity theft, the government said it will provide free credit monitoring to affected individuals. People who had their personal information compromised should expect a letter on how to access this service.
The ministries of Health, Finance, and Technology, Innovation and Citizens’ Services have launched an investigation and taken immediate steps to stop the breaches, and is working to implement “more robust security measures” with PharmaNet vendors, said the health ministry.
An independent security review of PharmaNet and an overall modernization of the system, which would include security enhancements, are also underway.
“You go into your pharmacy and say you want to lock down your records with a key word,” BCCLA policy director Micheal Vonn said Thursday. “With a key word, you have to give it to them every time you fill a prescription, but you know that only the people who are attending to your health care have access to your records.”
The PharmaNet system links all B.C. pharmacies to a central set of data systems and logs every prescription dispensed in the province.
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“Currently, physicians are required to have PharmaNet access in methadone clinics, and walk-in and urgent care settings. The College Board endorses the concept of mandatory use of PharmaNet for BC physicians at all points of clinical care.”
June 2, 2016
Vancouver Sun, Health Issues Reporter, Pamela Fayerman
The mandatory prescribing program of the College of Physicians and Surgeons of B.C., which took effect Wednesday, comes about because of an epidemic of narcotic addictions and deaths. Doctors who don’t follow the mandatory, professional standards could face complaint hearings and disciplinary actions like fines and licence suspensions.
The standards replace guidelines that were only recommendations on proper and safe prescribing of pain medications, sedatives, stimulants and other addictive medications. The guidelines allowed for some discretion; the new standards do not.
“It’s not a matter of if, when or maybe,” said Dr. Ailve McNestry, deputy registrar of the College, referring to the new standards.
“Unsafe prescribing needs to stop,” said Dr. Gerry Vaughan, president of the College’s board. “The new document clearly states what our registrants must and must not do when prescribing certain classes of drugs, especially if there is a risk of misuse or diversion.”
Last year, up to 200 doctors were ordered by the College to take educational programs to learn how to properly prescribe opioids and other addictive drugs.
Under the standards, doctors must now have discussions with patients about alternatives to opioids, especially for conditions like low back pain, headaches and other ailments that don’t require such medications. Doctors must take careful patient histories and do a risk-benefit analysis to consider if opioid therapy is safe.
McNestry said some mental health patients may be vulnerable to addiction, as are patients who have abused alcohol or come from families where addiction is a problem. Doctors must review PharmaNet records to see if a patient has taken such medications, because some individuals doctor-shop in order to collect more pills to either use themselves, give to others or sell on the street. If doctors do end up prescribing such medications, they are now required to start with the lowest dose, for a short time period, and monitor patients frequently.
While some opioids like fentanyl are illegally imported into B.C. or manufactured here by organized crime networks, the College says doctors have also had a role through inappropriate prescribing of opioids and other medications.
Dr. Perry Kendall, the provincial health officer, said a few months ago that B.C. has “a public health emergency” and as many as 800 people may die from opioids in 2016, almost double the number in 2015.
McNestry said B.C. is unique in introducing standards. Provinces have historically taken only an educational approach to prescribing recommendations.
“We are now calling these legally enforceable standards. Our mandate is public protection and if education doesn’t (achieve) that, then we need to do something more,” she said. While chronic pain doctors and their patients may have “valid”concerns about how the changes will affect them, McNestry said the College must do more to stop the overuse of such medications.
“There’s just too many people suffering from the side effects of high dose opioid therapy. There are people who are being prescribed dangerous combinations of drugs (opioids and sedatives), leading to people stopping to breathe.”
According to IMS Brogan, which monitors pharmaceutical sales, Canadian doctors have been heavy prescribers of opioids, writing 53 prescriptions for every 100 people. McNestry said one doctor who came to the attention of the College recently had prescribed 80,000 opioid tablets in a three-month period.
The new standards are based on a set published in March by the U.S. Centers for Disease Control and Prevention. The B.C. College and its board adopted them because they didn’t want to wait any longer for proposed new Canadian standards. The current national guidelines are six years old.
McNestry said coroner’s reports, which are reviewed by College officials, showed that a disturbing number of people who died of overdoses were never prescribed the medication that killed them, which means they had obtained drugs illegally. A Vancouver Sun series earlier this year showed that some health professionals steal opioids from hospitals for their personal use or sell them on the streets.
From ISMP Canada
Patients are at high risk of fragmented care, adverse drug events, and medication errors during transitions of care. Ensuring safe medication transitions is complex. It requires patients to be an active partner in their health to ensure that they have the information they need to use their medications safely.
ISMP Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association and the Canadian Society for Hospital Pharmacists have collaborated to develop a set of 5 questions to help patients and caregivers start a conversation about medications to improve communications with their health care provider.
It may be particularly helpful for patients to ask these questions at transitions of care. Examples include:
Forcing doctors to register with B.C.’s prescription database would help ensure patients are not receiving too many of the dangerous opioids behind fatal overdoses, addiction and other serious problems, according to a new report.
Less than a third of British Columbia’s physicians are using PharmaNet, the provincial system that records all prescriptions, according to a report released
PharmaNet records data such as the drug name, dose, quantity, prescribing doctor and duration for all prescriptions dispensed in B.C.’s pharmacies. All pharmacists can access it and physicians working in B.C.’s methadone clinics or transient-care settings, such as hospital emergency departments or walk-in clinics, must be able to use it. But many other physicians have been reluctant to sign up and pay the $8 monthly fee to access PharmaNet, according to Evan Wood, co-director of the Urban Health Research Initiative at the B.C. Centre for Excellence in HIV/AIDS.
That’s a huge problem, he said, because more than 70 per cent of the province’s doctors may be writing opioid prescriptions without knowing their patient’s history with the drugs or whether they are already being prescribed the dangerous form of pain medication from another doctor.
Without access to PharmaNet, doctors may also be unsure whether someone is receiving benzodiazepines, the risky pharmaceutical class of tranquilizers like valium or ativan that are often linked to opioid-related deaths in B.C., Dr. Wood added.
Globally, Canadians are the second-largest per capita consumer of opioids, a family of pain medications that includes oxycodone, hydromorphone, morphine and fentanyl. Deaths tied to the synthetic opioid fentanyl have spiked across the four largest provinces in recent years, with fatal overdoses increasing nearly seven times in B.C. from 13 in 2012 to 90 last year, according to a national network of drug researchers.
Dr. Ailve McNestry, deputy registrar for the College of Physicians and Surgeons of B.C., said her agency’s board will likely review and approve new guidelines this January mandating all clinicians use PharmaNet, and it could take up to a year for doctors to make the technological change.
“Most younger physicians, who have no technological challenges, would just say ‘Of course [I use PharmaNet],’” Dr. McNestry said. “It’s mostly about the hassle factor: so it would be physicians who are more of my generation who would have to read the instruction manual and figure out how to connect with PharmaNet through their electronic medical records.
“We’re the only province in Canada, I think, that has access to such an informative database and not using it is not justifiable any more.”
The experts’ report also called on the college to impose a maximum dose for opioid prescriptions, to cut down on supplying of the black market and abuse of the drugs, and for more investment in addiction care and education.
In 2013, more deaths in British Columbia were linked to opioids other than heroin (about 3.5 deaths per 100,000 people) than to motor vehicle accidents involving alcohol (just over 1 death per 100,000 people), according to Tuesday’s report.
Charles Webb, president of the association representing B.C.’s doctors, was unavailable for an interview before press time, but said in an e-mailed statement that his organization supports the use of PharmaNet “to ensure the safe prescription of opioids, particularly for patients unfamiliar to physicians at the point of prescription.”
Provincial Health Minister Terry Lake said he was surprised so few doctors reported using the database. He said he was committed to talking with the provincial medical association and college to increase participation in the system – something he said might be inevitable in coming years as all patient records are digitized.
Mr. Lake welcomed the new report, stating the province has made significant progress on the issue, through cracking down on pharmacies dispensing methadone illegally, and investing $3-million last year into new ways of treating substance addiction and Dr. Wood’s research at the centre.
“There’s a lot of blame going on in terms of prescribing practices, but I remember distinctly in the late ’80s, early ’90s, people said that physicians weren’t treating pain well enough, that people were going without good pain medication because of physicians’ fear or antipathy toward using opioids,” said Mr. Lake. “What we saw was the pendulum swung and it swung too far, so we’re seeing a lot of prescription opioid abuse and dependence.
“Now it’s time to bring it back into balance and use opioids appropriately.”
© Copyright (c) The Globe & Mail
The walk-in or urgent care clinic that you visited just once is obliged to be your “medical home” if that’s what you need and want, according to new standards set by the College of Physicians and Surgeons of BC.
Formerly, there was an expectation that such clinics became your primary care clinic of record after three visits.
Under beefed-up guidelines, walk-in clinics will be held to the same high standard as those where patients book appointments. That means doctors at walk-in clinics must keep excellent medical records, contact patients with lab or other diagnostic test results, send copies of reports to other doctors who need them, offer to be the primary-care clinic for patients who need a regular place to go, and schedule periodic screening and prevention checkups.
Dr. Heidi Oetter, CEO and registrar of the College, said professional standards and guidelines were updated with stronger language to let doctors and patients know there aren’t different standards of care for traditional medical clinics and walk-in clinics.
If patients have no other place to go, then walk-in clinic doctors must offer to be the patient’s primary care physician through a “verbal invitation.” They can no longer consider a patient’s visit as a one-off, she said,.
Oetter said the College hears regular complaints from the public that walk in clinics “cherry pick” the easiest cases. But even patients with complex or chronic illnesses should be able to depend on walk-in clinics for continuing care, she said. If it’s not offered, patients should feel comfortable demanding “what they need.”
The College also expects every walk-in clinic to have a medical director who is a doctor, not a business person, so the College can communicate “doctor to doctor.” The medical director must ensure compliance with College standards. Doctors at such clinics can’t delegate followup of medical care and lab tests to staff who are non-physicians.
The College is also insisting walk-in clinics provide after-hours coverage and have access to PharmaNet so they know what prescriptions patients are taking. Oetter said the latter rule arose after investigations which found evidence of prescription fraud throughout the Lower Mainland. One person got more than 250 prescriptions, from multiple physicians, and filled them at 34 different pharmacies from 2007 to 2013. The College found fault with 46 physicians who had deficient prescribing practices.
“This case serves to remind physicians of the important role they play in mitigating this public health problem, which starts with prescribing medication to patients according to current prescribing standards and principles. This includes taking the time to conduct an appropriate exam, asking the right questions, and checking the patient’s PharmaNet profile before issuing a prescription — especially for a narcotic.”
We find it interesting that the authorities quoted in the article, and not the software experts, seem to think that no damage was done—even though the hackers obviously had full access to the client machines.There seems to be a strong wish to deny the danger that comes from email hacking.
Here's the litmus test: Would you be okay sending your personal VISA number, expiry date and CRC code by email?
Read the full story.
The New York Times on November 12, 2014 reported that a Pew Research Center study released the same day indicates a majority of adults feel that their privacy is being challenged along such core dimensions as the security of their personal information and their ability to retain confidentiality.
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