Your questions on mandatory INSPECT checks answered
Indiana prescribers in these settings must start checking INSPECT records for all patients by the following dates.

Now
• Facilities with INSPECT-integrated EHRs

July 1, 2019
 • Hospital emergency departments • Pain-management clinics

July 1, 2020
 • Hospitals

July 1, 2021
 • All Indiana practitioners
Several members have contacted ISMA with questions about SEA 221. This law requires all physicians permitted to prescribe controlled substances in Indiana to be able to receive patient records from the INSPECT prescription drug monitoring database. It also requires those physicians to check INSPECT before prescribing or dispensing an opioid or benzodiazepine to a patient. 

It is not necessary to integrate your electronic health records (EHR) system with INSPECT to fulfill these requirements. INSPECT records will always be available to registered health care providers at no charge through the INSPECT software platform online. 

Here are answers to some key questions about this law.

Q. Does this law apply to all physicians?
A.
The law uses the word “practitioners,” which is defined in IC 35-28-1-24. In brief, the new requirements apply to any physician, hospital, researcher or anyone else who holds a controlled substance registration (CSR) to prescribe, distribute or dispense controlled substances in Indiana. 

Q. What is the deadline to register with INSPECT?
A.
The deadline to sign up for INSPECT is Jan. 1, 2019. If your health care facility has integrated with INSPECT, no other action is necessary. If your facility has not integrated with INSPECT, you must register with the program by the deadline. There is no charge.

Q. When do I have to start checking INSPECT? 
A.
That depends. If your facility has integrated its EHRs with INSPECT, you must begin checking patients’ histories Sunday, July 1. Practitioners in other settings, regardless of whether they have integrated with INSPECT, will be required to make the queries beginning on the following dates:
  • July 1, 2019: Practitioners who provide services to the patient in a hospital emergency department or a pain management clinic. The law defines a pain management clinic as a publicly or privately owned facility that primarily engages in the treatment of pain or management through prescribing controlled substances. It does not refer to hospice, outpatient surgical centers or long-term care facilities.
  • July 1, 2020: Practitioners who provide services to the patient in a hospital.
  • July 1, 2021: All Indiana practitioners.

Q. What if I don’t have internet access?
A.
Prescribers who don’t have internet access can receive a waiver from these requirements under a process to be established by the Indiana Board of Pharmacy. 

Q. What if I’m too busy to query INSPECT?
A.
A delegate may perform the queries on your behalf. 

Q. Do I have to check INSPECT for infants, hospice-care patients, patients receiving palliative care or those in long-term care?
A.
Yes. The requirement applies for all patients. No specific exceptions are made for a patient's age or for patients in hospice, palliative or long-term care.

Q. Do I have to check INSPECT every single time I prescribe or dispense a controlled substance?
A.
Yes, with one exception. If a patient is subject to a pain-management contract, INSPECT information needs to be obtained only once every 90 days.

Q. Are there any circumstances in which I do not have to query INSPECT at all before prescribing controlled substances? 
A.
Yes. You do not have to check INSPECT for hospital orders; an order to dispense a drug to a bed patient for immediate administration in a hospital is not considered a prescription under 856 IAC 2-1-1. 

These two PowerPoint slides explaining SEA 221 may help in understanding the new requirements.

Also, integrating your facility’s EHRs with INSPECT is fast, simple and free, thanks to the state’s decision last year to fund these costs. ISMA strongly supports integration, which reduces the time to search patients’ records from about five minutes to two or three seconds. You can begin the integration process here.