Clozapine REMS Program Not Fully Operational…Yet

Dr. Amos on phone 6I eagerly checked my voice mail this morning. I got a call yesterday afternoon (while I was out of my office) from my personal Clozapine REMS Program consultant. He says their IT (Imagination Technology) department has no “quick fix” for what remains a not fully operational system, at least as it applies to me as a user. Apparently I can update “current” patients  but can’t do anything about “new” patients. This reminds me of something about my role as a psychiatric consultant, at least as it applies to those taking clozapine.

Evidently, certification is one thing. Functionality is another. One peculiarity of my job as a psychiatric consultant to the general hospital which is in line with the theme of this year’s Academy of Psychosomatic Medicine (APM) Annual Meeting in New Orleans next week (the importance of communication, succinctly) is that every time a patient moves from one location to another (be it home to hospital or other facility to a hospital, for example), he has to be “reauthorized” to get clozapine in the new location.

However, the old clozapine registries as well as the new one don’t make a distinction between the clinician of record (meaning the local treating prescriber, which could be a psychiatrist, primary care doctor, Nurse Practitioner or Physician Assistant, etc.) and the psychiatric consultant (not the clinician of record but often a sort of stand-in doc who assures continuity of access to clozapine according to monitoring rules for safety). And that’s where I can be of further service on the safety issues. What if the patient is having a medical or surgical problem that is caused by clozapine? That’s a distinct possibility because it can cause many medical adverse effects.

That’s why I can’t just be a go-between to simply authorize clozapine. I have to communicate with a lot of other people and we all need to think about what we’re doing for the patient.

And that’s why I have a list of patients (see my comment from yesterday’s post) on my model of the Clozapine REMS Program website, which contains the names of those persons I’ve managed temporarily while they were in our general hospital being treated for medical or surgical issues.

But I’m not managing them now and I’ve not seen any of them in years. Further, I received a Patient Alert message about a patient who is not even on my list. I can’t even look up the Patient ID number, nor can I remove the patients I no longer care for from my current list–as near as I can tell.

Maybe that’s what tomorrow’s major IT update will fix; they tell me it should be road- ready by this Friday. I have no way of knowing. But the first step is sort of done. I’ve got the basic certification, which apparently is only the beginning, kind of like the Model T Ford that E.B. White wrote about in “Farewell My Lovely!”

The Clozapine REMS Program needs periodic fixing. You can’t regard it “…as a complete, finished product.” It’s initially “…naked as a baby…” and it’ll likely need “…an almost limitless assortment of decorative and functional hardware.”

And it’ll need a lot of functional software, too.



  1. Here’s a comment I just received from a colleague, “Dare I tell you that the struggles don’t stop when you become certified? You OR A DESIGNEE has to manually enter online the ANC results every week for every patient you have on clozapine…The woes continue!”


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