Who’s On First On Clozapine REMS Program Website?

So, I got a couple of Patient Alerts for overdue bloodwork which are evidently meant for me–even though I’m not the prescriber. My name is the only one on the Alert. I tried to follow instructions from my contact at the Clozapine REMS Program, who indicated I could remove them involving a somewhat complicated maneuver, which I could not remember.

However, I discovered that, by simply navigating to the field where the ANC can be entered and then just by clicking the “cancel” icon (because, of course, I didn’t order blood work on someone who is not my patient and there’s no other way to exit the field), I removed the Alerts…not deliberately; this was a totally accidental discovery.

Note this does not mean the blood work was done. I’m pretty sure this is not what the program intended although I’m told this feature was designed into the program and unlikely to change.

However, this appears to be a flaw because I’m not sure that the original Alert ever gets to the right clinician. Can the Alert be viewed by anyone, which I imply in my most recent post (November 6, 2015)? Or is the Alert visible only to the last clinician who reauthorized clozapine for the patient which is the only one known to the Clozapine REMS Program at the time patient data was migrated from the other clozapine registries, which are now retired?

If so, then the accountable prescriber doesn’t get the Alert and maybe the blood work is overlooked. I hope the system cannot be tricked so easily.

Of course, the other possibility is that the accountable prescriber and pharmacy never get the Alert but, because they know their job and have been doing it for years–they do what’s necessary for patient safety and the blood work is done.

Only the Clozapine REMS Program might be in the dark about it. What appears to have just occurred is that Alerts were sent to the wrong doctor, they were removed, the right doctors never got the Alerts and so do not have the opportunity to enter the ANC values and…”No blood, no drug?”

And another possibility is the right doctors know exactly what’s happening and enter the ANC regardless of getting the Alert, because they know the website is flawed.

That’s a stretch. This reminds me of baseball…or maybe matball.

Dr. Amos, just run the bases; you don't need to pick 'em up as you go!
Dr. Amos, just run the bases; you don’t need to pick ’em up as you go!

The Alert gets pitched, but to which batter? Who’s actually expected to run the bases? Who the heck is on first?