As a matter of record, any script must be written on state issues script pads which ARE numbered. Any script called in also goes into the state database. They don’t need to violate HIPPA all they need to do is cross reference script for drug X against permit holders and viola!!
Now, for the rest of the story...
Around '96 I visited one of the worlds' largest credit card processors. A twenty-some story building just outside a major city, I was there to discuss acquirer rates and so on. After the meetings, they took me on a tour of their processing center.
First, I was told they had power supplied by two different power companies and on site generation capacity in the event both went off line. Down in the bowels of the building, checked by one guard, through a secure door lock behind us, checked by another guard and through another door, locked behind us.
We were in a cavernous room that once, I was told, was filled with huge reel to reel data tape machines. They had been replaced by a cabinet, roughly the size of a couple dozen 4 drawer file cabinets arraigned in a row, two deep. All their data was inside that box. They removed the end cover and inside on small shelves, top to bottom, end to end, were countless DAT tape cartridges. The far end had a number of drives and each side had a robot that would retrieve tapes on call and plug them in to one of the drives, afterward pulling an idle tape and returning it to it's nitch.
Further on, behind another secure door, were a number of employees with terminals and monitors. On one wall was a video screen about 30 feet wide with a map of the U.S.A. Overlaid were all data trunks flowing throughout the county and the staff monitored the load. They had the ability to reroute data in the event of overload caused delays. They said they were required to complete a back and forth transaction within 25 seconds, but they were looking for the mid to upper teens.
Here's the kicker: those requirements weren't in place for credit cards. Their federal contract was to respond to every pharmacy query about medication conflicts. The DAT tape data was a record of prescriptions for every person in the country.
I have no doubt they could respond in a timely fashion for, say, a NICS check.