Driven partially by the benefits it offers, such as reducing prescription errors, e-prescribing is old hat for the healthcare industry in many ways. In fact, by April 2014, more than 40 percent of physicians in all states had already adopted e-prescribing practices, according to the Office of the National Coordinator for Health IT (ONC).
What’s new, however, is the adoption of the technology for controlled substances, something that’s becoming more commonplace as providers and governments alike seek to quell the opioid crisis. This response has been shaped by the Drug Enforcement Administration’s 2010 Electronic Prescriptions for Controlled Substances (EPCS) rule, which allows clinicians to transmit prescriptions for controlled substances electronically. Adoption also has been bolstered by many recent state and local laws that aim to better track controlled-substance prescriptions via e-prescribing tech, in conjunction with prescription drug monitoring programs.
Hartford Pivots to Electronic Prescriptions for Controlled Substances
Connecticut-based Hartford HealthCare is one organization that recently made the switch to EPCS, aiming to meet a mandate by the state as well as to do its part to help battle substance abuse, explains Spencer Erman, M.D., Hartford HealthCare’s vice president and chief medical informatics officer.
Prior to adopting EPCS, Hartford HealthCare was exclusively prescribing controlled substances using paper prescription pads.
“It was an inefficient system because clinicians were already e-prescribing noncontrolled drugs via autosigned fax straight from the Epic electronic health record system. But then, for scheduled drugs, we had to print scripts on paper, manually sign them and fax them to the pharmacy, or write a paper prescription and note in the EHR that we had prescribed it. It created dual workflows,” explains Erman.
Moreover, the paper prescriptions left room for fraud or forged prescriptions, not to mention that it was frustrating for patients who needed to return for a paper prescription if they needed a refill.
Legislation that passed in June 2017 left the healthcare organization with less than six months to implement the system. In the end, it took only six weeks to make the switch, Erman notes.
After forming a search committee, Hartford HealthCare chose to implement an EPCS system from Imprivata — a “no brainer,” as the organization was already using Imprivata’s single sign-on desktop virtualization system and had a HIPAA Business Associate Agreement in effect.
Imprivata’s EPCS technology allowed Hartford HealthCare to work seamlessly with already existing systems, including the Epic EHR, without alienating potentially change-resistant clinicians, Erman explains. “The system is simple to use once you are registered. Basically, if you are on the hospital Wi-Fi, you put in an electronic prescription, enter your password, and an instant message appears on the screen of your phone that says, ‘do you approve this medication?’ You swipe it, and you are done.”
After only a month, 94 percent of prescriptions at Hartford HealthCare are going out electronically, “which is incredible,” Erman notes.
The Benefits of EPCS
When it comes to battling the opioid epidemic, e-prescribing has one major advantage: It gets paper prescriptions off the streets. This, in turn, helps reduce doctor shopping, fraud and drug diversion, all of which can occur when the prescription is in the patient’s hands.
“EPCS provides a secure, transparent system that makes it easier to prescribe controlled substances to those patients who legitimately need them, while making it more difficult to commit fraud or abuse,” explains Sean Kelly, M.D., chief medical officer at Imprivata.
For Hartford HealthCare, Erman explains that with EPCS, forged and altered prescriptions have largely disappeared.
“With EPCS, everything we prescribe now automatically goes into the Connecticut Prescription Monitoring and Reporting System, which allows for a more complete state database,” Erman explains. “Instead of waiting for pharmacy benefit managers to manually enter prescription information, they go directly into the system in near real time. That prevents doctor shopping because people can’t go to three doctors within two hours and get multiple prescriptions.”
Moreover, the benefits for care organizations often extend beyond safety and security to bottom-line savings. CIO John Kravitz of Pennsylvania’s Geisinger Health System recently told The Sentinel that in adopting EPCS and extra safety and security measures for opioid prescriptions, the organization was able to reduce its prescriptions by 50 percent as well as create “new efficiencies in time and resources that save an estimated $1 million annually.”
“In short, e-Prescribing is more convenient, cheaper, and safer for doctors, pharmacies, and patients,” the ONC explains.
The Challenges for EPCS
As more providers adopt e-prescription software, security concerns are bound to arise, especially as organizations become more connected. Software safeguards and training can help overcome security issues for IT departments.
“The most important takeaway is for IT personnel to remember that simply tacking on a second factor token to existing e-prescribing systems is not sufficient to satisfy DEA regulations,” Kelly explains. “The IT department needs to thoroughly understand the technology used for EPCS and make sure the vendor offers a solution that addresses all of the DEA requirements, such as provider credentialing, certification of all components, two-factor authentication, data storage, reporting and auditing capabilities.”
Moreover, EPCS is subject to more stringent DEA requirements than e-prescribing of other prescriptions, meaning that IT needs to be conscious of these regulations when implementing the technology.
While compliance with federal regulations can be “confusing and difficult,” Kelly urges providers to look for a right vendor partner who can walk the organization through the regulatory thicket.