November 21, 2014

Dr First

EPCS Adoption: What Comes First, the Chicken (Pharmacies) or the Egg (Physicians)

When it comes to EPCS adoption, there’s a classic case of “which came first, the chicken or the egg?” In this particular instance the question is: which comes first in terms of controlled substance electronic prescribing adoption, the pharmacy or the provider? Let’s take a look at both sides of the argument.
The Physician’s Side of the Coin
We’ve talked to quite a few physicians about barriers to EPCS adoption. Many point to the scarcity of pharmacies accepting controlled substance e-prescriptions as the primary reason for not implementing the technology in their offices. Physicians also point to the time and effort involved in the EPCS on boarding and identity proofing process and express concerns about the safety of sending controlled substance scripts electronically. Both are very similar to arguments we heard in the early days of e-prescribing.
The Pharmacist’s Side of the Coin
We’ve also talked to pharmacists who say that they don’t want to start accepting EPCS-issued scripts until more prescribers start sending them. So here we have the classic “chicken or the egg” conundrum. Is there a solution to the growing, but still low in comparison to overall e-prescribers, EPCS adoption numbers?
While each side seems to be pointing to the lack of adoption on the part of the other as the cause, arguably, the barriers they suggest aren’t as substantive as perceived. In fact, approximately 45,000 pharmacies in the United States can now receive EPCS-issued scripts, but only about 1 percent of prescribers are signed up to send them. That’s many more chickens than eggs. Despite low prescriber adoption, there are places where EPCS advocates are hoping to solve the chicken or egg conundrum. Arizona is one state where the dilemma is being addressed.
The Arizona Exception
The state of Arizona sponsored a program to promote EPCS adoption and engaged a consulting firm, four EHR/e-prescribing vendors and two major pharmacy chains to support the effort.
The program ran for six months in late 2013, and during that period EPCS increased more than 10-fold from less than 200 EPCS transactions per month to more than 16,000. It is interesting to note that in Arizona, there is no mandate to e-prescribe controlled drugs, or even legend drugs, but with the right pieces in place, and with both providers and pharmacies coming together, the program was successful. You can find more details on this case study Advancing Electronic Prescribing of Controlled Substances: Lessons Learned in Arizona.
While Arizona provides a good example of pharmacists and providers coming together to change the “chicken or the egg” conundrum, it is important to look at how EPCS adoption is going universally. Let’s take a look: Surescripts reported 1.1 million EPCS prescriptions have been sent through their system as of early October 2014, and based on the controlled substance e-prescriptions that have passed through EPCS Goldsm, we estimate that approximately 60 percent of those prescriptions come from our users. However, these numbers only represent a small fraction of total controlled drug prescriptions that are being written today.
Things are moving in the right direction. Only time will tell if what happened in Arizona was enough to influence opinions on EPCS and will therefore become a model for other states to follow, or if other states will follow New York’s example by mandating the technology.
What are the benefits of writing all prescriptions electronically that might eliminate the chicken or the egg conundrum?

  • Enhanced patient safety with all prescriptions checked for clinical alerts
  • Financial savings for patients with more prescriptions checked for formulary coverage
  • Improved office workflow with role-based electronic systems used for all prescriptions, rather than a separate process of issuing controlled substance scripts on paper

EPCS also benefits pharmacists by:

  •  Streamlining workflow
  • Reducing chance of dealing with fraudulent prescriptions or edited prescriptions, and
  • Assurance that the prescription is for a legitimate issue

Both pharmacists and providers should take the time to closely look at the value of controlled substance e-prescribing and its benefits. It’s yet to be seen how broader EPCS adoption will roll out across the country. Until then, we’ll continue to look at how the chicken or egg conundrum is being addressed and track EPCS adoption progress.