May 27, 2015


I-STOP or Not – Why Physicians Should Start E-prescribing Now

Many New York physicians feel as if they dodged a bullet on March 13th, when Governor Cuomo signed bill S2486, delaying the mandatory e-prescribing component of the I-STOP bill for one year. We now have until March 27, 2016 to comply with the law, but that deadline is closer than it appears. To reiterate from the NY Bureau of Narcotics Enforcement website:
Although this amendment extends the effective date of mandated electronic prescribing, e-prescribing of both controlled and non-controlled substances is currently permissible in New York. Practitioners must continue their efforts to become compliant with the requirement, including working with their software vendors to implement the additional security requirements needed for e-prescribing of controlled substances, and registering their certified software applications with the Bureau of Narcotic Enforcement.”
I want to talk through what that really means to you as a provider, and why you still should work toward implementing controlled substance e-prescribing in the coming weeks. The main reason behind the delay was that, unlike DrFirst, many clinical IT vendors were not equipped to meet the deadline despite having 3 years to prepare.
Even though many healthcare organizations, physician advocacy groups and practitioners asked for the delay virtually no one is suggesting that universal e-prescribing should not be enacted, when ready, in New York and beyond. E-prescribing is critically important for both providers and patients, and this month we will take a closer look at how e-prescribing can improve practice workflows, protect against drug misuse, and, ultimately, help improve patient outcomes.
Fight Prescription Drug Abuse
Nationwide, drug overdose is the leading cause of death from injury, according to the Centers for Disease Control and Prevention (CDC), with most of those drug overdose deaths (53%) being caused by prescription drugs. An alarming 6.2 million adults in the U.S. use prescription drugs non-medically. Forty-six patients die each day from an overdose of prescription painkillers, and another 6,748 end up in emergency departments for the misuse or abuse of drugs. In 2013, a shocking 22,767 drug overdose deaths were related to pharmaceuticals. This is why the CDC has termed drug abuse as an epidemic, causing more deaths than traffic accidents.
In New York State, drug overdose deaths have risen 56% since 1999, according to the CDC, and New York physicians are the first line of defense in preventing drug-seeking patients from misusing prescription medications.
Advantages of Using E-Prescribing

  • Improved Patient Safety

The most significant advance that e-prescribing gives providers is in the improvement to the safety and quality of patient care. Access to patient medication history during the prescribing process gives providers better information about home medications and meds prescribed by other physicians. Combining medication history with automated clinical decision support such as formulary compliance, dose checking, drug-to-drug, drug-to-allergy, drug-to-condition and duplicate therapy alerts helps remind providers when there might be an increased risk of over-prescribing, or prescribing medications and combinations that may cause adverse drug events. Accessing patient medication history at the point of care also helps providers more easily identify potential doctor shoppers, particularly in the controlled substance category, thus helping to stem prescription misuse. Doctor shopping decreased significantly in New York after the August 27, 2013 deadline for consulting the PMP went into effect.

  • Better Prescribing Workflow

Workflow efficiency is another key benefit to implementing e-prescribing for all meds. A Medical Group Management study shows that e-prescribing helps practices achieve an average annual savings of $15,769 per full-time physician, per year. Such savings are realized in the form of lower administrative burdens, including reduced time for providers and staff in clarifying and/or otherwise re-communicating with pharmacies and health plans regarding patient prescriptions. In addition, there is no longer a need to fax or write prescriptions on paper – a more streamlined workflow.

  • Meeting Meaningful Use Requirements

Another benefit to using e-prescribing for both legend drugs and controlled substances lies in meeting Meaningful Use requirements in light of the schedule change by the DEA last year for hydrocodone combination products (HCP) from Schedule III to Schedule II. The impact of this change has been that with no call-ins or refills permitted, providers have been required to create a greater number of new prescriptions for products like Vicodin, which as a result increased the total number of prescriptions issued. Since Meaningful Use stage 2 requires that more than 50-percent of all prescriptions must be transmitted electronically, an increase in paper prescriptions may push some physicians out of Meaningful Use compliance.

  • Patient Convenience

The advantages of e-prescribing for patients are also quite significant. In addition to the patient safety benefits outlined above, patients benefit and copay savings related to formulary compliance from the ease and efficiency of e-prescribed medications. Having medications ready when the patient arrives at the pharmacy, with the formulary compliance check already completed by the physician, and any prior authorization activities completed in advance, there are fewer hurdles for patients. This convenience translates into better medication adherence as well since there is virtually no delay in patient access to their initial prescription. Some studies have demonstrated a 20% improvement in patients picking up their meds at the pharmacy.

  • Pharmacies Readiness

In New York State alone, there are more than 4,200 EPCS-enabled pharmacies.  Nationally, more than 70% of all pharmacies are certified for EPCS.

  • Security

Lastly, electronic prescribing is simply more secure than paper prescriptions. Paper prescriptions are subject to transcription errors and are targets for theft and tampering, making it relatively easy for drug-seeking patients to alter prescriptions by increasing dosage, number prescribed, or number of refills of medications. Special paper issued by New York and some other states has helped reduce some of this fraud and diversion, but after a decade of experience, New York regulators felt that more was needed. E-prescriptions are also delivered directly to the pharmacy, without exposing the physician’s DEA number to the patient. The consequences of DEA number theft include physician identity theft, temporary inability to prescribe controlled substances, and a damaged reputation, to name just a few.
Get Ready to E-Prescribe Now
The benefits of universal e-prescribing are numerous, which is why physicians should consider implementation of e-prescribing for both legend drugs and controlled substances now, regardless of the recently extended I-STOP deadline.. The value to practitioners and patients is clear, and it is important that practices deploy an e-prescribing solution sooner rather than later to avoid other pitfalls, particularly involving office staff as they transition away from paper and shift focus to ICD-10 in late September. With the time and effort required to successfully implement ICD-10, it is essential to get EPCS onboarding and training out of the way soon.
At DrFirst we will continue to drive toward successful EPCS implementation for all of our customers.  At the end of the day, we know that the benefits for prescribers and their patients—reducing drug abuse, fraud, diversion, improving patient safety and streamlining workflow—will be worth the effort. And as physician advocates and leaders in the healthcare technology community, we know that when we help you and your patients win, we all win.

About pkaufman

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).