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How Providers at One Hospital Have Answered the Call of New York’s E-Prescribing Mandate

April 7, 2016
by Rajiv Leventhal
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On March 27, a New York state that law that requires the electronic prescribing of all controlled and non-scheduled drugs went into effect. The law is part of the state’s Internet System for Tracking Over Prescribing (I-STOP) legislation, put in place in 2012 to curb prescription drug abuse, medical errors and fraud.

While the digital prescribing requirement was initially set to go into effect in March 2015, because so few providers were ready, the deadline for compliance was delayed a year. Now, in order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements. Throughout the state of New York, providers seem to be quickly adapting to this new mandate.

Recent data from Surescripts, the Arlington, Va.-based operator of a national clinical electronic network, found that doctors in New York are outpacing their counterparts in other states, with just 8 percent of providers enabled for EPCS nationwide compared to 47 percent in New York. This is a significant improvement compared to just one year ago, when fewer than two percent of providers in New York were ready. Since March 1, the number of New York providers enabled for electronic prescribing of controlled substances increased 28 percent, according to the data. Indeed, this rapid increase in adoption was made possible because of electronic health record (EHR) software vendors’ certification of the technology, which is a necessity in order for prescribers to start using it. Currently, EHRs serving 96 percent of prescribers in New York are certified for EPCS, according to Surescripts.

The benefits of e-prescribing are logical, as it provides for a safer and more convenient way of ensuring that a prescription reaches a pharmacy. Also, it improves patient medication adherence; drug diversion is a major concern when it comes to controlled substances, with diverted drugs for abuse sometimes being tied to fraud or forgery of paper prescriptions. Certainly, the concept of e-prescribing is not a new one, but the mandate to require paperless prescribing is. If providers do not comply with this requirement, they face the possibility of fines, loss of license or even jail time. Other states, such as Minnesota, have similar e-prescribing mandates, but its Department of Health says there is currently no enforcement for non-compliance.

On the contrarian side of the argument, a December 2015 study from the Rockville, Md.-based DrFirst and the Medical Society of the State of New York (MSSNY) found that 44 percent of the 900 MSSNY physician members who were surveyed said they were not ready for EPCS. The reasons the providers gave ranged from their EHR not being ready (37 percent); I don’t write many scripts (28 percent) to ‘I resent the mandate” (14 percent).

To this end, as Healthcare Informatics Senior Contributing Editor David Raths wrote last month, a recent Wall Street Journal article noted that several health systems in the New York, including Mount Sinai Health System, Montefiore Health System, Northwell Health and NYU Langone have applied for waivers for some of their providers, seeking more time to comply to the March 27 deadline. However, it’s not that the providers at these patient care organizations do not agree with e-prescribing, but rather the details in the requirement made it tough to be ready by March 27, Raths reported, via the WSJ article.

One N.Y. Hospital’s Prep Pays Off

Nevertheless, for one healthcare organization in upstate New York, the Plattsburgh-based Champlain Valley Physicians Hospital, only about 30 miles from Canada, the clinical informatics team was ready for this requirement long before the March 27 date. In fact, they were prepared for it to take place as originally intended—March 2015, says Lisa Rabideau, R.N., clinical informatics manager at the hospital. “We were one of the first organizations that Imprivata (Lexington, Mass.) installed their two-factor authentication software for. Our clinicians find [e-prescribing] seamless for the most part, and the ones who are doing it like it quite a bit,” Rabideau says. “Like any other mandate, some are early adopters while others aren’t jumping on board even though the law took effect [recently]. The positive is that this specific mandate is on the providers, so we don’t police it. We have to make it available and they are the ones who have to comply,” she says.

Champlain Valley Physicians Hospital uses Surecripts’ e-prescribing network, in addition to Imprivata’s software for single-sign on capabilities and its two-factor authentication. The technology gives three options for its two-factor authentication, notes Rabideau, with one of them being a password, which is required, with the other two options being biometric (fingerprint) or soft token, which can be an app downloaded on a mobile device that creates a single-use login PIN. Prescribing clinicians can choose between these two options, she says. For controlled substances, the two-factor authentication piece does add some complexity, but those are the Drug Enforcement Administration’s (DEA) regulations which you cannot get past, she adds.